Resistência antimicrobiana em cepas bacterianas isoladas de celulite aviária

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Agronomia e Medicina Veterinária, 2012.A celulite aviária é considerada uma das principais causas de condenação de carcaças de frangos de corte no Brasil e em outros países. O objetivo deste trabalho foi identificar as lesões de celulite de acordo com o Serviço de Inspeção Federal responsável pelo abatedouro frigorífico localizado no Estado de Goiás, realizar o isolamento microbiológico das lesões de celulite aviária, verificar o perfil de resistência antimicrobiana através da realização de antibiograma e promover uma pesquisa de genes de resistência antimicrobiana através da reação em cadeia da polimerase. Foram analisadas 25 amostras de lesões de celulite aviária, das quais foram isoladas 30 cepas bacterianas, sendo 11 (37%) cepas de Escherichia coli, 9 (30%) cepas de Staphylococcus epidermidis, 7 (23%) cepas de Proteus mirabillis e 3 (10%) cepas de Manheimia haemolytica. O teste de susceptibilidade antimicrobiana demonstrou que todas as cepas bacterianas isoladas apresentaram resistência a pelo menos um antimicrobiano, das quais todas (100%) as cepas de E.coli e Proteus mirabillis foram resistentes à penicilina, eritromicina e espiramicina, 8 (88,89%) cepas de Staphyloccocus epidermidis foram resistentes à penicilina e ampicilina. Duas cepas de E. coli (18,19%) e duas de P. mirabillis (14,29%) e uma cepa de S. epidermidis (11,11%) foram resistentes ao cloranfenicol. Foram detectados os genes de resistência antimicrobiana tet(B) em cepas de E. coli, P. mirabilli e S. epidermidis, sendo este o mais encontrado, seguido pelo Sul1 detectado em todas as espécies bacterianas identificadas, tet(A) em cepas de E. coli e S. epidermidis, SHV em cepas de E. coli. P. mirabillis e S. epidermidis, tet(C) em uma cepa de Manheimia haemolytica e cat1 em uma cepa de P. mirabillis. O isolamento de cepas bacterianas com resistência antimicrobiana em lesões de celulite aviária, observados neste estudo tanto no teste de antibiograma como na detecção de genes de resistência, sugerem um possível problema para a saúde pública, devido à capacidade que esses microrganismos apresentam de transmitir genes de resistência antimicrobiana para outros microrganismos presentes na microbiota intestinal de humanos e animais, podendo inviabilizar o uso destas drogas para uso clínico. _________________________________________________________________________________ ABSTRACTThe avian cellulitis is considered a major cause of condemnation of carcasses of broiler chickens in Brazil and other countries. The objective of this study was to identify lesions of cellulitis according to the Federal Inspection Service responsible for the slaughterhouse located in the State of Goiás, perform the microbiological isolation of avian cellulitis lesions, to verify the antimicrobial resistance profile by antibiogram test and promote research of antimicrobial resistance genes by polymerase chain reaction. A total of 25 samples of avian cellulitis lesions were analyzed, from which 30 bacterial strains were isolated. There were eleven (37%) strains of Escherichia coli, nine (30%) strains of Staphylococcus epidermidis, seven (23%) strains of Proteus mirabillis and three (10%) strains of Manheimia haemolytica. The antibiogram test showed that all strains were resistant to at least one antimicrobial. All strains of E.coli and P. mirabilis were resistant to penicillin, erythromycin and spiramycin, eight (88.89%) strains of Staphylococcus epidermidis were resistant to penicillin and ampicillin. Two strains of E. coli (18.19%), two strains of P. mirabilis (14.29%) and one strain of S. epidermidis (11.11%) were resistant to chloramphenicol. We detected genes of antimicrobial resistance as tet(B) in strains of E. coli, S. epidermidis and P. mirabillis, the latter being the most observed gene. Genes of antimicrobial resistance Sul1 were detected in all bacterial species, tet(A) in strains of E. coli and S. epidermidis , SHV in strains of E. coli, S. epidermidis and P. mirabillis, tet(C) in one strain of Manheimia haemolytica and cat1 in one strain of Proteus mirabillis. The results obtained in this work suggest a potential problem for public health, due the ability of this microorganisms to transmit genes of the antimicrobial resistance to other microorganisms presents in the intestinal tract of humans and animals, which may affect the usage of these drugs for clinical-medical treatment

