ABSTRACT OBJECTIVE To evaluate the association between gestational age and green areas, urban built areas, and the concentration of particulate matter 2.5 (PM2.5) in the city of São Paulo, analyzing the irregular distribution of these areas and pollution levels above the recommended level. METHODS The study population consisted of a cohort of live births from 2012, and data from the Live Birth Information System (Sinasc) of the city of São Paulo were used. Using satellite images and supervised classification, the distribution and quantity of green areas and built areas in the city of São Paulo was obtained, as well as the concentrations of PM2.5. Logistic regressions were used to obtain possible associations. RESULTS The results of the study show that a lower percentage of green areas is significantly associated with a higher chance of preterm births. A higher building density was positively associated with the odds ratio for preterm birth. We did not find any significant associations between air pollution (PM2.5) and preterm births. CONCLUSIONS The results of this study show that greener areas are less associated with preterm births when compared with less green areas.

RESUMO OBJETIVO Avaliar a associação entre a idade gestacional e as áreas verdes, áreas construídas urbanas e a concentração de material particulado 2,5 (MP2,5) em São Paulo, analisando a distribuição irregular dessas áreas e os níveis de poluição acima do recomendado. MÉTODOS A população utilizada no estudo foi a dos nascidos vivos no ano de 2012, com os dados do Sistema de Informações sobre Nascidos Vivo (Sinasc) na cidade de São Paulo. Por meio de imagens de satélites e realizando a classificação supervisionada, obtivemos a distribuição e quantidade de áreas verdes e de áreas construídas, na cidade de São Paulo, assim como as concentrações de MP2,5. Regressões logísticas foram utilizadas para obter possíveis associações. RESULTADOS Os resultados do estudo mostram que menor percentual de áreas verdes está associado significativamente com maior chance de prematuridade. Maior densidade de construção foi associada positivamente com a razão de chance de nascimento prematuro. Não encontramos resultados significativos entre a poluição do ar (MP2,5) e prematuridade. CONCLUSÕES Os resultados deste estudo demostraram que áreas mais verdes em relação às áreas menos verdes são menos associadas a nascimentos prematuros.

ABSTRACT As a result of the debates held during the XI Seminar on Service, Research and Public Policy, on the theme “Urban Agriculture and Food and Nutrition Security: organic food in school meals”, this article summarizes the speeches of researchers, agricultural producers, representatives of civil society institutions and government agencies on urban food production. From the perspective of the of urban agriculture contribution to the quality of food, issues related to the scope and limits of the distribution of these foods through public facilities and destination to public policies, such as the school meal program, are addressed in light of experiences in the cities of São Paulo and Castro, in Paraná. Considering the supply of urban centers and the importance of organizational and food environments, debate took national and international guidelines on the social determinants of contemporary health and nutrition as a theoretical reference. The difficulties that mark the production of urban agriculture were addressed, and the actions of local initiatives that made it possible to advance towards a viable economic activity that promotes healthy eating and equity were presented. The role of public food policies, still limited in the field of urban agriculture, is evident to strengthen the work of farmers and public managers engaged in initiatives that already point to the potential for growth in this form of food production.

RESUMO Produto dos debates realizados por ocasião do XI Seminário Serviço, Pesquisa e Política Pública, sobre o tema “Agricultura Urbana e Segurança Alimentar e Nutricional: o alimento orgânico na alimentação escolar”, este artigo sintetiza a fala de pesquisadores, produtores agrícolas, representantes de instituições da sociedade civil e de órgãos governamentais sobre a produção urbana de alimentos. Tendo como perspectiva a contribuição da agricultura urbana para a qualidade da alimentação, são tratados temas relativos aos alcances e limites para a distribuição destes alimentos por equipamentos públicos e destinação a políticas públicas como a alimentação escolar, à luz de experiências nas cidades de São Paulo e Castro, no Paraná. Considerações sobre o abastecimento de centros urbanos e a importância de ambientes organizacionais e ambientes alimentares tomaram como referencial diretrizes nacionais e internacionais sobre os determinantes sociais da situação de saúde e nutrição na contemporaneidade. São apontadas as dificuldades que marcam a produção da agricultura urbana, e as ações de iniciativas locais que possibilitaram avançar na direção de uma atividade econômica viável e promotora de alimentação saudável e de equidade. O papel das políticas públicas de alimentação, ainda limitado no que se refere à agricultura urbana, é patente para promover o fortalecimento do trabalho de agricultores e gestores públicos engajados nas iniciativas que já apontam o potencial de crescimento desta forma de produzir alimentos.

