Prevalência da COVID-19, perfil do acometimento renal e óbito em terapia intensiva durante a pandemia

Introduction: the acute kidney injury is one of the main complications of SARs-Cov-2 infection. Objective: identify the COVID-19 prevalence and kidney damage of evaluated patients followed up by nephrology team in an intensive care unit. Materials and Methods: adults and elderly people of both genders followed up by the nephrology team and performed the RT PCR test for COVID were included on this study. For analysis and comparison, the patients were divided in RTP PCR positive and negative groups. To assess the kidney damage impact on death rates another analysis was performed considering the death or the absence of death as outcome. Results: the prevalence of COVID-19 was 58.5% and the prevalence of AKI was 75.0% among the 176 patients. More than half of patients (55.2%) undergoing renal replacement therapy tested positive for COVID-19. On the evaluation of Charlson Comorbidity Index was identified statistically significant difference in the proportions of the negative and positive COVID-19 groups in scores 0, 1 and 2. The second analysis identified a significant association between kidney disease and death in the ICU (p < 0.05). Patients with CKD died less 13/98 (13.3%) when compared to those with AKI 85/98 (86.7%). When they had both COVID-19 and AKI, the mortality rate was 69.0%. Conclusion: the prevalence of COVID-19 in patients undergoing intensive care during the first semester of 2021 was higher than 50% and the AKI prevalence in patients tested positive for COVID-19 was higher than 80%. The death rates among the patients with AKI and COVID-19 simultaneously were upper than 60%.Introdução: entre as principais complicações da infecção do SARs-Cov-2 está a Insuficiência renal aguda. Objetivo: identificar a prevalência de COVID-19 e acometimento renal em pacientes avaliados e acompanhados pela equipe de nefrologia em centro de tratamento intensivo. Material e Métodos: participaram adultos e idosos de ambos os sexos acompanhados pela equipe de nefrologia e que realizaram o teste RT PCR para COVID. Para análise e comparação os pacientes foram agrupados em RTP PCR positivo e negativo. Para avaliar o impacto do acometimento renal nas taxas de óbito outra análise foi realizada considerando como desfecho evolução a óbito ou não. Resultados: incluídos 176 pacientes sendo a prevalência de COVID-19 58,5% e IRA 75%. Dos pacientes que realizaram Terapia Renal Substitutiva, mais da metade (55,2%) tinham COVID 19 +. O índice de Charlson identificou-se diferença estatisticamente significativa nas proporções dos grupos COVID-19 negativo e positivo nos índices 0, 1 e 2. A segunda análise identificou associação significativa entre doença renal e óbito no CTI (p < 0,05). Os pacientes com DRC evoluíram menos a óbito 13/98 (13,3%) quando comparados com aqueles com IRA 85/98 (86,7%). E quando tinham simultaneamente o COVID 19 e a IRA a taxa de mortalidade foi de 69,0%. Conclusão: A prevalência da COVID-19 em pacientes internados no CTI adulto durante o primeiro semestre de 2021 foi acima de 50% e a prevalência de IRA nos pacientes positivos ultrapassou a marca dos 80%.  A taxa de óbito entre os pacientes com IRA e COVID 19 + simultâneos ultrapassou 60%

Alteración de la función renal: prevalencia y factores asociados en pacientes de riesgo

