Estimativa de impacto da amamentação sobre a mortalidade infantil

OBJECTIVE: Infant mortality in the state of São Paulo has decreased in the last years and it seems to be leveling off at a limit beyond which further reductions are challenging. Early neonatal causes account for 50% of these deaths and the remaining are mostly due to pneumonia and diarrhea. This study is to assess the impact of breastfeeding over death reduction. METHODS: Fourteen municipalities of greater São Paulo were studied. Data on breastfeeding was collected through surveys conducted on national immunization campaign days and mortality data was taken from 1999 and 2000 official records. Drawing from literature parameters on risk for death from respiratory infection and diarrhea in non-breastfed infants, fractions of mortality preventable by breastfeeding were calculated. These figures applied to the number of recorded deaths allowed assessing the impact of breastfeeding over mortality for each municipality. RESULTS: Fractions of respiratory infection mortality preventable by breastfeeding varied according to locality and age group between 33% and 72%. As to diarrhea, variation was between 35% and 86%. The impact of breastfeeding over infant mortality was an average reduction of 9.3% with values raging from 3.6% to 13%, depending on the locality considered. CONCLUSIONS: Breastfeeding in the first year of life might be the most feasible strategy to further reduce the current levels of infant mortality in the state of São Paulo.OBJETIVO: A mortalidade infantil no Estado de São Paulo tem mostrado uma redução progressiva nos últimos anos. Atualmente, atinge níveis para além dos quais uma maior redução parece desafiadora. Causas neonatais precoces correspondem a 50% desses óbitos. Entre os óbitos não neonatais precoces, destacam-se a pneumonia e a diarréia como as principais causas. O objetivo da pesquisa é estudar o impacto da amamentação na redução dos óbitos. MÉTODOS: Foram estudados 14 municípios da Grande São Paulo, onde coletaram-se informações relativas à amamentação por entrevistas, em uma amostra por conglomerados em dias nacionais de vacinação (Projeto Amamentação e Municípios). Também foram consultadas informações sobre mortalidade infantil, recolhidas de fontes oficiais, dos anos de 1999 e 2000. Com base em parâmetros da literatura sobre o risco de óbito por infecção respiratória e diarréia para crianças não amamentadas, calculou-se a fração de mortalidade evitável por cada doença. Os valores, aplicados ao número de óbitos registrados em cada município, permitiram o cálculo do impacto da amamentação sobre o Coeficiente de Mortalidade Infantil (CMI). RESULTADOS: A fração de mortalidade evitável por infecção respiratória variou, segundo o município e a faixa etária, entre 33% e 72%. Para diarréia, a variação ficou entre 35% e 86%. A estimativa média de impacto foi de 9,3% no CMI, com variações, segundo o município, entre 3,6% e 13%. CONCLUSÕES: A amamentação no primeiro ano de vida pode ser a estratégia mais exeqüível de redução da mortalidade pós-neonatal para além dos níveis já alcançados em municípios do Estado de São Paulo

Implicações do uso empírico de antimicrobianos frente a resistência de uropatógenos encontrados em um hospital militar do Rio de Janeiro

A resistência bacteriana é um grave problema de saúde pública mundial, atingindo diferentes esferas da sociedade, aumentando os custos hospitalares e reduzindo as chances de cura do paciente, uma vez que os antimicrobianos deixam de ser eficazes no tratamento de infecções causadas por tais bactérias. Com o passar dos anos, os uropatógenos, agentes causadores de infecções do trato urinário, apresentaram taxas cada vez mais elevadas de resistência, fazendo com que seja cada vez mais necessário determinar o perfil de susceptibilidade de tais microrganismos. A partir disso, o presente estudo teve como objetivo verificar o perfil de resistência a antimicrobianos dos principais uropatógenos encontrados em um hospital militar do Rio de Janeiro. Para a elaboração deste estudo, foram obedecidos todos os princípios éticos, sendo aprovado pelo Comitê de Ética em Pesquisa do Hospital Universitário Pedro Ernesto, da Universidade do Estado do Rio de Janeiro, onde foram utilizados 825 laudos de uroculturas positivas, coletadas entre março de 2018 e março de 2020. Dentre os principais uropatógenos identificados, a Escherichia coli obteve destaque, totalizando 72,9% dos casos, seguida de Klebsiella pneumoniae (13%), Proteus mirabilis (5,7%) e Acinetobacter baumannii (2,09%). Tais bactérias também podem ser causadoras da chamada bacteriúria assintomática, cujo tratamento é empírico e baseado em antibióticos de amplo espectro. Ao analisar o perfil de susceptibilidade destes microrganismos, foi possível identificar uma tendência de crescimento de cepas resistentes às fluoroquinolonas e carbapenêmicos. O desenvolvimento de protocolos para o uso racional de antimicrobianos pode ser um avanço para o manejo clínico baseado em evidências