Abstract Objectives: To evaluate the inconsistency between clinical diagnosis of death and autopsy findings in adolescents with chronic diseases. Methods: A cross-sectional study including a sample of adolescents’ autopsies who died in a pediatric and adolescent tertiary hospital over 18 consecutive years. During this period, there were n = 2912 deaths, and n = 581/2912(20%) occurred in adolescents. Of these, n = 85/581(15%) underwent autopsies and were analyzed. Further results were divided into two groups: Goldman classes I or II (high disagreement between main clinical diagnosis of death and anatomopathological findings, n = 26) and Goldman classes III, IV or V (low or no disagreement between these two parameters, n = 59). Results: Median age at death (13.5 [10‒19] vs. 13 [10‒19] years, p = 0.495) and disease duration (22 [0‒164] vs. 20 [0‒200] months, p = 0.931), and frequencies for males (58% vs. 44%, p = 0.247) were similar between class I/II vs. class III/IV/V. The frequency of pneumonia (73% vs. 48%, p = 0.029), pulmonary abscess (12% vs. 0%, p = 0.026), as well as isolation of yeast (27% vs. 5%, p = 0.008), and virus (15% vs. 2%, p = 0.029) identified in the autopsy, were significantly higher in adolescents with Goldman class I/II compared to those with Goldman class III/IV/V. In contrast, cerebral edema was significantly lower in adolescents of the first group (4% vs. 25%, p = 0.018). Conclusion: This study showed that 30% of the adolescents with chronic diseases had major discrepancies between clinical diagnosis of death and autopsy findings. Pneumonia, pulmonary abscess, as well as isolation of yeast and virus were more frequently identified at autopsy findings in the groups with major discrepancies.

ABSTRACT Visceral leishmaniasis (VL) is a chronic vector-borne zoonotic disease caused by trypanosomatids, considered endemic in 98 countries, mainly associated with poverty. About 50,000–90,000 cases of VL occur annually worldwide, and Brazil has the second largest number of cases in the world. The clinical picture of VL is fever, hepatosplenomegaly, and pancytopenia, progressing to death in 90% of cases due to secondary infections and multi-organ failure, if left untreated. We describe the case of a 25-year-old female who lived in the metropolitan area of Sao Paulo, who had recently taken touristic trips to several rural areas in Southeastern Brazil and was diagnosed post-mortem. During the hospitalization in a hospital reference for the treatment of COVID-19, the patient developed acute respiratory failure, with chest radiographic changes, and died due to refractory shock. The ultrasound-guided minimally invasive autopsy diagnosed VL (macrophages containing amastigote forms of Leishmania in the spleen, liver and bone marrow), as well as pneumonia and bloodstream infection by gram-negative bacilli.

Abstract Vitamin D deficiency is a global health problem and approaches that consider Nature-Based Solutions (NbS) can bring new perspectives of solution. About 80% of the amount of vitamin D that the body needs is produced endogenously through exposure of the skin to ultraviolet B (UVB) radiation from sunlight. The average UVB exposure in urban areas will depend in part on the local climate and the amount of cover and types of trees. The study analyzed the association between green areas and vitamin D levels. A sample of 101 women aged 35 years and over, living in the city of Araraquara, Brazil, was analyzed. The Normalized Difference Vegetation Index (NDVI) was calculated as an indicator of exposure to green areas, being defined as the surrounding residential vegetation. A logistic regression model was used to analyze the association between residential vegetation index and vitamin D status. A statistically significant positive association was observed between exposure to below-median residential surrounding vegetation index and prevalence of insufficient levels of 25(HO)D (P=0,03). The study shows that lower levels of residential green are associated with a higher prevalence of vitamin D insufficiency. NbS approaches contribute to a better understanding of suitable environments for achieving good levels of vitamin D, avoiding the need for pharmaceutical supplementation of the nutrient.