Introduction: Chronic kidney disease (CKD) does not have any clinical symptoms in the early stages and, therefore, most people only attend healthcare units when they are already in the terminal phase of the disease, which is still common in Brazil. Objective: To identify the prevalence of altered estimated glomerular filtration rate (eGFR) and associated factors in users of the unified health system suffering from diabetes mellitus and/or systemic hypertension at high risk of cardiovascular disease. Materials and Methods: A cross-sectional study was conducted based on the medical records of 331 users attending the State Specialty Care Center located in the west-central region of Minas Gerais, Brazil between September 2017 and June 2019. A descriptive univariate analysis and multivariate logistic regression were performed. Results: A total of 118 (35.6%) of the participants had altered eGFR. A significant association between altered eGFR and age was identified: older people  ≥ 60 years old were 5.53 times more likely to have altered eGFR. Participants using polypharmacy were 2.64 times more likely to have altered eGFR. Discussion: In line with similar studies, a lack of follow-up on the initiation and development of CKD in the early stages was identified, implying a late approach and limited actions to preserve kidney function. Conclusions: A high prevalence of altered eGFR was identified (35.6%) with no records in the tables that could lead to a preventive approach to impaired kidney function. Advanced age and polypharmacy were identified as independent variables in the alteration of kidney function. How to cite this article: Castro, Tássia Lima Bernardino; Oliveira, Rayane Hellen; Sousa, João Antônio Gomides; Romano, Márcia Christina Caetano; Guedes, João Victor Marques; Otoni, Alba. Função renal alterada: prevalência e fatores associados em pacientes de risco. Revista Cuidarte. 2020; 11(2): e1019. http://dx.doi.org/10.15649/cuidarte.1019Introdução: a doença renal crônica (DRC) nos estágios iniciais não apresenta manifestações clínicas e, por isso, as pessoas somente procuram as unidades de saúde já na fase terminal da doença. Isso ainda é uma rotina no Brasil. Objetivo: identificar a prevalência de taxa de filtração glomerular estimada (TFGe) alterada e fatores associados em usuários do sistema único de saúde com Diabetes Mellitus e/ou com Hipertensão Arterial Sistêmica de alto e muito alto risco para doença cardiovascular. Materiais e Métodos: estudo transversal com prontuários de 331 usuários do Centro Estadual de Atenção Especializada no Centro-Oeste mineiro/ Minas Gerais/ Brasil, entre setembro de 2017 a junho de 2019. Realizou-se análise descritiva, univariada e regressão logística multivariada. Resultados: do total de participantes, 118 (35,6%) tiveram TFGe alterada. Identificou-se associação significativa da TFGe alterada com a idade: idosos ≥ 60 anos apresentaram 5,53 vezes mais chance de ter a TFGe alterada. Os participantes em uso da polifarmácia tiveram 2,64 vezes mais chance de terem a TFGe alterada. Discussão: em analogia com estudos semelhantes, registrou-se a ausência de acompanhamento da instalação e desenvolvimento da DRC nas fases iniciais, implicando em abordagem tardia e ações limitadas para preservação das funções renais. Conclusões: identificou-se alta prevalência de TFGe alterada (35,6%), sem registros nos prontuários que pudessem direcionar uma abordagem preventiva da degeneração das funções renais. A idade avançada e polifarmácia foram identificadas como variáveis independentes para alteração da função renal. Como citar este artigo: Castro, Tássia Lima Bernardino; Oliveira, Rayane Hellen; Sousa, João Antônio Gomides; Romano, Márcia Christina Caetano; Guedes, João Victor Marques; Otoni, Alba. Função renal alterada: prevalência e fatores associados em pacientes de risco. Revista Cuidarte. 2020; 11(2): e1019. http://dx.doi.org/10.15649/cuidarte.1019Introducción: La enfermedad renal crónica (ERC) en sus primeras etapas no presenta manifestaciones clínicas y, por lo tanto, la mayoría de las personas solo se acercan a las unidades de salud cuando ya están en la fase terminal de la enfermedad, lo cual sigue siendo habitual en Brasil. Objetivo: Identificar la prevalencia de la tasa estimada de filtración glomerular (TFG) alterada y los factores asociados en usuarios del sistema de salud único que sufran de diabetes mellitus y/o hipertensión sistémica de alto riesgo de enfermedad cardiovascular. Materiales y métodos: Se realizó un estudio transversal con las historias clínicas de 331 usuarios del Centro Estatal de Atención Especializada ubicado en el centro oeste de Minas Gerais, Brasil entre septiembre de 2017 y junio de 2019. Se realizaron un análisis univariado descriptivo y una regresión logística multivariante. Resultados: Del total de participantes, 118 (35,6%) tenían la TFG alterada. Se identificó una asociación significativa entre la alteración de la TFG y la edad: los ancianos ≥ 60 años tenían 5,53 veces más posibilidades de tener la TFG alterada. Los participantes que utilizaron la polifarmacia tenían 2,64 veces más probabilidades de que se alterara la TFG. Discusión: En consonancia con estudios similares, se registró la falta de seguimiento del inicio y el desarrollo de la ERC en las primeras etapas, lo que implica un enfoque tardío y acciones limitadas para preservar las funciones renales. Conclusiones: Se identificó una alta prevalencia de TFG alterada (35,6%) sin registros en las tablas que pudieran conducir a un enfoque preventivo de la degeneración de la función renal. La edad avanzada y la polifarmacia se identificaron como variables independientes en la alteración de la función renal. Como citar este artículo: Castro, Tássia Lima Bernardino; Oliveira, Rayane Hellen; Sousa, João Antônio Gomides; Romano, Márcia Christina Caetano; Guedes,Guedes, João Victor Marques; Otoni, Alba. Função renal alterada: prevalência e fatores associados em pacientes de risco. Revista Cuidarte. 2020; 11(2): e1019. http://dx.doi.org/10.15649/cuidarte.101