Avaliação da toxicidade de florações naturais e de cultura de cianobactérias: efeitos sobre Ceriodaphnia silvestri (Crustacea, Cladocera)

The incidence of toxic cyanobacterial blooms is one of the important consequences of eutrophication in aquatic ecosystems. It is a very common phenomenon in reservoirs and shrimp ponds in the State of Rio Grande do Norte (RN), Brazil. Cyanobacterias produce toxins which can affect aquatic organisms and men trough the food chain. Aiming to contribute to the studies of cyanobacterias in RN, we propose: a) to evaluate the toxicity of isolated cyanobacterias in important fresh-water environments; and b) to verify the effects of both natural and cultured blooms occurred in reservoirs for human supply and in the cladoceran Ceriodaphnia silvestrii. This study was carried out using samples of natural blooms occurred between March and October of 2004 in Gargalheiras Dam (08º L e 39º W), in July of 2004 in Armando Ribeiro Gonçalves Dam (06o S e 37o W) and in commercial shrimp ponds (Litopenaeus vannamei) located in fresh-water environments. The samples were collected with plankton net (20µm.) for identification, isolation and obtaining of phytoplanktonic biomass for liophilization and later toxicity bioassays. The toxicity of cultured samples and natural blooms was investigated through bioassays in Swiss mice. Quantification of cyanobacteria in samples was conducted following the Ütermol method, with 300mL samples fixed with lugol. The toxicity test with Ceriodaphnia silvestrii followed ABNT, 2001 recommendations, and were accomplished with natural hepatotoxic bloom s samples and cultured samples of both non-toxic and neurotoxic C. raciborskii. In this test, five newborns, aged between 6 and 24 hours, were exposed to different concentrations (0 a 800 mg.L-1) of crude cyanobacterial extracts during 24 and 48 hours. Three replicates were used per treatment. The pH, temperature and dissolved oxygen at the beginning and after 24 and 48hours from the test were measured. We estimated the CL50 through the Trimmed Spearman-Karber method. The blooms were constituted by Microcystis panniformis, M. aeruginosa, Anabaena circinalis, Cylindrospermopsis raciborskii and Planktothrix agardhii, producers of mycrocistin-LR confirmed with HPLC analysis. Samples of hepatotoxic blooms registered toxinogenic potential for C. silvestrii, with CL50-24h value of 47.48 mg.L-1 and CL5048h of 38.15 mg.L-1 for GARG samples in march/2005; CL50-24h of 113,13 mg.L-1 and CL5048h of 88,24 mg.L-1 for ARG July/2004; CL50-24h of 300.39 mg.L-1 and CL50-48h of 149.89 mg.L-1 for GARG October/2005. For cultured samples, values of CL50-24h and CL50-48h for C. raciborskii toxic strains were 228.05 and 120.28 mg.L-1, respectively. There was no mortality of C. silvestrii during the tests with non-toxic C. raciborskii strain. The toxicity test with C. silvestrii presented good sensitivity degree to cyanotoxins. The toxicity of natural hepatotoxic blooms samples (microcystins) and cultured neurotoxic saxitoxins producer samples analyzed in this study give us strong indications of that toxin s influence on the zooplanktonic community structure in tropical aquatic environments. Eleven cyanobacteria strains were isolated, representing 6 species: Anabaenopsis sp., Cylindrospermopsis raciborskii, Chroococcus sp., Microcystis panniformis, Geitlerinema unigranulatum e Planktothrix agardhii. None presented toxicity in Swiss mice. The strains were catalogued and deposited in the Laboratório de Ecologia e Toxicologia de Organismos Aquáticos (LETMA), in UFRN, and will be utilized in ecotoxicológical and ecophysiological studies, aiming to clarify the causes and control of cyanobacterial blooms in aquatic environments in RN. This state s reservoirs must receive broader attention from the authorities, considering the constant blooms occurring in waters used for human consumptionIncidência de florações tóxicas de cianobactérias é uma das conseqüências da