Résumé La carence en vitamine D est un problème de santé mondial et les approches qui considèrent les solutions basées sur la nature (NbS) peuvent apporter de nouvelles perspectives de solution. Environ 80% de la quantité de vitamine D dont le corps a besoin est produite de manière endogène par l’exposition de la peau aux rayons ultraviolets B (UVB) du soleil. L’exposition moyenne aux UVB dans les zones urbaines dépendra en partie du climat local et de la quantité de couverture et des types d’arbres. L’étude a analysé l’association entre les espaces verts et les niveaux de vitamine D. Un échantillon de 101 femmes, âgées de 35 ans et plus, vivant dans la ville d’Araraquara, au Brésil, a été analysé. L’indice de végétation par différence normalisée (NDVI) a été calculé comme un indicateur d’exposition aux espaces verts, définis comme la végétation résidentielle environnante. Un modèle de régression logistique a été utilisé pour analyser l’association entre l’indice de végétation résidentielle et le statut en vitamine D. Une association positive statistiquement significative a été observée entre l’exposition à un indice de végétation environnante résidentiel inférieur à la médiane et la prévalence de niveaux insuffisants de vitamine D 25(HO)D (P=0,03). L’étude montre que des niveaux inférieurs de vert résidentiel sont associés à une prévalence plus élevée d’insuffisance en vitamine D. Les approches NbS contribuent à une meilleure compréhension des environnements appropriés pour atteindre de bons niveaux de vitamine D, évitant ainsi le besoin d’une supplémentation pharmaceutique du nutriment.

Resumen La deficiencia de vitamina D es un problema de salud mundial y los enfoques que consideran las soluciones basadas en la naturaleza (SbN) pueden traer nuevas perspectivas de solución. Alrededor del 80% de la cantidad de vitamina D que el cuerpo necesita se produce de forma endógena a través de la exposición de la piel a la radiación ultravioleta B (UVB) de la luz solar. La exposición promedio a los rayos UVB en áreas urbanas dependerá en parte del clima local y la cantidad de cobertura y tipos de árboles. El estudio analizó la asociación entre las áreas verdes y los niveles de vitamina D. Se analizó una muestra de 101 mujeres, de 35 años o más, residentes en la ciudad de Araraquara, Brasil. El Índice de Vegetación de Diferencia Normalizada (NDVI) se calculó como un indicador de exposición a las áreas verdes, definiéndose como la vegetación residencial circundante. Se utilizó un modelo de regresión logística para analizar la asociación entre el índice de vegetación residencial y los niveles de vitamina D. Se observó una asociación positiva estadísticamente significativa entre la exposición a un índice de vegetación circundante residencial por debajo de la mediana y la prevalencia de niveles insuficientes de vitamina 25(HO)D (P=0,03). El estudio muestra que los niveles más bajos de verde residencial están asociados con una mayor prevalencia de insuficiencia de vitamina D. Los enfoques de NbS contribuyen a una mejor comprensión de los entornos adecuados para lograr buenos niveles de vitamina D, evitando la necesidad de suplementos farmacéuticos del nutriente.

Resumo A deficiência de vitamina D é um problema de saúde global e as abordagens que consideram as Soluções baseadas na Natureza (NbS) podem trazer novas perspectivas de solução. Cerca de 80% da quantidade de vitamina D que o corpo precisa é produzida endogenamente por meio da exposição da pele à radiação ultravioleta B (UVB) da luz solar. A exposição média à UVB em áreas urbanas dependerá em parte do clima local e da quantidade de cobertura e tipos de árvores. Este estudo discute a associação entre áreas verdes e níveis de vitamina D. Foi analisada uma amostra de 101 mulheres com 35 anos ou mais de idade, moradoras da cidade de Araraquara, Brasil. O Índice de Vegetação por Diferença Normalizada (NDVI) foi calculado como indicador de exposição às áreas verdes, sendo definido como a vegetação circundante residencial. Foi utilizado o modelo de regressão logística para analisar a associação entre o índice de vegetação residencial e o status (níveis) de vitamina D. Observou-se uma associação positiva estatisticamente significativa entre a exposição ao índice de vegetação circundante residencial abaixo da mediana e a prevalência de níveis insuficientes de 25(HO)D (P=0,03). O estudo mostra que níveis mais baixos de verde residencial estão associados à maior prevalência de insuficiência de vitamina D. Desta forma, as abordagens NbS contribuem para melhor compreensão dos ambientes adequados para o alcance de bons níveis de vitamina D, evitando a necessidade de suplementação farmacêutica do nutriente.