Comparação do estado nutricional em pacientes com insuficiência renal crônica com e sem hiperparatireoidismo secundário

Objective: To compare by means of a specific instrument (Malnutrition Inflammation Score - MIS) and dietary recall, the nutritional profile of patients with chronic renal failure (CRF) on hemodialysis with and without Secondary Hyperparathyroidism (HPT2). Methods: cross-sectional study with 204 patients with CRF on hemodialysis with and without HPT2. Nutritional status was assessed by means of the MIS instrument and food intake by 24-hour recall. Data from the latter was analyzed using Avanutri® software. Results: Of the total patients, 136 had HPT2 and 68 did not, most of them being male, alcoholic and sedentary in both groups. Regarding MIS, validated instrument to assess nutritional risk, the number of patients with a score> 6 (indicating nutritional risk) was 48.5% for those without HPT2 and 49.3% for those with HPT2, however, there was no statistical difference between the groups (p> 0.05). Regarding the consumption of micronutrients, it was found that people with CRF and HPT2 consumed in greater quantities all micronutrients, except for vitamin B12. With regard to micronutrients that can directly intervene in HPT2, vitamin D and phosphorus were significantly more consumed by the group with CRF and HPT2.Conclusion: There was no statistical difference in the nutritional status of patients with CRF on hemodialysis with and without HPT2. Patients with CRF and HPT2 consumed a greater amount of all micronutrients, especially vitamin D and phosphorus, but maintained adequate serum levels, which may indicate the fulfillment of specific recommendations for the treatment of HPT2.Objetivo: Comparar, por meio de instrumento específico (Malnutrition Inflammation Score - MIS) e recordatório alimentar, o perfil nutricional de pacientes com Insuficiência Renal Crônica (IRC) em hemodiálise com e sem Hiperparatireoidismo Secundário (HPT2). Métodos: estudo transversal com 204 pacientes com IRC em hemodiálise com e sem HPT2. O estado nutricional foi avaliado por meio do instrumento MIS e a ingesta alimentar por recordatório 24h, sendo dados deste último analisados pelo software Avanutri®. Resultados: Do total de pacientes, 136 tinham HPT2 e 68 não tinham, sendo a maioria do sexo masculino, etilistas e sedentários. Em relação ao MIS, o número de pacientes com pontuação > 6 (indicando risco nutricional) foi de 48,5% para aqueles sem HPT2 e 49,3% para os com HPT2, porém, não houve diferença estatística entre esses grupos (p >0,05). Com relação ao consumo de micronutrientes, identificou-se que as pessoas com IRC e HPT2 consumiram em maior quantidade todos os micronutrientes, com exceção a vitamina B12. No que diz respeito aqueles micronutrientes que podem intervir diretamente no HPT2, a vitamina D e o fósforo foram significativamente mais consumidos pelo grupo com IRC e HPT2. Conclusão: Não houve diferença estatística no estado nutricional de pacientes com IRC em hemodiálise com e sem HPT2. Os pacientes com IRC e HPT2 consumiram em maior quantidade todos os micronutrientes, em especial de vitamina D e fósforo, porém mantiveram os níveis séricos adequados podendo indicar, o atendimento de recomendações específicas para tratamento do HPT2

Trastorno mineral y óseo: prevalencia subestimada en las primeras fases de la enfermedad renal crónica