eutrofização nos ecossistemas aquáticos, sendo comum a sua ocorrência em reservatórios e viveiros de cultivo de camarão no Estado Rio Grande do Norte. Cianobactérias podem produzir toxinas que podem afetar organismos aquáticos e o homem através da cadeia alimentar. Visando contribuir com o desenvolvimento de estudos ecotoxicológicos de cianobactérias no RN, nos propomos avaliar a toxicidade de cianobactérias isoladas de ambientes de águas doces e verificar o efeito de cultura e florações naturais ocorridas em reservatórios para abastecimento humano, no crustáceo cladócero Ceriodaphnia silvestrii. O estudo foi conduzido com amostras de florações naturais ocorridas em março e outubro de 2004 na Barragem Gargalheiras (08º L e 39º W), em julho de 2004 na Barragem Armando Ribeiro Gonçalves (06o S e 37o W) e em fazendas comerciais de cultivo de camarão (Litopenaeus vannamei), localizadas em ambientes de água doce do RN (6o 58 S e 38o 36 W). As amostras de florações foram coletadas com rede de plâncton (20µm) para identificação, isolamento e obtenção de biomassa fitoplanctônica para liofilização e posterior determinação da toxicidade por bioensaios. A toxicidade das amostras de culturas e florações naturais foi investigada através de bioensaios em camundongos Swiss. A quantificação das cianobactérias foi realizada pelo método de Ütermol, utlizando-se amostras (300mL) fixadas com lugol. O teste de toxicidade com Ceriodaphnia silvestrii seguiu as recomendações da ABNT (2001) e foram realizadas com amostras de florações naturais hepatotóxicas e culturas de C. raciborskii neurotóxica e não tóxica. No teste, cinco neonatos com idade entre 6 e 24 horas foram expostos a diferentes concentrações (0 a 800 mg.L-1) de extrato bruto de cianobactérias durante 24 e 48 horas. Três replicatas por tratamentos foram usadas. Foram medidos o pH, a temperatura e o oxigênio dissolvido no início, com 24 e com 48 horas do teste. Através do método Trimmed Spearman-Karber foi estimado a CL50. As florações eram mistas e compostas por Microcystis panniformis, M. aeruginosa, Anabaena circinalis, Cylindrospermopsis raciborskii e Planktothrix agardhii, produtoras de microcistina- LR, confirmada através de análise por HPLC. Amostras de florações hepatotóxicas registraram potencial toxinogênico para o C. silvestrii, com valores de CL50-24h de 47.48 mg.L-1 e CL50-48h de 38.15 mg.L-1 para a amostra de GARG mar/05; CL50-24h de 113,13 mg.L-1 e CL50-48h de 88,24 mg.L-1 para ARG jul/04; CL50-24h de 300.39 mg.L-1 e CL50-48h de 149.89 mg.L-1 para GARG 10/05. Para as amostras de cultura valores de CL50-24h e CL50-48h para a cepa tóxica de C. raciborskii foram de 228.05 e 120.28 mg.L-1, respectivamente. Não houve mortalidade dos C. silvestrii nos testes com a cepa de C. raciborskii não-tóxica. O teste de toxicidade com C. silvestrii apresentou um bom grau de sensibilidade às cianotoxinas. A toxicidade das amostras de florações naturais hepatotóxicas (microcistinas) e culturas neurotóxicas produtoras de saxitoxinas verificadas neste estudo fornece forte indicativos da influência dessas toxinas sobre a estrutura da comunidade zooplanctônica em ambientes aquáticos tropicais. Foram isoladas 11 cepas de cianobactérias de reservatórios e viveiros do Estado, representadas por 6 espécies: Anabaenopsis sp., Cylindrospermopsis raciborskii, Chroococcus sp., Microcystis panniformis, Geitlerinema unigranulatum e Planktothrix agardhii. Nenhuma cepa apresentou toxicidade em camundongos Swiss. As cepas foram catalogadas e depositadas no Laboratório de Ecologia e Toxicologia de Organismos Aquáticos (LETMA) da UFRN e serão utilizadas em estudos ecotoxicológicos e ecofisiológicos visando esclarecer as causas e controle de florações de cianobactérias nos ambientes aquáticos do Estado. Os reservatórios do Rio Grande do Norte devem merecer maior atenção perante os órgãos responsáveis, tendo em vista os constantes florescimentos tóxicos de cianobactérias em águas utilizadas para consumo human