RESUMO A Agricultura Urbana (AU) tem sido apontada, mais recentemente, como elemento importante nos discursos e nas práticas que visam à segurança alimentar urbana. O presente artigo procurou discutir a produção agrícola do Município de São Paulo (MSP) e seu escoamento, considerando a diversidade de perfis que a AU pode assumir. Para tal, foi avaliada a produção agrícola em bases de dados oficiais. No que se refere à comercialização, foram coletadas informações em sete entrevistas semiestruturadas com agricultores do MSP entre 2018 e 2020. Os principais resultados encontrados indicam que houve um crescimento das práticas agropecuárias no município, acessando uma ampla variedade de canais de comercialização. A abertura de novos mercados, o desenvolvimento de políticas públicas e o reconhecimento público foram essenciais para o crescimento da agricultura no MSP.

ABSTRACT Urban agriculture (UA) has recently been pointed out as an important element in the discussion and practices of urban food security. This article seeks to discuss agricultural production and distribution in the city of São Paulo , considering the diversity of profiles that UA can assume. To this end, official databases were used to compute agricultural production. With regard to commercialization, information was collected from seven semi-structured interviews with farmers of the city of São Paulo between 2018 and 2020. The main findings indicate that there was an increase in agricultural practices in the city, encompassing a wide variety of commercialization channels. The opening of new markets, the development of public policies and public recognition were essential for the growth of agriculture in the city of São Paulo.

OBJECTIVES: Ultrasound-guided minimally invasive autopsies (MIA-US) are an alternative to conventional autopsies and have been used in our institution to investigate the pathophysiology of COVID-19 since the beginning of the pandemic. Owing to the limitations of post-mortem biopsies for evaluating cardiopulmonary events involving large vessels, we continuously improved the technique during this period. Objectives: To demonstrate the usefulness of an extended MIA-US technique (EMIA-US) for the study of thoracic involvement in COVID-19. METHOD: US-guided percutaneous tissue sampling was combined with a small thoracic incision (≤5 cm), allowing for the sampling of larger tissue samples or even the entire organ (lungs and heart). RESULTS: EMIA-US was performed for eight patients who died of COVID-19 in 2021. We demonstrate cardiopulmonary events, mainly thromboembolism and myocardial infarction, that could be evaluated using EMIA-US. CONCLUSIONS: Minimally invasive image-guided post-mortem tissue sampling is a flexible and practical method to conduct post-mortem studies of human diseases, mainly in areas that do not have autopsy facilities or, alternatively, when autopsy is not possible owing to financial constraints, cultural and religious values, or for safety reasons, such as in the case of highly contagious infectious diseases. We present evidence that EMIA-US is feasible and can be used as an alternative to increase the accuracy of MIA-US in detecting cardiopulmonary events involving large vessels, which may not be assessed through post-mortem biopsies.