Introduction: mineral and bone disorder (BMD) is a serious complication of chronic kidney disease (CKD) that increases risks for death from cardiovascular causes and impairs quality of life of affected patients. Objetive: to evaluate the prevalence of BMD in patients with CKD and the association between estimated Glomerular Filtration Rate (eGFR) and BMD indicators (calcium, phosphorus and PTH) in non-dialysis patients. Materials and Methods:sectional study of a two-year cohort of chronic renal adults and elderly patients on conservative treatment. BMD was identified by serum values of: PTH (> 150 pg/mL) and/or hypocalcemia (Ca < 8.8mg/dl) and/or hyperphosphatemia (P > 4.6 mg/dl). The statistical analysis used: Poisson regression; Student's T, Mann Whitney and Pearson and Spearman correlations with 5% significance level. Results:BMD prevalence was 54.6% (n=41) (95% CI: 43.45 - 65.43), more frequent in women, literate, elderly, non-drinkers, non-smokers, sedentary and white skin color. Correlations between P and PTH with GFRe were significant, inverse, moderate strength (p= <0.005 and p = 0.003; correlation coefficients = - 0.312 and - 0.379 respectively). Discussion: the findings of this study highlighted gaps in the monitoring of BMD-DRC by primary care, requiring a review of clinical practices. Conclusion: robust prevalence of BMD in the early stages of CKD was identified, in addition to correlations between increased phosphorus and PTH levels and worsening kidney function. How to cite this article: Quadros, Karla Amaral Nogueira; Morais, Flávio Augusto de; Vasconcelos, Francisco Edson Coelho de; Watanabe, Yoshimi José Ávila; Bessa, Allan de Morais; Silva, Fernanda Marcelino de Rezende e; Guedes, João Victor Marques; Belo, Vinicius Silva; Cardoso, Clareci Silva; Otoni, Alba. Distúrbio mineral e ósseo: prevalência subestimada nos estágios iniciais da doença renal crónica. Revista Cuidarte. 2022;13(3):e2266. http://dx.doi.org/10.15649/cuidarte.2266     Introdução: o objetivo foi avaliar a prevalência do distúrbio mineral e ósseo em pacientes com doença renal crônica e a associação entre Taxa de Filtração Glomerular estimada (TFGe) e os indicadores do distúrbio mineral e ósseo (DMO) (cálcio, fósforo e PTH) em pacientes renais crônicos não dialíticos. Materiais e Métodos: estudo seccional da linha de base de uma coorte de dois anos, com adultos e idosos renais crônicos em tratamento conservador. Para identificação do DMO utilizamos os seguintes valores séricos: PTH (> 150 pg/mL) e/ou hipocalcemia (Ca < 8,8mg/dl) e/ou hiperfosfatemia (P > 4,6 mg/dl). Na análise estatística utilizou-se: regressão de Poisson; T de Student, Mann Whitney e correlações de Pearson e Spearman. Nível de significância foi de 5%. Resultados: prevalência de DMO de 54,6% (n=41) (IC 95%: 43,45 - 65,43).  A maior prevalência de DMO foi em pessoas do sexo feminino, alfabetizadas, idosas, não etilistas, não tabagistas, sedentárias e de cor de pele branca, porém, sem diferença estatística entre os grupos com e sem DMO. As correlações entre P e PTH com TFGe foram significativas, inversas, de força moderada (p= <0,005 e p = 0,003; coeficientes de correlação = - 0,312 e - 0,379 respectivamente). Discussão:os achados desse estudo mostraram que existe uma lacuna no acompanhamento do DMO-DRC pela atenção primária e a prática clínica deve ser revista. Conclusão:identificou-se prevalência robusta de DMO nos estágios precoces da DRC, além de correlações significativas entre o aumento dos níveis de fósforo e PTH e piora das funções renais. Como citar este artigo: Quadros, Karla Amaral Nogueira; Morais, Flávio Augusto de; Vasconcelos, Francisco Edson Coelho de; Watanabe, Yoshimi José Ávila; Bessa, Allan de Morais; Silva, Fernanda Marcelino de Rezende e; Guedes, João Victor Marques; Belo, Vinicius Silva; Cardoso, Clareci Silva; Otoni, Alba. Distúrbio mineral e ósseo: prevalência subestimada nos estágios iniciais da doença renal crónica. Revista Cuidarte. 2022;13(3):e2266. http://dx.doi.org/10.15649/cuidarte.2266     Introducciòn: el trastorno mineral y óseo (TMO) es una complicación grave de la enfermedad renal crónica (ERC) que aumenta el riesgo de muerte por causas cardiovasculares y deteriora la calidad de vida de los pacientes afectados. Objetivo: evaluar la prevalencia de la DMO en pacientes con RDC y la asociación entre la tasa de filtración glomerular estimada (TFGe) y los indicadores de DMO (calcio, fósforo y PTH) en pacientes no dialíticos. Materiales y Métodos: estudio seccional de una cohorte de dos años de pacientes renales crónicos adultos y ancianos en tratamiento conservador. La DMO se identificó por los valores séricos de: PTH (> 150 pg/mL) y/o hipocalcemia (Ca < 8,8mg/dl) y/o hiperfosfatemia (P > 4,6 mg/dl). El análisis estadístico utilizado: regresión de Poisson; T de Student, Mann Whitney y correlaciones de Pearson y Spearman con un nivel de significación del 5%. Resultados: la prevalencia de DMO fue del 54,6% (n=41) (IC 95%: 43,45 - 65,43), más frecuente en mujeres, alfabetizadas, de edad avanzada, no bebedoras, no fumadoras, sedentarias y de color de piel blanca. Las correlaciones entre el P y la PTH con el GFRe fueron significativas, inversas, de fuerza moderada (p= <0,005 y p = 0,003; coeficientes de correlación = - 0,312 y - 0,379 respectivamente). Discusión: los resultados de este estudio evidencian lagunas en el seguimiento de la DMO-DRC por parte de la atención primaria, lo que requiere una revisión de las prácticas clínicas. Conclusión: se identificó una fuerte prevalencia de la DMO en las primeras fases de la ERC, además de correlaciones entre el aumento de los niveles de fósforo y PTH y el empeoramiento de la función renal. Como citar este artículo: Quadros, Karla Amaral Nogueira; Morais, Flávio Augusto de; Vasconcelos, Francisco Edson Coelho de; Watanabe, Yoshimi José Ávila; Bessa, Allan de Morais; Silva, Fernanda Marcelino de Rezende e; Guedes, João Victor Marques; Belo, Vinicius Silva; Cardoso, Clareci Silva; Otoni, Alba. Distúrbio mineral e ósseo: prevalência subestimada nos estágios iniciais da doença renal crónica. Revista Cuidarte. 2022;13(3):e2266. http://dx.doi.org/10.15649/cuidarte.2266      &nbsp

