Cardiomiopatia diabética e insuficiência cardíaca em pacientes com diabetes mellitus: revisão de literatura / Diabetic cardiomyopathy and heart failure in patients with diabetes mellitus: literature review

Com a tendência do aumento da expectativa de vida, principalmente em países desenvolvidos, ampliou-se também a prevalência de doenças crônicas na população mundial. Dessa maneira, existe uma predisposição a um aumento de indivíduos portadores de diabetes mellitus (DM) e, consequentemente, suas complicações. Dentre estas, evidencia-se a disfunção cardíaca que possui prevalência de 35% nos diabéticos do tipo 2 e 14,5% no tipo 1, sendo a insuficiência cardíaca (IC) uma apresentação inicial frequente, sobretudo a IC com fração de ejeção preservada, a qual tem íntima relação com a resistência insulínica. A cardiomiopatia diabética (CD) acomete indivíduos com tipo 1 e 2 de DM e as manifestações clínicas da doença decorrem-se devido às alterações glicêmicas de longa data que o paciente comumente apresenta; podendo causar um consequente remodelamento cardíaco, principalmente do ventrículo esquerdo. Em relação ao tratamento, terapias farmacológicas e não farmacológicas são imprescindíveis para o controle DM e prevenção de suas complicações. O tratamento não farmacológico do DM é baseado em dieta e exercícios. Já a terapia farmacológica é direcionada às vias neuro-humorais e metabólicas. O conhecimento acerca dos mecanismos do desenvolvimento da CD ainda são incertos, sendo propostas na literatura várias hipóteses sobre o assunto. Ressalta-se que mais estudos são necessários para entender os mecanismos fisiopatológicos responsáveis pelo desenvolvimento da CD e para que novas abordagens preventivas e terapêuticas sejam estabelecidas

A social and ecological assessment of tropical land uses at multiple scales: the Sustainable Amazon Network

Science has a critical role to play in guiding more sustainable development trajectories. Here, we present the Sustainable Amazon Network (Rede Amazonia Sustentavel, RAS): a multidisciplinary research initiative involving more than 30 partner organizations working to assess both social and ecological dimensions of land-use sustainability in eastern Brazilian Amazonia. The research approach adopted by RAS offers three advantages for addressing land-use sustainability problems: (i) the collection of synchronized and co-located ecological and socioeconomic data across broad gradients of past and present human use; (ii) a nested sampling design to aid comparison of ecological and socioeconomic conditions associated with different land uses across local, landscape and regional scales; and (iii) a strong engagement with a wide variety of actors and non-research institutions. Here, we elaborate on these key features, and identify the ways in which RAS can help in highlighting those problems in most urgent need of attention, and in guiding improvements in land-use sustainability in Amazonia and elsewhere in the tropics. We also discuss some of the practical lessons, limitations and realities faced during the development of the RAS initiative so far.Keywords: Social–ecological systems, Tropical forests, Land use, Interdisciplinary research, Sustainability, Trade-off

A social and ecological assessment of tropical land uses at multiple scales:the Sustainable Amazon Network

Science has a critical role to play in guiding more sustainable development trajectories. Here, we present the Sustainable Amazon Network (Rede Amazonia Sustentavel, RAS): a multidisciplinary research initiative involving more than 30 partner organizations working to assess both social and ecological dimensions of land-use sustainability in eastern Brazilian Amazonia. The research approach adopted by RAS offers three advantages for addressing land-use sustainability problems: (i) the collection of synchronized and co-located ecological and socioeconomic data across broad gradients of past and present human use; (ii) a nested sampling design to aid comparison of ecological and socioeconomic conditions associated with different land uses across local, landscape and regional scales; and (iii) a strong engagement with a wide variety of actors and non-research institutions. Here, we elaborate on these key features, and identify the ways in which RAS can help in highlighting those problems in most urgent need of attention, and in guiding improvements in land-use sustainability in Amazonia and elsewhere in the tropics. We also discuss some of the practical lessons, limitations and realities faced during the development of the RAS initiative so far