Antimicrobial resistance of bacterial strains isolated from avian cellulitis

Avian cellulitis is an inflammatory process in the subcutaneous tissue, mainly located in the abdomen and thighs. This problem is commonly observed in poultry at slaughter and it is considered one of the major causes of condemnation of carcasses in Brazil. The aim of this study was to perform the microbial isolation of lesions of avian cellulitis from a processing plant located in the State of Goiás in order to analyze antimicrobial resistance by antibiogram test and to detect resistance genes by polymerase chain reaction. A total of 25 samples of avian cellulitis lesions were analyzed, from which 30 bacterial strains were isolated. There were eleven (44%) strains of Escherichia coli, nine (36%) strains of Staphylococcus epidermidis, seven (28%) strains of Proteus mirabilis and three (12%) strains of Manheimiahaemolytica. The antibiogram test showed that all strains were resistant to at least one antimicrobial. The gene of antimicrobial resistance tetB was detected in E. coli, S. epidermidis and P. mirabilis strains, and was the most frequently observed gene. The gene of antimicrobial resistance Sul1 was detected in all bacterial species, while tetA was found in E. coli and S. epidermidis strains, SHV in E. coli strains, S. epidermidis and P. mirabilis,and cat1 in one P. mirabilis strain. The results suggest a potential public health hazard due to the ability of these microorganisms to transmit antimicrobial resistancegenes to other microorganisms present in the intestinal tract of humans and animals, which may affect clinical-medical usage of these drugs

Breast reconstruction in young women and their peculiarities

INTRODUCTION: To evaluate the main features and methods used in breast reconstruction in young women considering their unique characteristics. METHODS: A retrospective records review of patients who underwent mastectomy followed by breast reconstruction between January 2008 and December 2015 was conducted, selecting those reconstructions that were performed in women younger than 40 years. RESULTS: Forty-three patients were selected. The average age was 33.86 years. Many had some comorbidities, the most common being overweight and anxiety/depressive disorder. Fourteen patients had a family history of the disease. Most were diagnosed with invasive ductal carcinoma. Additional cancer treatments were administered in most cases. All patients underwent a full mastectomy in the breast with cancer, and in 16, there was the option of contralateral risk-reducing mastectomy. Of the 43 reconstructions, 36 were immediate and 7 were delayed, and 17 involved use of implants, 13 involved use of tissue expanders, 4 involved the TRAM, and 9 involved the GD. We observed 15 complications; the most severe were infection with reconstruction loss in one patient and areola necrosis in another. CONCLUSIONS: Young women undergoing breast reconstruction represent a population subgroup with its own characteristics. The tumors and personal and social patterns differ, and based on this long list of variables, treatment options are diverse. In our series, breast implants and tissue expanders were often most used

Encapsulation into Stealth Liposomes Enhances the Antitumor Action of Recombinant Cratylia mollis Lectin Expressed in Escherichia coli

