Erythrina velutina Willd. - Fabaceae: Árvore de múltiplos usos no nordeste brasileiro

 O mulungu (Erythrina velutina Willd.) é uma árvore que ocorre no nordeste do Brasil e usada como medicinal, madeireira, artesanal, ornamental e como componente de sistema agroflorestais. A partir de consulta a Bases Bibliográficas foi realizada uma revisão sobre a espécie tratando os aspectos taxonômicos e botânicos, composição química e aplicações na fitoterapia, propagação e conservação

CONHECIMENTO DO PACIENTE DIABÉTICO SOBRE A RELAÇÃO BIDIRECIONAL DA DIABETES MELLITUS COM A DOENÇA PERIODONTAL

A diabetes mellitus (DM) é uma doença crônica caracterizada pelo quadro de hiperglicemia e algumas complicações, incluindo a doença periodontal (DP). Pacientes com DM têm maior risco de desenvolver DP, e a DP mal controlada pode dificultar o controle glicêmico. O tratamento da DP em pacientes com DM pode reduzir significativamente os níveis de hemoglobina glicada (HbA1C) e minimizar a inflamação. O presente estudo teve como premissa avaliar o nível de conhecimento e esclarecimento do paciente portador da diabetes mellitus e a relação bidirecional com a doença periodontal. Trata-se de uma pesquisa epidemiológica observacional de corte transversal, de abordagem quantitativa, conduzida com 54 pacientes, de ambos os sexos, maiores de 18 anos e com diagnóstico confirmado de diabetes mellitus. Um questionário contendo 15 perguntas foi aplicado no período de abril a maio de 2023. Os dados obtidos foram analisados com auxílio do software IBM SPSS Statistics. O estudo foi aprovado pelo Comitê de Ética em Pesquisa.  A amostra com média de idade de 60 anos, apresentou maioria feminina (61%), com ensino médio completo (37,04%). Destas, a maioria 88,89% dos indivíduos nunca obtiveram esclarecimentos acerca da relação da diabetes com a doença periodontal e, quando questionados se acreditavam que existe relação entre as doenças, 66,67% afirmam acreditar, do contrário, 33,33% informou não acreditar. A colaboração multidisciplinar entre médicos e odontólogos é importante para uma abordagem eficaz no tratamento de pacientes com DM e DP. Diabetes mellitus (DM) is a chronic disease characterized by hyperglycemia and various complications, including periodontal disease (PD). Patients with DM have a higher risk of developing PD, and uncontrolled PD can hinder glycemic control. Treating PD in patients with DM can significantly reduce glycated hemoglobin (HbA1C) levels and minimize inflammation. The present study aimed to assess the level of knowledge and awareness of patients with diabetes mellitus regarding the bidirectional relationship with periodontal disease. This was an observational cross-sectional epidemiological study with a quantitative approach, conducted with 54 patients of both sexes, over 18 years of age, and with a confirmed diagnosis of diabetes mellitus. A questionnaire with 15 questions was administered from April to May 2023. The data obtained were analyzed using IBM SPSS Statistics software. The study was approved by the Research Ethics Committee. The sample, with a mean age of 60 years, predominantly consisted of females (61%) with a completed high school education (37.04%). Among them, the majority (88.89%) had never received clarifications regarding the relationship between diabetes and periodontal disease. When asked if they believed there was a relationship between the diseases, 66.67% affirmed their belief, while 33.33% stated they did not believe. Multidisciplinary collaboration between physicians and dentists is important for an effective approach in treating patients with DM and PD.    La diabetes mellitus (DM) es una enfermedad crónica caracterizada por hiperglicemia y diversas complicaciones, incluyendo la enfermedad periodontal (EP). Los pacientes con DM tienen un mayor riesgo de desarrollar EP, y una EP mal controlada puede dificultar el control glucémico. El tratamiento de la EP en pacientes con DM puede reducir significativamente los niveles de hemoglobina glucosilada (HbA1C) y minimizar la inflamación. El presente estudio tuvo como premisa evaluar el nivel de conocimiento y conciencia del paciente con diabetes mellitus sobre la relación bidireccional con la enfermedad periodontal. Se trata de un estudio epidemiológico observacional de corte transversal, con enfoque cuantitativo, realizado con 54 pacientes de ambos sexos, mayores de 18 años y con diagnóstico confirmado de diabetes mellitus. Se aplicó un cuestionario con 15 preguntas durante el período de abril a mayo de 2023. Los datos obtenidos se analizaron con la ayuda del software IBM SPSS Statistics. El estudio fue aprobado por el Comité de Ética en Investigación. La muestra, con una edad promedio de 60 años, presentó una mayoría femenina (61%) y educación secundaria completa (37.04%). De ellos, la mayoría (88.89%) nunca había recibido aclaraciones sobre la relación entre la diabetes y la enfermedad periodontal. Cuando se les preguntó si creían que existía una relación entre las enfermedades, el 66.67% afirmó creerlo, mientras que el 33.33% afirmó no creerlo. La colaboración multidisciplinaria entre médicos y odontólogos es importante para un enfoque efectivo en el tratamiento de pacientes con DM y EP.    A diabetes mellitus (DM) é uma doença crônica caracterizada pelo quadro de hiperglicemia e algumas complicações, incluindo a doença periodontal (DP). Pacientes com DM têm maior risco de desenvolver DP, e a DP mal controlada pode dificultar o controle glicêmico. O tratamento da DP em pacientes com DM pode reduzir significativamente os níveis de hemoglobina glicada (HbA1C) e minimizar a inflamação. O presente estudo teve como premissa avaliar o nível de conhecimento e esclarecimento do paciente portador da diabetes mellitus e a relação bidirecional com a doença periodontal. Trata-se de uma pesquisa epidemiológica observacional de corte transversal, de abordagem quantitativa, conduzida com 54 pacientes, de ambos os sexos, maiores de 18 anos e com diagnóstico confirmado de diabetes mellitus. Um questionário contendo 15 perguntas foi aplicado no período de abril a maio de 2023. Os dados obtidos foram analisados com auxílio do software IBM SPSS Statistics. O estudo foi aprovado pelo Comitê de Ética em Pesquisa.  A amostra com média de idade de 60 anos, apresentou maioria feminina (61%), com ensino médio completo (37,04%). Destas, a maioria 88,89% dos indivíduos nunca obtiveram esclarecimentos acerca da relação da diabetes com a doença periodontal e, quando questionados se acreditavam que existe relação entre as doenças, 66,67% afirmam acreditar, do contrário, 33,33% informou não acreditar. A colaboração multidisciplinar entre médicos e odontólogos é importante para uma abordagem eficaz no tratamento de pacientes com DM e DP

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Funding WHO