Hipotireoidismo e suas Implicações no Período Gestacional: uma Revisão de Literatura

Hypothyroidism during pregnancy is a serious health concern, increasing the risk of complications such as miscarriage and neurointellectual disability in offspring. Careful regulation of thyroid hormones is crucial for optimal fetal development. This article is an integrative review that seeks to clarify thyroid disorders in pregnancy and their treatment options. 175 articles from the PubMed database were analyzed, limited to human studies published in English between 2018 and 2023. Eleven articles were selected for analysis. Fetal consumption of maternal thyroid hormone and physiological changes during pregnancy demand an increase in maternal secretion of this hormone. Iodine deficiency can cause thyroid dysfunction, resulting in serious complications in pregnancy and child development. Diagnosing hypothyroidism is challenging, especially in pregnant women. Serum TSH is used as an initial test, and levothyroxine therapy is recommended to prevent complications. Hypothyroidism in pregnancy requires careful regulation of thyroid hormones. Diagnostic complexity highlights the need to consider physiological and ethnic variations. Treatment recommendations vary between organizations, highlighting the need for consensus. Close monitoring and adjustments in therapy are essential, but challenges remain, highlighting the need for more research into treatment limits and the potential benefit of combination therapy to improve long- term quality of life. Keywords: Pregnancy, Hypothyroidism, Thyroid Gland Disease.El hipotiroidismo durante el embarazo es un problema de salud grave que aumenta el riesgo de complicaciones como aborto espontáneo y discapacidad neurointelectual en la descendencia. La regulación cuidadosa de las hormonas tiroideas es crucial para el desarrollo fetal óptimo. Este artículo es una revisión integradora que busca esclarecer los trastornos tiroideos en el embarazo y sus opciones de tratamiento. Se analizaron 175 artículos de la base de datos PubMed, limitados a estudios en humanos publicados en inglés entre 2018 y 2023. Se seleccionaron once artículos para el análisis. El consumo fetal de hormona tiroidea materna y los cambios fisiológicos durante el embarazo exigen un aumento en la secreción materna de esta hormona. La deficiencia de yodo puede causar disfunción tiroidea, lo que resulta en complicaciones graves en el embarazo y el desarrollo infantil. Diagnosticar el hipotiroidismo es un desafío, especialmente en mujeres embarazadas. La TSH sérica se utiliza como prueba inicial y se recomienda el tratamiento con levotiroxina para prevenir complicaciones. El hipotiroidismo durante el embarazo requiere una regulación cuidadosa de las hormonas tiroideas. La complejidad diagnóstica resalta la necesidad de considerar variaciones fisiológicas y étnicas. Las recomendaciones de tratamiento varían entre organizaciones, lo que destaca la necesidad de consenso. La monitorización estrecha y los ajustes en la terapia son esenciales, pero persisten desafíos, lo que destaca la necesidad de realizar más investigaciones sobre los límites del tratamiento y el beneficio potencial de la terapia combinada para mejorar la calidad de vida a largo plazo. Palabras clave: Embarazo, Hipotiroidismo, Enfermedad de la Glándula Tiroides.O hipotireoidismo durante a gravidez pode ocasionar sérios problemas à saúde, aumentando o risco de complicações como aborto espontâneo e deficiência neurointelectual na descendência. A regulação cuidadosa dos hormônios tireoidianos é crucial para o desenvolvimento fetal ideal. Este artigo é uma revisão integrativa que busca esclarecer distúrbios tireoidianos na gravidez e suas opções de tratamento. Foram analisados 175 artigos da base PubMed, limitados a estudos em humanos publicados em inglês entre 2018 e 2023. Onze artigos foram selecionados para a análise. O consumo fetal de hormônio tireoidiano materno e alterações fisiológicas na gravidez demandam um aumento na secreção materna desse hormônio. A deficiência de iodo pode causar disfunção tireoidiana, resultando em complicações graves na gravidez e no desenvolvimento infantil. O diagnóstico do hipotireoidismo é desafiador, especialmente em mulheres grávidas. O TSH sérico é usado como teste inicial, e a terapia com levotiroxina é recomendada para prevenir complicações. O hipotireoidismo na gravidez requer regulação cuidadosa dos hormônios tireoidianos. A complexidade diagnóstica destaca a necessidade de considerar variações fisiológicas e étnicas. Recomendações de tratamento variam entre organizações, destacando a necessidade de consenso. O monitoramento rigoroso e ajustes na terapia são essenciais, mas persistem desafios, evidenciando a necessidade de mais pesquisas sobre limites de tratamento e o potencial benefício da terapia combinada para melhorar a qualidade de vida a longo prazo. Palavras-chave: Gravidez, Hipotireoidismo, Doenças da Glândula Tireoide