This study evaluated the in vivo antitumor potential of new recombinant lectin from seeds of Cratylia mollis (rCramoll) expressed in Escherichia coli, free or encapsulated in stealth liposomes, using mice transplanted with sarcoma 180. rCramoll-loaded stealth liposomes (rCramoll-lipo) were formulated by hydration of the lipid film followed by cycles of freezing and thawing, and about 60% of rCramoll was encapsulated. This novel preparation showed particle size, polydispersity index, and pH suitable for the evaluation of antitumor activity in vivo. Tumor growth inhibition rates were 68% for rCramoll and 80% for rCramoll-lipo. Histopathological analysis of the experimental groups showed that both free and encapsulated lectin caused no changes in the kidneys of animals. Hematological analysis revealed that treatment with rCramoll-lipo significantly increased leukocyte concentration when compared with the untreated and pCramoll group. In conclusion, the encapsulation of rCramoll in stealth liposomes improves its antitumor activity without substantial toxicity; this approach was more successful than the previous results reported for pCramoll loaded into conventional liposomes. At this point, a crucial difference between the antitumor action of free and encapsulated rCramoll was found along with their effects on immune cells. Further investigations are required to elucidate the mechanism(s) of the antitumor effect induced by rCramoll

Comparison between surgical sutures and Prineo® in terms of esthetic result and scar formation

INTRODUCTION: Wound healing is a well-organized, directed process of tissue repair. The process can be expedited using topical glues and adhesives, which offer a non-invasive, easily removable alternative to suturing. Furthermore, such products have good tensile strength and involve lower application time. In particular, the Prineo® adhesive is applied to a polyester mesh that covers the wound. METHOD: We carried out a retrospective, cross-sectional study, with subsequent statistical analysis , involving 101 surgical procedures in which wound closure was performed using either nylon sutures or Prineo®. All the procedures were performed between 2012 and 2014. RESULTS: Six patients had contact dermatitis after Prineo® was used, with statistical significance (p = 0.042). Furthermore, Prineo® decreased the rate of scar enlargement (p < 0.05) . There was no statistical difference between the Prineo® and suture groups in terms of scar quality (p = 0.068); in both groups, the scar result was mostly excellent (87 %) to good (27%). CONCLUSION: Patients whose wounds were closed using Prineo® a system involving octyl-2-cyanoacrylate and an associated polyester mesh displayed lower rates of scar enlargement, which depended on whether the thickness of the dermis was satisfactory. However, the same patients had higher rates of contact dermatitis than those whose wounds were closed using surgical sutures. Both groups showed excellent to good scar quality, with no significant difference in terms of esthetic scar results

Assessment of immediate symmetrization in breast reconstruction

INTRODUCTION: The surgical treatment of breast cancer frequently results in mutilation. Breast reconstruction in mastectomized women aims to create a new esthetically acceptable breast symmetrical to the contralateral breast. The objective of this study was to assess the feasibility of symmetrization of the contralateral breast simultaneously with breast reconstruction, discuss possible complications, and perform a brief review of the literature. METHODS: A retrospective study was conducted in the Department of Plastic Surgery of Hospital Daher from October 2013 to February 2015. Breast reconstruction outcomes immediately after mastectomy for breast cancer were assessed, and all patients undergoing symmetrization of the contralateral breast in the same surgical stage using the same surgical technique were selected for inclusion and statistical analysis. RESULTS: The study comprised 42 patients within the established criteria, totaling 21 reconstructions with simultaneous symmetrization (Group 1) and 21 symmetrization procedures in two stages (Group 2). The mean age was 53.86 years in Group 1 and 52.62 years in the control group. The groups were comparable in all variables. Data regarding postoperative complications were analyzed. Some of the studied patients did not complete all stages of reconstruction. The group that underwent immediate symmetrization attained more symmetry. The patients aged 45 years and with lower body mass index attained more symmetry in Group 1. CONCLUSION: The implementation of symmetrization procedures at the same stage of unilateral breast reconstruction is associated with low complication rates and revision surgeries. In selected cases, immediate symmetrization may be preferable to the procedure in another surgical stage