ANESTESIA PERIDURAL PARA CIRURGIA ORTOPÉDICA DE QUADRIL EM IDOSOS

Epidural anesthesia is a technique that involves administering local anesthetic close to the spinal cord to block the sensation of pain in a specific region of the body. In orthopedic hip surgeries in the elderly, it is often chosen due to its effective analgesic effect and lower overall impact on the body compared to general anesthesia. However, the decision on the type of anesthesia should be made based on individual medical assessment. Epidural anesthesia works by temporarily blocking pain signals transmitted by nerves in the spinal cord region. A local anesthetic is injected into the epidural space, which is located outside the membrane surrounding the spinal cord. This impedes the conduction of nerve impulses, resulting in numbness and reduced pain sensation in the specific area of ​​the body where the anesthesia is administered. It is a common option for surgeries and procedures involving lower areas of the body, such as orthopedic hip surgery. The objective of this study is to understand the action of epidural anesthesia in this type of procedure. The results of epidural anesthesia generally include the absence of pain in the affected region during the surgical procedure. Furthermore, as epidural anesthesia allows for greater preservation of respiratory function and other autonomic reflexes compared to general anesthesia, it may contribute to faster postoperative recovery.A anestesia peridural é uma técnica que envolve a administração de anestésico local próximo à medula espinhal para bloquear a sensação de dor em uma determinada região do corpo. Em cirurgias ortopédicas de quadril em idosos, ela é frequentemente escolhida devido ao seu efeito analgésico eficaz e menor impacto geral no organismo em comparação com a anestesia geral. No entanto, a decisão sobre o tipo de anestesia deve ser feita com base na avaliação médica individual.A anestesia peridural age bloqueando temporariamente os sinais de dor transmitidos pelos nervos na região da medula espinhal. Um anestésico local é injetado no espaço peridural, que está localizado fora da membrana que envolve a medula espinhal. Isso impede a condução dos impulsos nervosos, resultando em dormência e redução da sensação de dor na área específica do corpo onde a anestesia é administrada. É uma opção comum para cirurgias e procedimentos que envolvem áreas inferiores do corpo, como cirurgias ortopédicas de quadril. O objetivo deste estudo é compreender a ação da anestesia peridural nesse tipo de procedimento. Os resultados da anestesia peridural geralmente incluem a ausência de dor na região afetada durante o procedimento cirúrgico. Além disso, como a anestesia peridural permite maior preservação da função respiratória e outros reflexos autonômicos em comparação com a anestesia geral, pode contribuir para uma recuperação mais rápida pós-operatória

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

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

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

Geography and ecology shape the phylogenetic composition of Amazonian tree communities

AimAmazonia 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.LocationAmazonia.TaxonAngiosperms (Magnoliids; Monocots; Eudicots).MethodsData 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's 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.ResultsIn 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 (R2 = 19% overall for combined spatial/environmental effects). The phylogenetic composition also shows substantial spatial patterns not related to the environmental variables we quantified (R2 = 28%). A greater number of lineages were significant indicators of geographic regions than forest types.Main ConclusionNumerous 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

The biogeography of the Amazonian tree flora

We describe the geographical variation in tree species composition across Amazonian forests and show how environmental conditions are associated with species turnover. Our analyses are based on 2023 forest inventory plots (1 ha) that provide abundance data for a total of 5188 tree species. Withinplot species composition reflected both local environmental conditions (especially soil nutrients and hydrology) and geographical regions. A broader-scale view of species turnover was obtained by interpolating the relative tree species abundances over Amazonia into 47,441 0.1-degree grid cells. Two main dimensions of spatial change in tree species composition were identified. The first was a gradient between western Amazonia at the Andean forelands (with young geology and relatively nutrient-rich soils) and central–eastern Amazonia associated with the Guiana and Brazilian Shields (with more ancient geology and poor soils). The second gradient was between the wet forests of the northwest and the drier forests in southern Amazonia. Isolines linking cells of similar composition crossed major Amazonian rivers, suggesting that tree species distributions are not limited by rivers. Even though some areas of relatively sharp species turnover were identified, mostly the tree species composition changed gradually over large extents, which does not support delimiting clear discrete biogeographic regions within Amazonia