Sustainable intensification of agriculture is one of the main strategies to provide global food security. However, its implementation raises enormous political, technological, and social challenges. Meeting these challenges will require, among other things, accurate information on the spatial and temporal patterns of agricultural land use and yield. Here, we investigate historical patterns of agricultural land use (1940-2012) and productivity (1990-2012) in Brazil using a new high-resolution (approximately 1 km(2) ) spatially explicit reconstruction. Although Brazilian agriculture has been historically known for its extensification over natural vegetation (Amazon and Cerrado), data from recent years indicate that extensification has slowed down and was replaced by a strong trend of intensification. Our results provide the first comprehensive historical overview of agricultural land use and productivity in Brazil, providing clear insights to guide future territorial planning, sustainable agriculture, policy, and decision-making.

BackgroundDengue is an increasing public health concern in Brazil. There is a need for an updated evaluation of the economic impact of dengue within the country. We undertook this multicenter study to evaluate the economic burden of dengue in Brazil.MethodsWe estimated the economic burden of dengue in Brazil for the years 2009 to 2013 and for the epidemic season of August 2012- September 2013. We conducted a multicenter cohort study across four endemic regions: Midwest, Goiania; Southeast, Belo Horizonte and Rio de Janeiro; Northeast: Teresina and Recife; and the North, Belem. Ambulatory or hospitalized cases with suspected or laboratory-confirmed dengue treated in both the private and public sectors were recruited. Interviews were scheduled for the convalescent period to ascertain characteristics of the dengue episode, date of first symptoms/signs and recovery, use of medical services, work/school absence, household spending (out-of-pocket expense) and income lost using a questionnaire developed for a previous cost study. We also extracted data from the patients’ medical records for hospitalized cases. Overall costs per case and cumulative costs were calculated from the public payer and societal perspectives. National cost estimations took into account cases reported in the official notification system (SINAN) with adjustment for underreporting of cases. We applied a probabilistic sensitivity analysis using Monte Carlo simulations with 90% certainty levels (CL).ResultsWe screened 2,223 cases, of which 2,035 (91.5%) symptomatic dengue cases were included in our study. The estimated cost for dengue for the epidemic season (2012–2013) in the societal perspective was US$ 468 million (90% CL: 349–590) or US$ 1,212 million (90% CL: 904–1,526) after adjusting for under-reporting. Considering the time series of dengue (2009–2013) the estimated cost of dengue varied from US$ 371 million (2009) to US$ 1,228 million (2013).ConclusionsThe economic burden associated with dengue in Brazil is substantial with large variations in reported cases and consequently costs reflecting the dynamic of dengue transmission.

The organophosphate temephos has been the main insecticide used against larvae of the dengue and yellow fever mosquito (Aedes aegypti) in Brazil since the mid-1980s. Reports of resistance date back to 1995; however, no systematic reports of widespread temephos resistance have occurred to date. As resistance investigation is paramount for strategic decision-making by health officials, our objective here was to investigate the spatial and temporal spread of temephos resistance in Ae. aegypti in Brazil for the last 12 years using discriminating temephos concentrations and the bioassay protocols of the World Health Organization. The mortality results obtained were subjected to spatial analysis for distance interpolation using semi-variance models to generate maps that depict the spread of temephos resistance in Brazil since 1999. The problem has been expanding. Since 2002-2003, approximately half the country has exhibited mosquito populations resistant to temephos. The frequency of temephos resistance and, likely, control failures, which start when the insecticide mortality level drops below 80%, has increased even further since 2004. Few parts of Brazil are able to achieve the target 80% efficacy threshold by 2010/2011, resulting in a significant risk of control failure by temephos in most of the country. The widespread resistance to temephos in Brazilian Ae. aegypti populations greatly compromise effective mosquito control efforts using this insecticide and indicates the urgent need to identify alternative insecticides aided by the preventive elimination of potential mosquito breeding sites.

In Western Bahia, one of the most active agricultural frontiers of the world, cropland area and irrigated area are increasing at fast rates, and water conflicts have been happening at least since 2010. This study makes a hydroclimatic analysis of the water resources in Western Bahia, from both supply and demand viewpoints. Time series of precipitation for the period 1980–2015 and river discharge for the period 1978–2015 are analyzed, indicating a significant reduction of up to 12% in rainfall since the 1980s, and a reduction in river discharge in all stations studied, in both the rainy season and the dry season. Combined with that, irrigated area has increased over 150-fold in 30 years, and in the most irrigated regions, has increased by 90% in the last eight years only. Seven regions in Western Bahia have been identified where the potential for water use conflicts is critical. Moreover, the combination of reduced availability and increased demand of water resources indicates that, if current trends are maintained, conflicts over water may become more frequent in the next years or decades. A short-term alternative to avoid such conflicts is to largely avoid irrigation during the months with low discharge. However, a monitoring system in which the availability and demand of water resources for irrigation are actually measured and monitored, is the safest path to provide water security to this region.