CIRURGIA BARIÁTRICA PARA TRATAMENTO DE DIABETES TIPO 2

Introduction: most adult patients with diabetes are overweight or obese, resulting in the connotation of 'diabesity'. Bariatric surgeries have been shown to be the most efficient treatment for obesity and T2DM. Given the above, the study aims to group the most recent studies and directly and scientifically clarify the relationship between bariatric surgery for the treatment of type 2 diabetes mellitus. Materials and methods: this is an integrative literature review, in which the terms “bariatric surgery”, “treatment” and “type 2 diabetes” were searched, combined with Boolean operators. Articles published between 2020 and 2022 were delimited. Result and discussion: Lipid and glucose profiles were substantially improved after Roux-en-Y gastric bypass, including decrease in total cholesterol, LDL, triglycerides, insulin resistance and increase in HDL. However, it demonstrates that biliopancreatic diversion without duodenal switch appears to be the most effective surgery to achieve long-term remission of diabetes in patients with obesity and T2DM. Conclusion: according to the studies that were analyzed, there was an improvement in glycemic levels after bariatric surgery, especially in young patients. There is still a need for more specific studies to clarify which bariatric surgery technique benefits the patient the most, since current articles do not reach a consensus. &nbsp;Introducción: La mayoría de los pacientes adultos con diabetes tienen sobrepeso u obesidad, lo que genera la connotación de 'diabesidad'. Se ha demostrado que las cirugías bariátricas son el tratamiento más eficaz para la obesidad y la DM2. Dado lo anterior, el estudio tiene como objetivo agrupar los estudios más recientes y esclarecer de manera directa y científica la relación entre la cirugía bariátrica para el tratamiento de la diabetes mellitus tipo 2. Materiales y métodos: se trata de una revisión integrativa de la literatura, en la que los términos “cirugía bariátrica ”, “tratamiento” y “diabetes tipo 2”, combinados con operadores booleanos. Se delimitaron los artículos publicados entre 2020 y 2022. Resultado y discusión: Los perfiles de lípidos y glucosa mejoraron sustancialmente después del bypass gástrico en Y de Roux, incluida la disminución del colesterol total, LDL, triglicéridos, resistencia a la insulina y aumento de HDL. Sin embargo, demuestra que la derivación biliopancreática sin cruce duodenal parece ser la cirugía más efectiva para lograr la remisión a largo plazo de la diabetes en pacientes con obesidad y DM2. Conclusión: según los estudios analizados, hubo una mejoría en los niveles glucémicos después de la cirugía bariátrica, especialmente en pacientes jóvenes. Aún se necesitan estudios más específicos para aclarar qué técnica de cirugía bariátrica beneficia más al paciente, ya que los artículos actuales no alcanzan un consenso.Introdução: a maioria dos pacientes adultos com diabetes estão com sobrepeso ou obesidade, resultando na conotação de 'diabesidade'. Cirurgias bariátricas têm se mostrado o tratamento mais eficiente para obesidade e DM2. Diante do exposto, o estudo tem como objetivo agrupar os estudos mais recentes e esclarecer de forma direta e científica a relação entre a cirurgia bariátrica para o tratamento de diabetes mellitus tipo 2. Materiais e métodos: trata-se de uma revisão integrativa de literatura, em que foram pesquisados os termos “bariatric surgery”, “treatment” e “type 2 diabetes”, combinados entre si por operadores booleanos. Foram delimitados artigos publicados entre 2020 e 2022.&nbsp; Resultado e discussão: os perfis lipídicos e de glicose foram substancialmente melhorados após bypass gástrico em Y de Roux, incluindo diminuição do colesterol total, LDL, triglicerídeos, resistência à insulina e aumento do HDL. Porém, demonstra que a derivação biliopancreática sem switch duodenal parece ser a cirurgia mais eficaz para alcançar a remissão do diabetes a longo prazo em pacientes com obesidade e DM2. Conclusão: de acordo com os estudos que foram analisados, houve melhora dos níveis glicêmicos após realização de cirurgia bariátrica, principalmente em pacientes jovens. Há ainda a necessidade de estudos mais específicos para esclarecer qual técnica de cirurgia bariátrica beneficia mais o paciente, visto que os artigos atuais não entram em um consenso.Introdução: a maioria dos pacientes adultos com diabetes estão com sobrepeso ou obesidade, resultando na conotação de 'diabesidade'. Cirurgias bariátricas têm se mostrado o tratamento mais eficiente para obesidade e DM2. Diante do exposto, o estudo tem como objetivo agrupar os estudos mais recentes e esclarecer de forma direta e científica a relação entre a cirurgia bariátrica para o tratamento de diabetes mellitus tipo 2. Materiais e métodos: trata-se de uma revisão integrativa de literatura, em que foram pesquisados os termos “bariatric surgery”, “treatment” e “type 2 diabetes”, combinados entre si por operadores booleanos. Foram delimitados artigos publicados entre 2020 e 2022.  Resultado e discussão: os perfis lipídicos e de glicose foram substancialmente melhorados após bypass gástrico em Y de Roux, incluindo diminuição do colesterol total, LDL, triglicerídeos, resistência à insulina e aumento do HDL. Porém, demonstra que a derivação biliopancreática sem switch duodenal parece ser a cirurgia mais eficaz para alcançar a remissão do diabetes a longo prazo em pacientes com obesidade e DM2. Conclusão: de acordo com os estudos que foram analisados, houve melhora dos níveis glicêmicos após realização de cirurgia bariátrica, principalmente em pacientes jovens. Há ainda a necessidade de estudos mais específicos para esclarecer qual técnica de cirurgia bariátrica beneficia mais o paciente, visto que os artigos atuais não entram em um consenso

