Desafios Contemporâneos na Gestão de Doenças Cardiovasculares: uma perspectiva de Saúde Coletiva

Objective: The aim of this article is to analyze and present a comprehensive understanding of contemporary challenges in the management of cardiovascular diseases, with a special emphasis on the perspective of public health. Seeking to identify and discuss factors contributing to the complexity of managing these diseases, considering epidemiological, social, and technological nuances.Methodology: This involves a comprehensive literature review of scientific literature across databases such as PubMed, Scielo, Latindex, and Medline. Health Science Descriptors (DeCS) were utilized, including “Cardiology,” “Public Health,” and “Health-Disease Process.” No restrictions were applied regarding time and metrology. Results: Exploration of how the public health approach can provide valuable insights and innovative strategies to address these challenges. The integration of care, the application of health technologies, and the promotion of equity are crucial elements to be addressed in light of the collective perspective, aiming to provide a holistic and effective view in managing these conditions. Conclusion: In summary, an in-depth analysis of contemporary challenges in the management of cardiovascular diseases was provided, highlighting the crucial perspective of public health. By exploring epidemiological, social, and technological factors, we identified the complexity involved in managing these conditions. The collective approach, integrating care, technology, and promoting equity, emerges as a fundamental strategy to address these challenges and promote a more effective and comprehensive management of cardiovascular diseases.Objetivo: O objetivo deste artigo é analisar e apresentar uma compreensão aprofundada dos desafios contemporâneos na gestão de doenças cardiovasculares, com uma ênfase especial na perspectiva de saúde coletiva. Buscando identificar e discutir os fatores que contribuem para a complexidade da gestão dessas doenças, considerando as nuances epidemiológicas, sociais e tecnológicas. Metodologia: Trata-se de uma revisão bibliográfica abrangente da literatura científica em bases de dados como PubMed, Scielo, Latindex e Medline. Com a utilização dos DeCs (descritores de saúde): “Cardiology”; “Public Health”; Health-Disease Process”. Sem restrições de tempo e de metrologia. Resultados: Exploração de como a abordagem de saúde coletiva pode oferecer insights valiosos e estratégias inovadoras para enfrentar esses desafios. A integração de cuidados, a aplicação de tecnologias em saúde e a promoção da equidade são elementos cruciais que serão abordados à luz da perspectiva coletiva, visando proporcionar uma visão holística e eficaz na gestão dessas condições. Conclusão: Em suma, proporcionou-se uma análise aprofundada dos desafios contemporâneos na gestão de doenças cardiovasculares, destacando a perspectiva crucial da saúde coletiva. Ao explorar fatores epidemiológicos, sociais e tecnológicos, identificamos a complexidade envolvida na gestão dessas condições. A abordagem coletiva, integrando cuidados, tecnologia e promovendo a equidade, emerge como uma estratégia fundamental para enfrentar esses desafios e promover uma gestão mais eficaz e abrangente das doenças cardiovasculares

Erisipela: Explorando a Contaminação e a Incidência de Lesões Causadas por Infecção Bacteriana

Introduction: Erysipelas is a pathological condition resulting from skin infection, often triggered by the bacteria Streptococcus pyogenes. The disease can be triggered by several factors, including vulnerability in the skin barrier, poor blood circulation, immunological compromise and lymphatic disorders, thus highlighting the importance of a holistic approach in preventing this skin infection. Objective: To understand the contamination of erysipelas and the incidence of lesions caused by bacterial infection. Methodology: The Pubmed, Cochrane and MedLine databases were used, searching for articles published between 2015 and 2023, in Portuguese or English. Conclusion: Immediate and adequate medical follow-up is essential for better treatment and recovery from erysipelas, which despite not being a contagious disease, can promote skin complications from the emergence of a new infectious agent.Introdução: A erisipela é uma condição patológica resultante da infecção cutânea, frequentemente desencadeada pela bactéria Streptococcus pyogenes. A doença pode ser desencadeada por diversos fatores, dentre eles a vulnerabilidade na barreira cutânea, má circulação sanguínea, comprometimento imunológico e distúrbios linfáticos, sublinhando assim, a importância de uma abordagem holística na prevenção dessa infecção cutânea. Objetivo: Compreender a contaminação da erisipela e a incidência de lesões causadas por infecção bacteriana. Metodologia: Foram utilizadas as bases de dados Pubmed, Cochrane e MedLine, buscando artigos publicados entre os anos 2015 a 2023, nos idiomas Português ou Inglês. Conclusão: O acompanhamento médico imediato e adequado é essencial para o melhor direcionamento de tratamento e recuperação da erisipela, que apesar de não ser uma doença contagiosa, pode promover complicações cutâneas a partir do surgimento de um novo agente infeccioso

Transtorno Bipolar: uma abordagem integrativa entre neurobiologia, terapias e psicoterapia