MAMMALS IN PORTUGAL : A data set of terrestrial, volant, and marine mammal occurrences in P ortugal

Mammals are threatened worldwide, with 26% of all species being includedin the IUCN threatened categories. This overall pattern is primarily associatedwith habitat loss or degradation, and human persecution for terrestrial mam-mals, and pollution, open net fishing, climate change, and prey depletion formarine mammals. Mammals play a key role in maintaining ecosystems func-tionality and resilience, and therefore information on their distribution is cru-cial to delineate and support conservation actions. MAMMALS INPORTUGAL is a publicly available data set compiling unpublishedgeoreferenced occurrence records of 92 terrestrial, volant, and marine mam-mals in mainland Portugal and archipelagos of the Azores and Madeira thatincludes 105,026 data entries between 1873 and 2021 (72% of the data occur-ring in 2000 and 2021). The methods used to collect the data were: live obser-vations/captures (43%), sign surveys (35%), camera trapping (16%),bioacoustics surveys (4%) and radiotracking, and inquiries that represent lessthan 1% of the records. The data set includes 13 types of records: (1) burrowsjsoil moundsjtunnel, (2) capture, (3) colony, (4) dead animaljhairjskullsjjaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8),observation in shelters, (9) photo trappingjvideo, (10) predators dietjpelletsjpine cones/nuts, (11) scatjtrackjditch, (12) telemetry and (13) vocalizationjecholocation. The spatial uncertainty of most records ranges between 0 and100 m (76%). Rodentia (n=31,573) has the highest number of records followedby Chiroptera (n=18,857), Carnivora (n=18,594), Lagomorpha (n=17,496),Cetartiodactyla (n=11,568) and Eulipotyphla (n=7008). The data setincludes records of species classified by the IUCN as threatened(e.g.,Oryctolagus cuniculus[n=12,159],Monachus monachus[n=1,512],andLynx pardinus[n=197]). We believe that this data set may stimulate thepublication of other European countries data sets that would certainly contrib-ute to ecology and conservation-related research, and therefore assisting onthe development of more accurate and tailored conservation managementstrategies for each species. There are no copyright restrictions; please cite thisdata paper when the data are used in publications.info:eu-repo/semantics/publishedVersio