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The present open pilot study was conducted to assess the efficacy of azithromycin for the treatment of patients with cutaneous leishmaniasis in Araçuaí and Varzelândia, MG. Twenty-four patients with less of six months of disease evolution were treated after clinical examination, Montenegro test and a biopsy. The treatment schemes consisted of oral doses of 500 mg per day for 3, 5 and 10 days and of 1000 mg for two days. A clinical control was performed monthly and treatment cycles were repeated when necessary until full reepithelialization of the lesions. On the occasion of the final evaluation, 20 patients had completed the study and 17 of them (85%) were cured. The time to obtain a cure was 60 days ifor 6 (30%) patients, 90 days for 7 (35%), and 120 for 4 (20%). The three patients with treatment failure received a pentavalent antimonial for 20 days. No adverse reactions to the medication were observed and a 14 month follow-up did not show recurrence in any patient. These results suggest that azithromycin can be a good therapeutic option for the treatment of cutaneous leishmaniasis caused by Leishmania Viannia brasiliensis. Key words: Cutaneous leishmaniasis. Azithromycin. Leishmania Viannia brasiliensis.Resumo O presente estudo piloto aberto avaliou a eficácia da Azitromicina em pacientes com leishmaniose cutânea, em Araçuaí e Varzelândia, MG. Foram tratados 24 pacientes após exame clínico, teste de Montenegro, e biópsia, e que tivessem menos de seis meses de evolução da doença. Os esquemas de tratamento empregaram doses, pela via oral, de 500 mg por dia durante 3,5 e 10 dias e de 1000 mg durante dois dias. Mensalmente foi realizado controle clínico e quando necessário, repetidos ciclos do medicamento, até reepitelização completa das lesões. Na avaliação final 20 pacientes terminaram o estudo, dos quais 17 (85%) foram curados. O tempo de cura foi de 60 dias em 6 (30%) pacientes, de 90 dias em 7 (35%) e de 120 dias em 4 (20%). Os três pacientes que tiveram falha terapêutica receberam antimonial pentavalente durante 20 dias. Não foram observadas reações adversas ao medicamento e o seguimento até 14 meses pós-tratamento não mostrou recidiva em nenhum dos pacientes. Estes resultados sugerem que a Azitromicina pode ser uma boa opção terapêutica para o tratamento de leishmaniose cutânea causada por Leishmania Viannia brasiliensis.

The coronavirus disease of 2019 (COVID-19) pandemic challenges public health systems around the world. Tropical countries will face complex epidemiological scenarios involving the simultaneous transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with viruses transmitted by Aedes aegypti. The occurrence of arboviral diseases with COVID-19 in the Latin America and the Caribbean (LAC) region presents challenges and opportunities for strengthening health services, surveillance and control programs. Financing of training, equipment and reconversion of hospital spaces will have a negative effect on already the limited resource directed to the health sector. The strengthening of the diagnostic infrastructure reappears as an opportunity for the national reference laboratories. Sharing of epidemiological information for the modeling of epidemiological scenarios allows collaboration between health, academic and scientific institutions. The fear of contagion by COVID-19 is constraining people with arboviral diseases to search for care which can lead to an increase in serious cases and could disrupt the operation of vector-control programs due to the reluctance of residents to open their doors to health personnel. Promoting intense community participation along with the incorporation of long lasting innovations in vector control offers new opportunities for control. The COVID-19 pandemic offers challenges and opportunities that must provoke positive behavioral changes and encourage more permanent self-care actions.

RESUMO: Objetivo: Avaliar a mortalidade por áreas de Belo Horizonte (BH) durante a pandemia de COVID-19 conforme a vulnerabilidade social, visando a uma estratégia de vacinação. Métodos: Estudo ecológico com análise de mortalidade, segundo setores censitários classificados pelo índice de vulnerabilidade da saúde, composto de indicadores de saneamento e socioeconômicos. Óbitos por causas naturais e COVID-19 foram obtidos do Sistema de Informação sobre Mortalidade, entre a 10ª e a 43ª semanas epidemiológicas (SE) de 2020. Calculou-se o excesso de mortalidade por modelo de série temporal, considerando-se as mortes observadas por SE entre 2015 e 2019, por setor censitário. Taxas de mortalidade (TM) foram calculadas e padronizadas por idade com base em estimativas populacionais do Instituto Brasileiro de Geografia e Estatística (IBGE). Resultados: Houve 16,1% (n = 1.524) de excesso de mortalidade em BH: 11, 18,8 e 17,3% nas áreas de baixa, média e elevada vulnerabilidade, respectivamente. As diferenças entre TM observadas e esperadas por causas naturais, padronizadas por idade, foi igual a 59/100 mil habitantes em BH, aumentando de 31 para 77 e 95/100 mil, nas áreas de baixa, média e elevada vulnerabilidade, respectivamente. Houve gradiente de aumento com a idade nas TM por COVID-19, variando de 4 a 611/100 mil habitantes entre as idades de 20-39 anos e 75+ anos. A TM por COVID-19 por 100 mil idosos (60+ anos) foi igual a 292, aumentando de 179 para 354 e 476 nos setores de baixa, média e elevada vulnerabilidade, respectivamente. Conclusão: Desigualdades na mortalidade, mesmo entre idosos, aliadas à baixa oferta de doses, demonstram a importância de priorizar áreas socialmente vulneráveis durante a vacinação contra COVID-19.