Introduction: Bipolar disorder is characterized by a variation in episodes and moods, which can range from a feeling of euphoria to a depressive state. Symptoms of this disorder may include difficulty sleeping, lack of energy or motivation, as well as a loss of meaning in reality. These signs may vary according to the crisis present at the time and the condition the individual is in. Objective: Understand bipolar disorder and the factors that may be associated with this disease. Methodology: A systematic literature review was carried out covering the years from January 2003 to December 2023. The study was based and guided by the question mentioned throughout the article. Conclusion: In summary, the integrated approach combining mood stabilizing medications and psychotherapy is crucial to effectively managing Bipolar Disorder, providing support and promoting a better understanding of the condition for a more stable quality of life.Introdução: O transtorno bipolar se caracteriza pela variação de  episódios e quadros de humor, que podem ir da sensação de euforia até o estado depressivo. Os sintomas desse distúrbio podem incluir dificuldade para dormir, falta de energia ou motivação, além da perda de sentido com a realidade. Esses sinais podem variar de acordo com a crise presente no momento e com o quadro que o indivíduo se encontra. Objetivo: Compreender o transtorno da bipolaridade e os fatores que podem ser associados a essa doença. Metodologia: Foi realizada uma revisão sistemática de literatura abrangendo os anos de janeiro de 2003 a dezembro de 2023. O estudo teve como base e norteamento a pergunta citada no decorrer do artigo. Conclusão: Em resumo, a abordagem integrada que combina medicamentos estabilizadores de humor e psicoterapia é crucial para gerenciar eficazmente o Transtorno Bipolar, proporcionando suporte e promovendo uma melhor compreensão da condição para uma qualidade de vida mais estável

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

Geography and ecology shape the phylogenetic composition of Amazonian tree communities

Aim: Amazonia hosts more tree species from numerous evolutionary lineages, both young and ancient, than any other biogeographic region. Previous studies have shown that tree lineages colonized multiple edaphic environments and dispersed widely across Amazonia, leading to a hypothesis, which we test, that lineages should not be strongly associated with either geographic regions or edaphic forest types. Location: Amazonia. Taxon: Angiosperms (Magnoliids; Monocots; Eudicots). Methods: Data for the abundance of 5082 tree species in 1989 plots were combined with a mega-phylogeny. We applied evolutionary ordination to assess how phylogenetic composition varies across Amazonia. We used variation partitioning and Moran\u27s eigenvector maps (MEM) to test and quantify the separate and joint contributions of spatial and environmental variables to explain the phylogenetic composition of plots. We tested the indicator value of lineages for geographic regions and edaphic forest types and mapped associations onto the phylogeny. Results: In the terra firme and várzea forest types, the phylogenetic composition varies by geographic region, but the igapó and white-sand forest types retain a unique evolutionary signature regardless of region. Overall, we find that soil chemistry, climate and topography explain 24% of the variation in phylogenetic composition, with 79% of that variation being spatially structured (R$^{2}$ = 19% overall for combined spatial/environmental effects). The phylogenetic composition also shows substantial spatial patterns not related to the environmental variables we quantified (R$^{2}$ = 28%). A greater number of lineages were significant indicators of geographic regions than forest types. Main Conclusion: Numerous tree lineages, including some ancient ones (>66 Ma), show strong associations with geographic regions and edaphic forest types of Amazonia. This shows that specialization in specific edaphic environments has played a long-standing role in the evolutionary assembly of Amazonian forests. Furthermore, many lineages, even those that have dispersed across Amazonia, dominate within a specific region, likely because of phylogenetically conserved niches for environmental conditions that are prevalent within regions

Geographic patterns of tree dispersal modes in Amazonia and their ecological correlates

Aim: To investigate the geographic patterns and ecological correlates in the geographic distribution of the most common tree dispersal modes in Amazonia (endozoochory, synzoochory, anemochory and hydrochory). We examined if the proportional abundance of these dispersal modes could be explained by the availability of dispersal agents (disperser-availability hypothesis) and/or the availability of resources for constructing zoochorous fruits (resource-availability hypothesis). Time period: Tree-inventory plots established between 1934 and 2019. Major taxa studied: Trees with a diameter at breast height (DBH) ≥ 9.55 cm. Location: Amazonia, here defined as the lowland rain forests of the Amazon River basin and the Guiana Shield. Methods: We assigned dispersal modes to a total of 5433 species and morphospecies within 1877 tree-inventory plots across terra-firme, seasonally flooded, and permanently flooded forests. We investigated geographic patterns in the proportional abundance of dispersal modes. We performed an abundance-weighted mean pairwise distance (MPD) test and fit generalized linear models (GLMs) to explain the geographic distribution of dispersal modes. Results: Anemochory was significantly, positively associated with mean annual wind speed, and hydrochory was significantly higher in flooded forests. Dispersal modes did not consistently show significant associations with the availability of resources for constructing zoochorous fruits. A lower dissimilarity in dispersal modes, resulting from a higher dominance of endozoochory, occurred in terra-firme forests (excluding podzols) compared to flooded forests. Main conclusions: The disperser-availability hypothesis was well supported for abiotic dispersal modes (anemochory and hydrochory). The availability of resources for constructing zoochorous fruits seems an unlikely explanation for the distribution of dispersal modes in Amazonia. The association between frugivores and the proportional abundance of zoochory requires further research, as tree recruitment not only depends on dispersal vectors but also on conditions that favour or limit seedling recruitment across forest types