CIRURGIA BARIÁTRICA PARA TRATAMENTO DE DIABETES TIPO 2

Introduction: most adult patients with diabetes are overweight or obese, resulting in the connotation of 'diabesity'. Bariatric surgeries have been shown to be the most efficient treatment for obesity and T2DM. Given the above, the study aims to group the most recent studies and directly and scientifically clarify the relationship between bariatric surgery for the treatment of type 2 diabetes mellitus. Materials and methods: this is an integrative literature review, in which the terms “bariatric surgery”, “treatment” and “type 2 diabetes” were searched, combined with Boolean operators. Articles published between 2020 and 2022 were delimited. Result and discussion: Lipid and glucose profiles were substantially improved after Roux-en-Y gastric bypass, including decrease in total cholesterol, LDL, triglycerides, insulin resistance and increase in HDL. However, it demonstrates that biliopancreatic diversion without duodenal switch appears to be the most effective surgery to achieve long-term remission of diabetes in patients with obesity and T2DM. Conclusion: according to the studies that were analyzed, there was an improvement in glycemic levels after bariatric surgery, especially in young patients. There is still a need for more specific studies to clarify which bariatric surgery technique benefits the patient the most, since current articles do not reach a consensus. &nbsp;Introducción: La mayoría de los pacientes adultos con diabetes tienen sobrepeso u obesidad, lo que genera la connotación de 'diabesidad'. Se ha demostrado que las cirugías bariátricas son el tratamiento más eficaz para la obesidad y la DM2. Dado lo anterior, el estudio tiene como objetivo agrupar los estudios más recientes y esclarecer de manera directa y científica la relación entre la cirugía bariátrica para el tratamiento de la diabetes mellitus tipo 2. Materiales y métodos: se trata de una revisión integrativa de la literatura, en la que los términos “cirugía bariátrica ”, “tratamiento” y “diabetes tipo 2”, combinados con operadores booleanos. Se delimitaron los artículos publicados entre 2020 y 2022. Resultado y discusión: Los perfiles de lípidos y glucosa mejoraron sustancialmente después del bypass gástrico en Y de Roux, incluida la disminución del colesterol total, LDL, triglicéridos, resistencia a la insulina y aumento de HDL. Sin embargo, demuestra que la derivación biliopancreática sin cruce duodenal parece ser la cirugía más efectiva para lograr la remisión a largo plazo de la diabetes en pacientes con obesidad y DM2. Conclusión: según los estudios analizados, hubo una mejoría en los niveles glucémicos después de la cirugía bariátrica, especialmente en pacientes jóvenes. Aún se necesitan estudios más específicos para aclarar qué técnica de cirugía bariátrica beneficia más al paciente, ya que los artículos actuales no alcanzan un consenso.Introdução: a maioria dos