Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Diretriz sobre Diagnóstico e Tratamento da Cardiomiopatia Hipertrófica – 2024

Hypertrophic cardiomyopathy (HCM) is a form of genetically caused heart muscle disease, characterized by the thickening of the ventricular walls. Diagnosis requires detection through imaging methods (Echocardiogram or Cardiac Magnetic Resonance) showing any segment of the left ventricular wall with a thickness > 15 mm, without any other probable cause. Genetic analysis allows the identification of mutations in genes encoding different structures of the sarcomere responsible for the development of HCM in about 60% of cases, enabling screening of family members and genetic counseling, as an important part of patient and family management. Several concepts about HCM have recently been reviewed, including its prevalence of 1 in 250 individuals, hence not a rare but rather underdiagnosed disease. The vast majority of patients are asymptomatic. In symptomatic cases, obstruction of the left ventricular outflow tract (LVOT) is the primary disorder responsible for symptoms, and its presence should be investigated in all cases. In those where resting echocardiogram or Valsalva maneuver does not detect significant intraventricular gradient (> 30 mmHg), they should undergo stress echocardiography to detect LVOT obstruction. Patients with limiting symptoms and severe LVOT obstruction, refractory to beta-blockers and verapamil, should receive septal reduction therapies or use new drugs inhibiting cardiac myosin. Finally, appropriately identified patients at increased risk of sudden death may receive prophylactic measure with implantable cardioverter-defibrillator (ICD) implantation.La miocardiopatía hipertrófica (MCH) es una forma de enfermedad cardíaca de origen genético, caracterizada por el engrosamiento de las paredes ventriculares. El diagnóstico requiere la detección mediante métodos de imagen (Ecocardiograma o Resonancia Magnética Cardíaca) que muestren algún segmento de la pared ventricular izquierda con un grosor > 15 mm, sin otra causa probable. El análisis genético permite identificar mutaciones en genes que codifican diferentes estructuras del sarcómero responsables del desarrollo de la MCH en aproximadamente el 60% de los casos, lo que permite el tamizaje de familiares y el asesoramiento genético, como parte importante del manejo de pacientes y familiares. Varios conceptos sobre la MCH han sido revisados recientemente, incluida su prevalencia de 1 entre 250 individuos, por lo tanto, no es una enfermedad rara, sino subdiagnosticada. La gran mayoría de los pacientes son asintomáticos. En los casos sintomáticos, la obstrucción del tracto de salida ventricular izquierdo (TSVI) es el trastorno principal responsable de los síntomas, y su presencia debe investigarse en todos los casos. En aquellos en los que el ecocardiograma en reposo o la maniobra de Valsalva no detecta un gradiente intraventricular significativo (> 30 mmHg), deben someterse a ecocardiografía de esfuerzo para detectar la obstrucción del TSVI. Los pacientes con síntomas limitantes y obstrucción grave del TSVI, refractarios al uso de betabloqueantes y verapamilo, deben recibir terapias de reducción septal o usar nuevos medicamentos inhibidores de la miosina cardíaca. Finalmente, los pacientes adecuadamente identificados con un riesgo aumentado de muerte súbita pueden recibir medidas profilácticas con el implante de un cardioversor-desfibrilador implantable (CDI).A cardiomiopatia hipertrófica (CMH) é uma forma de doença do músculo cardíaco de causa genética, caracterizada pela hipertrofia das paredes ventriculares. O diagnóstico requer detecção por métodos de imagem (Ecocardiograma ou Ressonância Magnética Cardíaca) de qualquer segmento da parede do ventrículo esquerdo com espessura > 15 mm, sem outra causa provável. A análise genética permite identificar mutações de genes codificantes de diferentes estruturas do sarcômero responsáveis pelo desenvolvimento da CMH em cerca de 60% dos casos, permitindo o rastreio de familiares e aconselhamento genético, como parte importante do manejo dos pacientes e familiares. Vários conceitos sobre a CMH foram recentemente revistos, incluindo sua prevalência de 1 em 250 indivíduos, não sendo, portanto, uma doença rara, mas subdiagnosticada. A vasta maioria dos pacientes é assintomática. Naqueles sintomáticos, a obstrução do trato de saída do ventrículo esquerdo (OTSVE) é o principal distúrbio responsável pelos sintomas, devendo-se investigar a sua presença em todos os casos. Naqueles em que o ecocardiograma em repouso ou com Manobra de Valsalva não detecta gradiente intraventricular significativo (> 30 mmHg), devem ser submetidos à ecocardiografia com esforço físico para detecção da OTSVE.   Pacientes com sintomas limitantes e grave OTSVE, refratários ao uso de betabloqueadores e verapamil, devem receber terapias de redução septal ou uso de novas drogas inibidoras da miosina cardíaca. Por fim, os pacientes adequadamente identificados com risco aumentado de morta súbita podem receber medida profilática com implante de cardiodesfibrilador implantável (CDI)