Lesão Pulmonar Associada Ao Uso De Cigarros Eletrônicos: Revisão De Literatura

E-cigarettes, a widely used emerging product, are facing growing popularity despite little research into their health risks. Electronic Cigarette Use Associated Lung Injury, or EVALI, has become a prominent concern in recent research, expanding the need to understand the health effects of vaping, given the diversity of technologies and liquids involved. An integrative review was carried out to analyze the relationship between electronic cigarettes and lung injuries, using the PubMed database. 664 articles were selected, with inclusion criteria based on human studies published between 2018 and 2023. The analysis, exclusion and selection process was carefully conducted by the authors. Electronic cigarettes, consisting of a battery, atomizer and liquid, stand out due to the uncertainty about their health effects, in contrast to traditional cigarettes. EVALI, predominantly associated with the vaporization of THC products, reveals serious symptoms and significant risks. The complex composition of e-liquids, especially when exposed to high temperatures, generates harmful substances, including carbonyl compounds, suspected of causing oxidative stress and inflammation in the airways. The integrative review highlights the lack of consensus on the safety of electronic cigarettes and the urgency in understanding the associated risks. EVALI, as a diagnosis of exclusion, highlights the need for immediate investigation in the event of respiratory symptoms. Treatment and monitoring of EVALI patients requires a careful approach, considering clinical and risk factors. Public education about potential dangers and cessation strategies becomes crucial, especially among young people.Los cigarrillos electrónicos, un producto emergente ampliamente utilizado, se enfrentan a una creciente popularidad a pesar de la poca investigación sobre sus riesgos para la salud. La lesión pulmonar asociada al uso de cigarrillos electrónicos, o EVALI, se ha convertido en una preocupación destacada en investigaciones recientes, ampliando la necesidad de comprender los efectos del vapeo en la salud, dada la diversidad de tecnologías y líquidos involucrados. Se realizó una revisión integradora para analizar la relación entre los cigarrillos electrónicos y las lesiones pulmonares, utilizando la base de datos PubMed. Se seleccionaron 664 artículos, con criterios de inclusión basados ​​en estudios en humanos publicados entre 2018 y 2023. El proceso de análisis, exclusión y selección fue cuidadosamente realizado por los autores. Los cigarrillos electrónicos, compuestos por batería, atomizador y líquido, destacan por la incertidumbre sobre sus efectos sobre la salud, a diferencia de los cigarrillos tradicionales. EVALI, predominantemente asociado con la vaporización de productos de THC, revela síntomas graves y riesgos importantes. La compleja composición de los e-líquidos, especialmente cuando se exponen a altas temperaturas, genera sustancias nocivas, incluidos compuestos carbonílicos, sospechosos de causar estrés oxidativo e inflamación en las vías respiratorias. La revisión integradora destaca la falta de consenso sobre la seguridad de los cigarrillos electrónicos y la urgencia de comprender los riesgos asociados. EVALI, como diagnóstico de exclusión, destaca la necesidad de investigación inmediata en caso de síntomas respiratorios. El tratamiento y seguimiento de los pacientes con EVALI requiere un enfoque cuidadoso, considerando los factores clínicos y de riesgo. La educación pública sobre los peligros potenciales y las estrategias para dejar de fumar se vuelve crucial, especialmente entre los jóvenes.Os cigarros eletrônicos, produto emergente amplamente utilizado, enfrentam crescente popularidade apesar da escassa investigação sobre seus riscos à saúde. A Lesão Pulmonar Associada ao Uso de Cigarro Eletrônico, ou EVALI, tornou-se uma preocupação destacada nas pesquisas recentes, ampliando a necessidade de compreender os efeitos da vaporização na saúde, dada a diversidade de tecnologias e líquidos envolvidos. Realizou-se uma revisão integrativa para analisar a relação entre cigarros eletrônicos e lesões pulmonares, utilizando a base de dados PubMed. Foram selecionados 664 artigos, com critérios de inclusão baseados em estudos humanos publicados entre 2018 e 2023. O processo de análise, exclusão e seleção foi conduzido de forma criteriosa pelos autores. Os cigarros eletrônicos, compostos por bateria, atomizador e líquido, destacam-se pela incerteza sobre seus efeitos à saúde, em contraste com os tradicionais. A EVALI, predominantemente associada à vaporização de produtos com THC, revela sintomas graves e riscos significativos. A composição complexa dos e-líquidos, especialmente quando expostos a altas temperaturas, gera substâncias nocivas, incluindo compostos carbonílicos, suspeitos de causar estresse oxidativo e inflamação nas vias aéreas. A revisão integrativa destaca a falta de consenso sobre a segurança dos cigarros eletrônicos e a urgência em compreender os riscos associados. A EVALI, como diagnóstico de exclusão, destaca a necessidade de investigação imediata diante de sintomas respiratórios. O tratamento e o acompanhamento de pacientes EVALI requerem abordagem cuidadosa, considerando fatores clínicos e de risco. A educação pública sobre os perigos potenciais e estratégias de cessação torna-se crucial, especialmente entre os jovens