pacientes adultos com diabetes estão com sobrepeso ou obesidade, resultando na conotação de 'diabesidade'. Cirurgias bariátricas têm se mostrado o tratamento mais eficiente para obesidade e DM2. Diante do exposto, o estudo tem como objetivo agrupar os estudos mais recentes e esclarecer de forma direta e científica a relação entre a cirurgia bariátrica para o tratamento de diabetes mellitus tipo 2. Materiais e métodos: trata-se de uma revisão integrativa de literatura, em que foram pesquisados os termos “bariatric surgery”, “treatment” e “type 2 diabetes”, combinados entre si por operadores booleanos. Foram delimitados artigos publicados entre 2020 e 2022.&nbsp; Resultado e discussão: os perfis lipídicos e de glicose foram substancialmente melhorados após bypass gástrico em Y de Roux, incluindo diminuição do colesterol total, LDL, triglicerídeos, resistência à insulina e aumento do HDL. Porém, demonstra que a derivação biliopancreática sem switch duodenal parece ser a cirurgia mais eficaz para alcançar a remissão do diabetes a longo prazo em pacientes com obesidade e DM2. Conclusão: de acordo com os estudos que foram analisados, houve melhora dos níveis glicêmicos após realização de cirurgia bariátrica, principalmente em pacientes jovens. Há ainda a necessidade de estudos mais específicos para esclarecer qual técnica de cirurgia bariátrica beneficia mais o paciente, visto que os artigos atuais não entram em um consenso.Introdução: a maioria dos pacientes adultos com diabetes estão com sobrepeso ou obesidade, resultando na conotação de 'diabesidade'. Cirurgias bariátricas têm se mostrado o tratamento mais eficiente para obesidade e DM2. Diante do exposto, o estudo tem como objetivo agrupar os estudos mais recentes e esclarecer de forma direta e científica a relação entre a cirurgia bariátrica para o tratamento de diabetes mellitus tipo 2. Materiais e métodos: trata-se de uma revisão integrativa de literatura, em que foram pesquisados os termos “bariatric surgery”, “treatment” e “type 2 diabetes”, combinados entre si por operadores booleanos. Foram delimitados artigos publicados entre 2020 e 2022.  Resultado e discussão: os perfis lipídicos e de glicose foram substancialmente melhorados após bypass gástrico em Y de Roux, incluindo diminuição do colesterol total, LDL, triglicerídeos, resistência à insulina e aumento do HDL. Porém, demonstra que a derivação biliopancreática sem switch duodenal parece ser a cirurgia mais eficaz para alcançar a remissão do diabetes a longo prazo em pacientes com obesidade e DM2. Conclusão: de acordo com os estudos que foram analisados, houve melhora dos níveis glicêmicos após realização de cirurgia bariátrica, principalmente em pacientes jovens. Há ainda a necessidade de estudos mais específicos para esclarecer qual técnica de cirurgia bariátrica beneficia mais o paciente, visto que os artigos atuais não entram em um consenso

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