Educomunicação e suas áreas de intervenção: Novos paradigmas para o diálogo intercultural

oai:omp.abpeducom.org.br:publicationFormat/1O material aqui divulgado representa, em essência, a contribuição do VII Encontro Brasileiro de Educomunicação ao V Global MIL Week, da UNESCO, ocorrido na ECA/USP, entre 3 e 5 de novembro de 2016. Estamos diante de um conjunto de 104 papers executivos, com uma média de entre 7 e 10 páginas, cada um. Com este rico e abundante material, chegamos ao sétimo e-book publicado pela ABPEducom, em seus seis primeiros anos de existência. A especificidade desta obra é a de trazer as “Áreas de Intervenção” do campo da Educomunicação, colocando-as a serviço de uma meta essencial ao agir educomunicativo: o diálogo intercultural, trabalhado na linha do tema geral do evento internacional: Media and Information Literacy: New Paradigms for Intercultural Dialogue

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Prevalence of Helicobacter pylori infection and associated factors in inhabitants of the municipalities of Cássia dos Coqueiros-SP and Maceió-AL

Introdução: A Helicobacter pylori possui características microbiológicas que permitem sua sobrevivência em condições extremamente adversas, e seu principal reservatório é o estômago. Esta bactéria é considerada a causa de infecção crônica mais frequente em humanos e responsável pela colonização gástrica em mais de 50% da população mundial. Entretanto, há ampla variação na taxa de prevalência da bactéria nas diferentes faixas etárias nas regiões brasileiras, que pode estar relacionada a diversas variáveis, especialmente as socioeconômicas e de condições de vida. Objetivo: Avaliar, por método não invasivo, a prevalência de infecção por H. pylori e suas variáveis determinantes em duas cidades brasileiras. Materiais e Métodos: Foram coletados dados socioeconômicos, demográficos, antropométricos e sintomas digestivos. Para tanto foi aplicado formulário padronizado, realizada avaliação antropométrica e o teste respiratório de ureia marcada com Carbono 13. A coleta de dados foi realizada no Centro de Recuperação e Educação Nutricional em Maceió- AL, e no Centro Médico Social Comunitário Dr. Pedreira de Freitas em Cássia dos Coqueiros-SP. Resultados: A população estudada foi composta por 210 participantes em Cássia dos Coqueiros-SP e 442 participantes em Maceió-AL. Em Cássia dos Coqueiros -SP, a idade variou de 9 a 87 anos com média de 47,4±14,1 anos, os participantes sendo predominantemente adultos (67,2%) e idosos (24,8%). Em Maceió-AL, foi observada a faixa etária de 5 a 80 anos com média de 34,8±12,7 anos. Com relação às condições de vida, as populações apresentam características bem distintas com representatividade estatística. Em Cássia dos Coqueiros-SP, os participantes possuíam domicílio com maior número de cômodos e com menos membros familiares por domicílio, ao comparar com dados de Maceió-AL, havendo diferença significativa (p<0,01). Em Maceió-AL, a maioria das famílias consumem água sem tratamento, sendo também observada diferença significativa (p<0,01). Quanto ao estado nutricional, em virtude do tamanho da amostra, não foi possível aplicar teste estatístico na faixa etária de crianças e adolescentes. Na faixa etária de adultos e idosos não foi observada diferença significativa entre as populações. A prevalência da infecção por H. pylori foi 50,5% (106) em Cássia dos Coqueiros-SP e 57,5% (254) em Maceió-AL com diferença significante (p=0.05). Enquanto em Maceió-AL, os participantes possuíam em média 5,2±4,3 anos de estudo, em Cássia dos Coqueiros-SP 8,9±4,9 (p<0.01). No entanto, não houve diferença significativa com relação aos anos de estudo (p=0.52) ao se considerar o diagnóstico de infecção de H. pylori. Observa-se ainda que, quem mora em Maceió-AL, tem 1,47 mais chance adquirir a infecção por H. pylori, com IC95% [1.03-2.09] p=0.029, após o ajuste para idade, sexo e escolaridade em anos, ao comparar com quem mora em Cássia dos Coqueiros-SP. A aglomeração familiar não foi um fator de risco para adquirir a infecção por H. pylori, e houve associação significativa da água sem tratamento à infecção por H. pylori. Conclusão: A população estudada em Cássia dos Coqueiros-AL apresenta melhores condições socioeconômicas em comparação com a população estudada em Maceió-AL. A prevalência de infecção por H. pylori foi mais elevada em Maceió-AL ao se comparar com Cássia dos Coqueiros-SP.Introduction: Helicobacter pylori has microbiological characteristics that allow it to survive in extremely adverse conditions, and its main reservoir is the stomach. It is considered the most frequent cause of chronic infection in humans and is responsible for gastric colonization in more than 50% of the world population. However, there is wide variation in the prevalence rate of the bacterium in different age groups in Brazilian regions, which can be related to several variables, especially socioeconomic and living conditions. Objective: To evaluate, by a non-invasive method, the prevalence of H. pylori infection and its determining variables in two Brazilian cities. Materials and Methods: Socioeconomic, demographic, anthropometric and digestive symptoms data were collected. For this purpose, a standardized form was applied, an anthropometric assessment and urea breath test were performed. Data collection was carried out at the Nutritional Education and Recovery Center in Maceió-AL, and at the Dr. Pedreira de Freitas Community Social Medical Center in Cássia dos Coqueiros-SP. Results: The studied population was composed of 210 individuals in Cássia dos Coqueiros-SP and 442 individuals in Maceió-AL. In Cássia dos Coqueiros - SP, age ranged from 9 to 87 years with an average of 47.4 ± 14.1 years, being predominantly adults (67.2%) and elderly (24.8%). In Maceió-AL, the age group from 5 to 80 years was observed with an average of 34.8 ± 12.7 years. With regard to living conditions, the populations have very different characteristics with statistical representativeness. In Cássia dos Coqueiros-SP, individuals had a household with a greater number of rooms and with fewer family members per household, when compared with data from Maceió-AL, with a significant difference (p <0.01). In Maceió-AL, most families consume untreated water, with a significant difference also being observed (p <0.01). As for nutritional status, due to the sample size, it was not possible to apply a statistical test to the age group of children and adolescents. In the age group of adults and the elderly, no significant difference was observed between populations. The prevalence of H. pylori infection was 50.5% (106) in Cássia dos Coqueiros-SP and 57.5% (254) in Maceió-AL with a significant difference (p = 0.05). While in Maceió-AL the individuals have an average of 5.2 ± 4.3 years of study, in Cássia dos Coqueiros-SP the individuals have an average of 8.9 ± 4.9 years of study with a difference between them (p <0.01). However, there is no significance (p = 0.52) when considering the diagnosis of H. pylori infection. It is also observed that those who live in Maceió-AL have 1.47 more chance of acquiring H. pylori infection, with ic95% [1.03-2.09] p = 0.03, after adjusting for age, sex and education in years, when comparing with those who live in Cássia dos Coqueiros-SP. Family agglomeration was not a risk factor for acquiring H. pylori infection, and there was a statistical association between untreated water and H. pylori infection. Conclusion: The population studied in Cássia dos Coqueiros-AL has better socioeconomic conditions compared to the population studied in Maceió-AL. The prevalence of infection by H. pylori was higher in Maceió-AL when compared to Cássia dos Coqueiros-SP