Mapping density, diversity and species-richness of the Amazon tree flora

Using 2.046 botanically-inventoried tree plots across the largest tropical forest on Earth, we mapped tree species-diversity and tree species-richness at 0.1-degree resolution, and investigated drivers for diversity and richness. Using only location, stratified by forest type, as predictor, our spatial model, to the best of our knowledge, provides the most accurate map of tree diversity in Amazonia to date, explaining approximately 70% of the tree diversity and species-richness. Large soil-forest combinations determine a significant percentage of the variation in tree species-richness and tree alpha-diversity in Amazonian forest-plots. We suggest that the size and fragmentation of these systems drive their large-scale diversity patterns and hence local diversity. A model not using location but cumulative water deficit, tree density, and temperature seasonality explains 47% of the tree species-richness in the terra-firme forest in Amazonia. Over large areas across Amazonia, residuals of this relationship are small and poorly spatially structured, suggesting that much of the residual variation may be local. The Guyana Shield area has consistently negative residuals, showing that this area has lower tree species-richness than expected by our models. We provide extensive plot meta-data, including tree density, tree alpha-diversity and tree species-richness results and gridded maps at 0.1-degree resolution

Panoramic snapshot of serum soluble mediator interplay in pregnant women with convalescent COVID-19: an exploratory study

IntroductionSARS-CoV-2 infection during pregnancy can induce changes in the maternal immune response, with effects on pregnancy outcome and offspring. This is a cross-sectional observational study designed to characterize the immunological status of pregnant women with convalescent COVID-19 at distinct pregnancy trimesters. The study focused on providing a clear snapshot of the interplay among serum soluble mediators.MethodsA sample of 141 pregnant women from all prenatal periods (1st, 2nd and 3rd trimesters) comprised patients with convalescent SARS-CoV-2 infection at 3-20 weeks after symptoms onset (COVID, n=89) and a control group of pre-pandemic non-infected pregnant women (HC, n=52). Chemokine, pro-inflammatory/regulatory cytokine and growth factor levels were quantified by a high-throughput microbeads array.ResultsIn the HC group, most serum soluble mediators progressively decreased towards the 2nd and 3rd trimesters of pregnancy, while higher chemokine, cytokine and growth factor levels were observed in the COVID patient group. Serum soluble mediator signatures and heatmap analysis pointed out that the major increase observed in the COVID group related to pro-inflammatory cytokines (IL-6, TNF-α, IL-12, IFN-γ and IL-17). A larger set of biomarkers displayed an increased COVID/HC ratio towards the 2nd (3x increase) and the 3rd (3x to 15x increase) trimesters. Integrative network analysis demonstrated that HC pregnancy evolves with decreasing connectivity between pairs of serum soluble mediators towards the 3rd trimester. Although the COVID group exhibited a similar profile, the number of connections was remarkably lower throughout the pregnancy. Meanwhile, IL-1Ra, IL-10 and GM-CSF presented a preserved number of correlations (≥5 strong correlations in HC and COVID), IL-17, FGF-basic and VEGF lost connectivity throughout the pregnancy. IL-6 and CXCL8 were included in a set of acquired attributes, named COVID-selective (≥5 strong correlations in COVID and <5 in HC) observed at the 3rd pregnancy trimester.Discussion and conclusionFrom an overall perspective, a pronounced increase in serum levels of soluble mediators with decreased network interplay between them demonstrated an imbalanced immune response in convalescent COVID-19 infection during pregnancy that may contribute to the management of, or indeed recovery from, late complications in the post-symptomatic phase of the SARS-CoV-2 infection in pregnant women

Consistent patterns of common species across tropical tree communities

Trees structure the Earth’s most biodiverse ecosystem, tropical forests. The vast number of tree species presents a formidable challenge to understanding these forests, including their response to environmental change, as very little is known about most tropical tree species. A focus on the common species may circumvent this challenge. Here we investigate abundance patterns of common tree species using inventory data on 1,003,805 trees with trunk diameters of at least 10 cm across 1,568 locations1,2,3,4,5,6 in closed-canopy, structurally intact old-growth tropical forests in Africa, Amazonia and Southeast Asia. We estimate that 2.2%, 2.2% and 2.3% of species comprise 50% of the tropical trees in these regions, respectively. Extrapolating across all closed-canopy tropical forests, we estimate that just 1,053 species comprise half of Earth’s 800 billion tropical trees with trunk diameters of at least 10 cm. Despite differing biogeographic, climatic and anthropogenic histories7, we find notably consistent patterns of common species and species abundance distributions across the continents. This suggests that fundamental mechanisms of tree community assembly may apply to all tropical forests. Resampling analyses show that the most common species are likely to belong to a manageable list of known species, enabling targeted efforts to understand their ecology. Although they do not detract from the importance of rare species, our results open new opportunities to understand the world’s most diverse forests, including modelling their response to environmental change, by focusing on the common species that constitute the majority of their trees.Publisher PDFPeer reviewe