Historically, during periods of extreme drought, food security in the drylands of the semiarid region of Northeast Brazil (NEB) is under severe risk due to agricultural collapse. The drought that started in 2012 continues to highlight the vulnerability of this region, and arid conditions have been detected during the last years mainly in the central semiarid region, covering almost 2% of the NEB. Climate projections show an increase in the area under water stress condition, covering 49% and 54% of the NEB region by 2700 and 2100, respectively, with a higher likelihood with warming above 4 °C. The projections of vegetative stress conditions derived from the empirical model for Vegetation Health Index (VHI) are consistent with projections from vegetation models, where semi-desert types typical of arid conditions would replace the current semiarid bushland vegetation ("caatinga") by 2100. Due to the impacts of the 2012-2017 drought, public policies have been implemented to reduce social and economic vulnerability for small farmers but are not enough as poor population continues to be affected. In the long term, to make the semiarid less vulnerable to drought, strengthened integrated water resources management and a proactive drought policy are needed to restructure the economy. Integrating drought monitoring and seasonal climate forecasting provides means of assessing impacts of climate variability and change, leading to disaster risk reduction through early warning. Lastly, there is an urgent need for integrated assessments because the possibility that under permanent drought conditions with warming above 4 °C, arid conditions would prevail in NEB since 2060.

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The clinical diagnosis and laboratory identification of Leishmania braziliensis braziliensis, a parasitic disease affecting the upper aerodigestive tract, is difficult. A retrospective computer-assisted analysis of patient records was done after examination of 58 patients with mucosal leishmaniasis in an endemic area of L. braziliensis braziliensis in Bahia, Brazil during January 1987. Biopsies of clinically active and clinically inactive mucosal patients were examined for parasites using routine hematoxylin and eosin histopathology and a new technique for rapid detection of Leishmania amastigotes using a genus-specific indirect immunofluorescent assay. No amastigotes were found in specimens from seven patients with clinically inactive mucosal disease using immunofluorescent monoclonal assay techniques, whereas specimens from seven out of 14 patients with clinically active mucosal disease were positive. These results suggest that the immunofluorescent antibody technique is markedly superior in identifying the intracellular amastigote in tissue sections of mucosal biopsies when compared to histopathology techniques or with other standard tests done in rural areas of Brazil. Various clinical and laboratory test data of the entire group of patients were examined and the efficacy of treatment evaluated. The median interval of time noted between cutaneous and mucosal disease was 4.5 years. Relapse was noted in 31% of patients treated with a low dose of meglumine antimoniate (10 mg per kg of body weight). Patients treated with a high dose of meglumine antimoniate (20 mg per kg of body weight) had a relapse rate of 27.3%. A chi-square statistical analysis revealed no significant difference (chi 2 = 0.049) between the two groups. Patients were considered cured if mucosal granulations were clinically absent after 4.6 years.

RESUMOOs A A. analisaram as alterações histológicas encontradas em 162 casos de Leishmaniose Tegumentar da localidade de Três Braços, Estado da Bahia, dos quais 131 (80,9%) eram de portadores de lesões cutâneas e 31 (19,1%) de portadores de lesões mucosas. Analisaram, também, o comportamento clínico dos cinco padrões histopatológicos, já antes descritos, em relação à terapêutica. O melhor prognóstico esteve sempre ligado ao padrão de Reação Exsudativa e Granulomatosa, ou seja, a uma fase na qual o organismo, tendo lançado mão de um mecanismo endógeno de lise parasitária, já circunscreveu a área de necrose por uma reação granulomatosa, e esta é agora apenas o elemento residual. A ação terapêutica nessa fase somente acelera a resolução natural do caso. O grupo seguinte é amplo, e compreende os casos em que a lesão pertence aos padrões de Reação Exsudativa Celular (formas cutâneas), Reação Exsudativa e Necrótica e Reação Exsudativa e Necrótico-Granulomatosa. Nesses casos, o mecanismo de auto-controle da lesão encontra-se ainda em curso, e a ação terapêutica encurta o período de evolução natural. Os f.asos do padrão de Reação Exsudativa e Tuberculóide tiveram um prognóstico variável. Houve boa resposta à terapêutica quando o granuloma tuberculóide característico desse padrão surgiu em pacientes jovens, com curto tempo de evolução da doença e intradermorreação não exacerbada. Nos demais casos tuberculóides -. principalmente em pacientes adultos, com longo tempo de evolução da doença e intradermorreação exacerbada -, a resposta foi menos satisfatória. Em último lugar, com prognóstico reservado, ficaram os casos da forma mucosa que apresentaram o padrão de Reação Exsudativa Celular, onde o infiltrado pode estar desempenhando papel de auto-agressão. O presente estudo evoluiu para a proposição de uma classificação da Leishmaniose Tegumentar, baseada nos padrões histopatológicos observados. Esta classificação, estritamente morfológica, deverá ser de fácil aplicação para o Patologista e, como apresenta também uma correspondência clínico-evolutiva[ poderá constituir auxílio valioso ao médico envolvido no diagnóstico e tratamento da Leishmaniose Tegumentar. UNITERMOS: Leishmaniose tegumentar; Leishmania braziliensis braziliensis;Histopatologia. INTRODUÇÃOA Leishmaniose Tegumentar, endêmica em muitas regiões do Brasil, voltou a ser estudada

Fibrous mastopathy does not occur in diabetic patients only; fibrous mastopathy may also occur in healthy subjects; the lesion is characterized by a higher number of T-lymphocytes over B-lymphocytes, the presence of absolute lobular lymphocytic infiltrate, reactivity for alpha-smooth muscle actin, and macrophages. Relapses were found in one-quarter of the lesions and spontaneous regression was observed in one case.