Manejo Terapêutico do Paciente com Gangrena de Fournier: Revisão de Literatura

This Fournier syndrome, known as Fournier Gangrene, is a serious polymicrobialinfection that mainly affects the perineum and genital region. The research, anintegrative review between 2020 and 2024, resulted in the analysis of 41 articles, ofwhich 6 were selected. The incidence is higher in men, with an increase after the age of50. The results point to several sources of technology, highlighting skin, urological andgastrointestinal. The pathophysiology involves endarteritis obliterans, ischemia andthrombosis, leading to necrosis. The progression of the disease is divided into fourphases, with the third phase characterized by general signs and severe infectioussyndrome, which can lead to septic shock. Treatment includes broad-spectrumantibiotics, surgical debridement and, in severe cases, superficial scrotal debridement.Hyperbaric oxygen therapy is considered an adjuvant, periodic at the request ofmicroorganisms and stimulating healing. It concludes by highlighting the urgency ofearly diagnosis and multidisciplinary treatment, given the rapid progression of necrosisand high rates of morbidity and mortality associated with Fournier syndrome. Theresearch contributes to clinical understanding and highlights the importance ofimproving knowledge for a correct diagnosis and improving treatment conditions.A síndrome de Fournier, conhecida como Gangrena de Fournier, é uma infecçãopolimicrobiana grave que afeta principalmente a região do períneo e genital. Apesquisa, uma revisão integrativa entre 2020 e 2024, resultou na análise de 41 artigos,dos quais foram selecionados 6. A incidência é maior em homens, com aumento apósos 50 anos. Os resultados apontam diversas fontes de infecção, destacando pele,urológicas e gastrointestinais. A fisiopatologia envolve endarterite obliterante,isquemia e trombose, levando à necrose. A progressão da doença é dividida em quatrofases, com a terceira fase caracterizada por sinais gerais e síndrome infecciosa grave,podendo levar ao choque séptico. O tratamento abrange antibióticos de amploespectro, desbridamentos cirúrgicos e, em casos graves, reconstrução escrotal. Aoxigenioterapia hiperbárica é considerada adjuvante, reduzindo a proliferação demicro-organismos e estimulando a cicatrização. Conclui-se ressaltando a urgência dodiagnóstico precoce e tratamento multidisciplinar, dado o rápido avanço da necrose ealtas taxas de morbimortalidade associadas à síndrome de Fournier. A pesquisacontribui para a compreensão clínica e destaca a importância de aprimorar oconhecimento para um diagnóstico correto e melhorar as condições de tratamento

Manejo Terapêutico do Paciente Queimado: Revisão de Literatura

Burns are traumatic wounds resulting from thermal, chemical, electrical or radioactive agents that compromise vital skin functions. In Brazil, they constitute one of the main external causes of death, alongside transport accidents and homicides. An integrative review was carried out, using the Google Scholar database with the following descriptors “Burn”, “Pain Management”, “Therapeutic Indication”. In which 8 articles were selected from 1,710, published in English and Portuguese from 2019 to 2024. The main author conducted the analysis, with disagreements resolved between the authors. WHO estimates indicate 300,000 annual deaths from burns globally. In Brazil, one million people suffer burns annually, with young adults being the most vulnerable, mainly in domestic or work environments. The classification of burns, extent of the affected area and treatment are fundamental for the best therapeutic management, given that pain is a prevalent complaint that is difficult to control in these patients. Protocols vary, and wound care, hydration, and pain management are challenges. Different therapies, including agents such as silver sulfadiazine and essential fatty acids, show promising results. Surgical treatment aims to remove compromised tissues, contributing to effective healing. The study reinforces the importance of medical knowledge in the management of burns and its relevance to public health.As queimaduras são feridas traumáticas resultantes de agentes térmicos, químicos, elétricos ou radioativos que comprometem funções vitais tanto da pele, como dos demais órgãos internos. No Brasil, constituem uma das principais causas externas de morte, disputando com acidentes de transporte e homicídios. Realizou-se uma revisão integrativa, utilizando a base de dados Google Acadêmico com os seguintes descritores “Queimadura”, “Manejo da Dor”, “Indicação Terapêutica”. Nos quais foram selecionados 8 artigos entre 1.710, publicados em inglês e português de 2019 a 2024. O autor principal conduziu a análise, com discordâncias resolvidas entre os autores. Estimativas da OMS indicam 300 mil mortes anuais por queimaduras globalmente. No Brasil, um milhão de pessoas anualmente sofrem queimaduras, sendo adultos jovens mais vulneráveis, principalmente em ambientes domésticos ou laborais. A classificação das queimaduras, extensão da área afetada e o tratamento são fundamentais para o melhor manejo terapêutico, haja vista que a dor é uma queixa prevalente e de difícil controle nesses pacientes. Protocolos variam, e o cuidado da ferida, hidratação e manejo da dor são desafios. Diferentes terapias, incluindo agentes como sulfadiazina de prata e ácidos graxos essenciais, apresentam resultados promissores. O tratamento cirúrgico visa a remoção de tecidos comprometidos, contribuindo para a cicatrização eficaz. O estudo reforça a importância do conhecimento médico na abordagem de queimaduras e sua relevância para a saúde pública

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

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

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data