Mammals in Portugal: a data set of terrestrial, volant, and marine mammal occurrences in Portugal

Mammals are threatened worldwide, with ~26% of all species being included in the IUCN threatened categories. This overall pattern is primarily associated with habitat loss or degradation, and human persecution for terrestrial mammals, and pollution, open net fishing, climate change, and prey depletion for marine mammals. Mammals play a key role in maintaining ecosystems functionality and resilience, and therefore information on their distribution is crucial to delineate and support conservation actions. MAMMALS IN PORTUGAL is a publicly available data set compiling unpublished georeferenced occurrence records of 92 terrestrial, volant, and marine mammals in mainland Portugal and archipelagos of the Azores and Madeira that includes 105,026 data entries between 1873 and 2021 (72% of the data occurring in 2000 and 2021). The methods used to collect the data were: live observations/captures (43%), sign surveys (35%), camera trapping (16%), bioacoustics surveys (4%) and radiotracking, and inquiries that represent less than 1% of the records. The data set includes 13 types of records: (1) burrows | soil mounds | tunnel, (2) capture, (3) colony, (4) dead animal | hair | skulls | jaws, (5) genetic confirmation, (6) inquiries, (7) observation of live animal (8), observation in shelters, (9) photo trapping | video, (10) predators diet | pellets | pine cones/nuts, (11) scat | track | ditch, (12) telemetry and (13) vocalization | echolocation. The spatial uncertainty of most records ranges between 0 and 100 m (76%). Rodentia (n =31,573) has the highest number of records followed by Chiroptera (n = 18,857), Carnivora (n = 18,594), Lagomorpha (n = 17,496), Cetartiodactyla (n = 11,568) and Eulipotyphla (n = 7008). The data set includes records of species classified by the IUCN as threatened (e.g., Oryctolagus cuniculus [n = 12,159], Monachus monachus [n = 1,512], and Lynx pardinus [n = 197]). We believe that this data set may stimulate the publication of other European countries data sets that would certainly contribute to ecology and conservation-related research, and therefore assisting on the development of more accurate and tailored conservation management strategies for each species. There are no copyright restrictions; please cite this data paper when the data are used in publications

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

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

Omeprazole use and risk of chronic kidney disease evolution.

RATIONALE, AIMS AND OBJECTIVES:In recent years, the use of proton pump inhibitors (PPI), especially omeprazole, has been associated with development of chronic kidney disease (CKD). These drugs are widely used worldwide. Although some studies have found an association between the use of PPI and the onset of acute renal failure and CKD. This study aims to analyze the association between the continuous use of omeprazole and the progression of CKD in adult and elderly individuals. METHOD:A retrospective cohort study was conducted with patients followed up at a nephrology clinic in Brazil, in 2016 and 2017. Information about clinical and sociodemographic data, health behaviors, and medication use were collected from all patients diagnosed with CKD through consultation of medical charts and the Brazilian health information system (SIS). The participants were allocated into two groups: users and non-users of omeprazole, and the progression of CKD was then evaluated for each group. In the bivariate analysis, the Mann-Whitney U test to compare the quantitative variables between groups, and the Pearson/Fisher two-tailed chi-square test to compare the categorical variables were applied. Multivariate analysis was performed using Cox regression. RESULTS:A total of 199 CKD patients were attended in the polyclinic, and of these, 42.7% were omeprazole users. There was a higher percentage of CKD progression in users (70.6%) compared to non-users (10.5%). The hazard ratio was 7.34 (CI: 3.94-13.71), indicating a higher risk of progression to worse stages of CKD in omeprazole users than in non-users. As for the other variables, no statistically significant difference was found between groups (p > 0.05). CONCLUSION:An association between omeprazole use and progression of CKD stage was identified, showing a higher risk of disease evolution among omeprazole users