Bone tuberculosis: a case report on child

The authors report a case of a 12-year-old child with a complaint of pain and deformity in the lower thoracic region that had lasted for two years. Clinical, epidemiological and laboratory characteristics associated with images of apparent damage in the T9-T10 and T11-T12 vertebrae taken by radiography of the thoracic spine and nuclear magnetic resonance in addition to the positivity of the molecular test based on the polymerase chain reaction, led to tuberculous spondylitis being diagnosed and specific therapy was started. Culture of vertebral biopsy was positive for Mycobacterium tuberculosis after thirty days

Association between Adult Stature and Energy Expenditure in Low-Income Women from Northeastern Brazil

<div><p>Background</p><p>Perinatal undernutrition may lead to important metabolic adaptations in adult life, short stature being the most visible. The present study aimed to evaluate the association between stature and total energy expenditure of low-income women.</p><p>Method</p><p>Women aged 19–45 years from low-income communities in Maceió-AL were recruited. A sample of 67 volunteers was selected and divided into either short stature (≤152.4 cm; n = 34) or non-short stature (≥158.7 cm; n = 33) group. Data on socioeconomic status, anthropometric variables, and hormonal profiles was collected. Total energy expenditure and body composition were assessed by the doubly labeled water technique with multiple points over 14 days. In addition, physical activity levels were measured with triaxial accelerometers and dietary intake data were collected using three 24-hour food records.</p><p>Results</p><p>The mean subject age was 30.94 years. Women of short stature had lower body weight and lean body mass compared to non-short women, but there were no differences in thyroid hormone concentrations or daily energy intake between the two groups. Short-stature women showed lower total energy expenditure (P = 0.01) and a significantly higher physical activity level (P = 0.01) compared to non-short women. However, the difference in total energy expenditure was no longer significant after statistical adjustment for age, lean body mass, and triiodothyronine concentrations.</p><p>Conclusion</p><p>Women with short stature present the same energy intake, but lower total energy expenditure than non-short women, even with a higher physical activity level, which suggests that they are more prone to weight gain.</p></div