The resignification of medical practices based on contact with the Other - with indigenous and caboclo-riverside residents: An experience report in the Amazon

Introduction:The Amazonas\u27 State University provides Nursing, Medicine, Dentistry, and Pharmacy degrees with the experience of Rural Training in Public Health. Two MD students had high expectations of experiencing health care in the Amazonas interior, as they realized that there was a lapse in their academic training. They questioned the fact that they were about to take the place of "doctors trained by the state of Amazonas" without knowing the population, ethnocultural and geographical variety of the region. This lack encouraged the choice of the location of the internship to be the city of São Gabriel da Cachoeira. Methods:Meetings and lectures were held with health teams that enabled clinical experiences and interactions with indigenous and riverside residents. Finally, seminars/activity reports were produced, which contributed to the awakening of reflections on medical practices. Thus, this experience report is based on the particular apprehension of the reality described, based on daily observation. Results and Discussions: During the internship, the students began to question and deconstruct the doctor-user relationship hierarchy. Conclusions: Thus, they re-signified their practices beyond technical and biological knowledge, in line with the decolonial epistemology

ANÁLISE DO USO DO SLEEVE GÁSTRICO NO TRATAMENTO DA OBESIDADE MÓRBIDA

The present study aims to analyze the effectiveness and safety of Sleeve Gastrectomy as a surgical technique for treating morbid obesity, comparing its outcomes with other bariatric methods and evaluating its impact on patients' quality of life. This research utilized a comprehensive literature review, encompassing studies published between 2000 and 2024 in English, Portuguese, and Spanish. Databases such as PubMed, Google Scholar, SciELO, as well as specialized scientific journals and academic repositories were consulted. The results indicate that Sleeve Gastrectomy is an effective technique for weight loss, showing outcomes comparable to other bariatric surgeries such as Roux-en-Y Gastric Bypass. Literature analysis revealed that Sleeve Gastrectomy provides significant short-term and long-term weight loss with lower incidence of postoperative complications compared to other techniques. Furthermore, patients' quality of life improved considerably after surgery, covering physical, psychological, and social aspects. It is concluded that Sleeve Gastrectomy is a viable and safe surgical option for treating morbid obesity, offering significant advantages in terms of weight loss and patient quality of life. However, further long-term studies are needed to fully compare this technique with other bariatric treatment modalities and assess the maintenance of weight loss and improvement of associated comorbidities.O presente estudo visa analisar a eficácia e a segurança do Sleeve Gástrico como técnica cirúrgica no tratamento da obesidade mórbida, comparando seus resultados com outros métodos bariátricos e avaliando seu impacto na qualidade de vida dos pacientes. Esta pesquisa utilizou uma revisão da literatura abrangente, incluindo estudos publicados entre 2000 e 2024 em inglês, português e espanhol. Foram consultadas bases de dados como PubMed, Google Acadêmico, SciELO, além de revistas científicas especializadas e repositórios acadêmicos. Os resultados indicam que o Sleeve Gástrico é uma técnica eficaz para a perda de peso, apresentando resultados comparáveis a outras cirurgias bariátricas como o Bypass Gástrico em Y de Roux. A análise da literatura revelou que o Sleeve Gástrico proporciona uma perda de peso significativa a curto e longo prazo, com menor incidência de complicações pós-operatórias em comparação com outras técnicas. Além disso, a qualidade de vida dos pacientes melhorou consideravelmente após a cirurgia, abrangendo aspectos físicos, psicológicos e sociais. Conclui-se que o Sleeve Gástrico é uma opção cirúrgica viável e segura para o tratamento da obesidade mórbida, oferecendo vantagens significativas em termos de perda de peso e qualidade de vida dos pacientes. No entanto, é necessário mais estudo de longo prazo para comparar plenamente esta técnica com outras modalidades de tratamento bariátrico e avaliar a manutenção da perda de peso e a melhoria das comorbidades associadas

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

A evolução clínica do paciente portador de abscesso pulmonar: Clinical evolution of patients with lung abscess

Atualmente, com a era da antibioticoterapia e demais meios terapêuticos, o abscesso pulmonar decaiu em termos de morbimortalidade, mas ainda permanece como um desafio em termos diagnósticos e manejo clínico. O abscesso pulmonar corresponde a uma cavidade com pus no pulmão, envolvido por tecido inflamado e geralmente oriunda de uma infecção. O artigo objetivou descrever de modo narrativo a evolução clínica do portador de abscesso pulmonar, ressaltando os principais dados para a compreensão deste fenômeno. Um abscesso pulmonar é causado principalmente por bactérias existentes na boca ou garganta, a qual são aspiradas até os pulmões. A sintomatologia é inespecífica, abordando fadiga, inapetência, sudorese noturna, febre, perda ponderal e tosse com expectoração. O quadro clínico geralmente necessita do complemento de exames de imagem, principalmente a radiografia torácica para diagnóstic

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

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

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