Resumo Introdução Um dos principais problemas no lúpus eritematoso sistêmico juvenil (LESJ) é a infecção, como a tuberculose (TB). É importante observar que pacientes com LES são suscetíveis à tuberculose pulmonar e extrapulmonar. No entanto, de acordo com o que se sabe, essa doença contagiosa é raramente relatada na população pediátrica com lúpus, particularmente a TB difusa ou miliar. De janeiro de 1983 a dezembro de 2011, 5.635 pacientes foram acompanhados na Unidade de Reumatologia Pediátrica; 285 deles (5%) preencheram os critérios de classificação para LES do American College of Rheumatology. Relatos de caso Quatro (1,4%) de nossos pacientes com LESJ tinham tuberculose disseminada e foram descritos neste estudo. Todos eram do sexo feminino, receberam a vacina BCG e não tinham história de contato domiciliar com a TB. A mediana da idade no momento do diagnóstico da TB e o período entre os diagnósticos de LES e tuberculose foram de 17 anos (variação de 14 a 20) e 5,5 anos (variação de dois a sete), respectivamente. Todas as pacientes desenvolveram tuberculose miliar durante o curso da doença. A mediana no SLE Disease Activity Index 2000 (SLEDAI-2K) foi de 4 (2 a 16) e as pacientes foram tratadas com agentes imunossupressores (glicocorticoides, azatioprina e/ou ciclofosfamida intravenosa). Duas delas apresentaram sepse e o diagnóstico de tuberculose só foi determinado na necropsia, com envolvimento especialmente dos pulmões, do sistema nervoso central e do abdome. A terapia antituberculose (isoniazida, rifampicina e pirazinamida) foi indicada nos outros dois casos de TB; porém, as pacientes foram a óbito. Discussão A TB miliar é uma infecção oportunista rara e grave na população pediátrica com lúpus. Este estudo reforça a importância de pesquisas de rotina para TB em pacientes com LESJ.

Abstract Introduction One of the main issues in juvenile systemic lupus erythematosus (JSLE) patients is infection, such as tuberculosis (TB). Of note, SLE patients are susceptible to pulmonary and extrapulmonary TB. However, to our knowledge, this contagious disease was rarely reported in pediatric lupus population, particularly diffuse or miliary TB. Therefore, from January 1983 to December 2011, 5,635 patients were followed-up at our Pediatric Rheumatology Unit and 285 (5%) of them met the American College of Rheumatology classification criteria for SLE. Case reports Four (1.4%) of our JSLE patients had disseminated TB and were described herein. All of them were female gender, received BCG vaccination and did not have a history of TB household contact. The median of current age at TB diagnosis and the period between JSLE and TB diagnosis were 17 years old (range 14-20) and 5.5 years (range 2-7), respectively. All patients developed miliary TB during the course of the disease. The median of SLE Disease Activity Index 2000 (SLEDAI-2K) was 4 (2-16) and the patients were treated with immunosuppressive agents (glucocorticoid, azathioprine and/or intravenous cyclophosphamide). Two of them presented sepsis and TB diagnosis was only established at autopsy, especially with lungs, central nervous system and abdominal involvements. Anti-TB therapy (isoniazid, rifampicin and pyrazinamide) was indicated in the other two TB cases, however they deceased. Discussion Miliary TB is a rare and severe opportunist infection in pediatric lupus population. This study reinforces the importance of routine searches for TB in JSLE patients.

A falta de planejamento no processo de urbanização das grandes metrópoles tem produzido numerosas externalidades negativas, entre elas a supressão de sua cobertura vegetal e de áreas verdes. Inúmeros benefícios têm sido reportados sobre como a presença da vegetação no meio ambiente urbano favorece fatores ambientais, sociais e econômicos, influenciando na saúde da população. O presente trabalho busca apresentar uma série de estudos com enfoque na associação entre áreas verdes e saúde e também uma sucinta reflexão sobre a importância do assunto no município de São Paulo.

The lack of planning in the urbanization process of big cities worldwide has produced numerous negative externalities, including the suppression of vegetation and green spaces. Multiple benefits have been reported on how urban vegetation promotes and influences environmental, social and economic factors, as well as people's health. This paper presents a series of studies focusing on the association between urban vegetation and human health, as well as a brief reflection on the importance of this issue in the city of São Paulo.

Discinesia ciliar primária (DCP) é uma doença genética que compromete a estrutura e/ou a função ciliar, causando retenção de muco e bactérias no trato respiratório e levando a infecções crônicas nas vias aéreas superiores e inferiores, defeitos de lateralidade visceral e problemas de fertilidade. Revisamos os sinais e sintomas respiratórios da DCP, os testes de triagem e a investigação diagnóstica, bem como detalhes relacionados ao estudo da função, ultraestrutura e genética ciliar. Descrevemos também as dificuldades em diagnosticar a DCP por meio de microscopia eletrônica de transmissão, bem como o seguimento dos pacientes.

