Traumatisms, in general, result in high costs for health systems worldwide. They consist of the leading cause of death in young adults, primarily males. Traumatic brain injury (TBI) represents good part of this spending, reaching globally significant mortality rate, around 1.5 million victims a year. Only in the United States (US) attendances related to traumatic brain injuries in emergency departments revolve around 1.35 million annually, plus about 275,000 hospitalizations and 52,000 deaths. In Brazil, only in 2012 was spent over one billion dollars with hospitalizations related to external causes, including TBI. Mild TBI (Glasgow Coma Scale (GCS) 14-15) occur in about 80% of the total demand, moderate (GCS 9-13) in 10% and serious (GCS 3-8) in 10 %. Regarding mortality rate, this is relatively low compared to the total number, since much of fatal outcomes fits in the moderate to severe groups. One of lesions a valuable prognostic factor related to the TBI is the subdural hematoma (SDH), responsible for complications in up to 45% of cases of TBI, expressing mortality between 60-80% depending on the implemented workup and may even reach 90% when in delay of appropriate treatment. The acute subdural hematoma (ASDH) thus represents a neurosurgical emergency, taking most of these patients to be subjected to urgent evacuation of the hematoma by craniotomy, which also is not without risks, with several reports in literature of new contralateral hematoma formation after craniotomy for evacuation of hematoma, further aggravating the patient's prognosis. For best results of the TBI is needed better understanding of the pathophysiology, identification of newer parameters of brain function and development of innovative therapeutic modalities. According to the Centers for Disease Control and Prevention (CDC), under the Department of Health and Human Services, population data on TBI are fundamental for understanding its impact on the society and know the profile of patients and the mechanisms trauma, to assist in the formulation of prevention strategies and in setting priorities for research and support services to patients living with traumatic brain injury.
The overarching biological impact of microbiomes on their hosts, and more generally their environment, reflects the co-evolution of a mutualistic symbiosis, generating fitness for both. Knowledge of microbiomes, their systemic role, interactions, and impact grows exponentially. When a research field of importance for planetary health evolves so rapidly, it is essential to consider it from an ethical holistic perspective. However, to date, the topic of microbiome ethics has received relatively little attention considering its importance. Here, ethical analysis of microbiome research, innovation, use, and potential impact is structured around the four cornerstone principles of ethics: Do Good; Don’t Harm; Respect; Act Justly. This simple, but not simplistic approach allows ethical issues to be communicative and operational. The essence of the paper is captured in a set of eleven microbiome ethics recommendations, e.g., proposing gut microbiome status as common global heritage, similar to the internationally agreed status of major food crops.
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