Primary ciliary dyskinesia (PCD) is a genetic disorder of ciliary structure or function. It results in mucus accumulation and bacterial colonization of the respiratory tract which leads to chronic upper and lower airway infections, organ laterality defects, and fertility problems. We review the respiratory signs and symptoms of PCD, as well as the screening tests for and diagnostic investigation of the disease, together with details related to ciliary function, ciliary ultrastructure, and genetic studies. In addition, we describe the difficulties in diagnosing PCD by means of transmission electron microscopy, as well as describing patient follow-up procedures.

RESUMO OBJETIVO: Descrever a imunofenotipagem de granulomas TB pulmonar de pacientes autopsiados com tuberculose (grupo TB) e de pacientes infectados pelo HIV com tuberculose (grupo TB/HIV) e identificar as espécies de Mycobacterium em cadeia da polimerase utilizando reação PCR. MÉTODOS: Foram selecionadas amostras pulmonares de 15 pacientes do grupo TB e 23 pacientes do grupo TB/HIV. Realizamos Histopatológia e imuno-histoquímica para descrever os granulomas e para detectar o agente infeccioso (anti-BCG). Avaliamos CD4, CD8, CD20 e CD68 para caracterizar a imunofenotipagem dos granulomas e realizamos a reação PCR para identificar as espécies de micobactéria. RESULTADOS: linfócitos T CD4 + foram as células com densidade mais elevada no grupo de TB, ao passo que as células CD68 exibiram maior densidade no grupo TB/HIV. A comparação entre os grupos mostrou que a densidade de linfócitos T CD4 + foi significativamente maior nos pacientes com TB, ao passo que a densidade CD68 foi significativamente maior nos pacientes com TB/HIV. M. tuberculosis foi identificado em 8 casos de cada grupo; M. avium só foi encontrado em um caso do grupo TB/HIV. CONCLUSÃO: Com o advento da AIDS, o perfil imunológico da tuberculose se alterou. Isto pode estar associado com a depleção de linfócitos T CD4 + em granulomas pulmonares. M. tuberculosis foi o principal agente etiológico da tuberculose em ambos os grupos.

OBJECTIVE: To describe the immunophenotype of pulmonary TB granulomas from autopsied patients with tuberculosis (TB group) and from HIV patients with tuberculosis (TB/HIV group), and to identify the Mycobacterium species using polymerase chain reaction (PCR) technique. METHODS: Lung samples of 15 TB group patients and 23 TB/HIV group patients were selected. Histopathologic analyses and immunohistochemistry tests were performed to describe the granulomas and to detect the infectious agent (anti-BCG). CD4, CD8, CD20 and CD68 were evaluated to characterize the immnophenotype of the granulomas. Polymerase Chain Reaction was performed to identify the mycobacterium species. RESULTS: CD4 + T lymphocytes were the cells with highest density in the TB group, whereas CD68 cells exhibited the highest density in the TB/HIV group. Comparison between groups showed that the CD4 + T density was significantly higher in the TB patients; whereas, CD68 density was significantly higher in the TB/HIV patients. M. tuberculosis was identified in 8 cases of each group; M. avium was only found in one case of the TB/HIV group. CONCLUSION: With the advent of AIDS, the immunological profile of TB has changed. This may be associated with the depletion of CD4 + T lymphocytes in lung granulomas. M. tuberculosis was the major etiological agent of TB in both groups.

Antiretroviral therapy has been associated with side effects, either from the drug itself or in conjunction with the effects of human immunodeficiency virus infection. Here, we evaluated the side effects of the protease inhibitor (PI) indinavir in hamsters consuming a normal or high-fat diet. Indinavir treatment increased the hamster death rate and resulted in an increase in triglyceride, cholesterol and glucose serum levels and a reduction in anti-oxLDL auto-antibodies. The treatment led to histopathological alterations of the kidney and the heart. These results suggest that hamsters are an interesting model for the study of the side effects of antiretroviral drugs, such as PIs.