Acute Myocardial Infarction Risk in Patients with Coronary Artery Disease Doubled after Upper Gastrointestinal Tract Bleeding: A Nationwide Nested Case-Control Study

Prior studies of upper gastrointestinal bleeding (UGIB) and acute myocardial infarction (AMI) are small, and long-term effects of UGIB on AMI have not been delineated. We investigated whether UGIB in patients diagnosed with coronary artery disease (CAD) increased their risk of subsequent AMI. This was a population-based, nested case-control study using Taiwan’s National Health Insurance Research Database. After propensity-score matching for age, gender, comorbidities, CAD date, and follow-up duration, we identified 1,677 new-onset CAD patients with AMI (AMI^[+]) between 2001 and 2006 as the case group and 10,062 new-onset CAD patients without (AMI^[−]) as the control group. Conditional logistic regression was used to examine the association between UGIB and AMI. Compared with UGIB^[−] patients, UGIB^[+] patients had twice the risk for subsequent AMI (adjusted odds ratio [AOR] = 2.08; 95% confidence interval [CI], 1.72–2.50). In the subgroup analysis for gender and age, UGIB^[+] women (AOR = 2.70; 95% CI, 2.03–3.57) and patients < 65 years old (AOR = 2.23; 95% CI, 1.56–3.18) had higher odds of an AMI. UGIB^[+] AMI^[+] patients used nonsignificantly less aspirin than did UGIB^[−] AMI^[+] patients (27.69% vs. 35.61%, respectively). UGIB increased the risk of subsequent AMI in CAD patients, especially in women and patients < 65. This suggests that physicians need to use earlier and more aggressive intervention to detect UGIB and prevent AMI in CAD patients.     

Developing a Social Autopsy Tool for Dengue Mortality: A Pilot Study

BackgroundDengue fever is a public health problem in the tropical and sub-tropical world. Dengue cases have grown dramatically in recent years as well as dengue mortality. Colombia has experienced periodic dengue outbreaks with numerous dengue related-deaths, where the Santander department has been particularly affected. Although social determinants of health (SDH) shape health outcomes, including mortality, it is not yet understood how these affect dengue mortality. The aim of this pilot study was to develop and pre-test a social autopsy (SA) tool for dengue mortality.ConclusionsThe SA tool is based on the scientific literature, a validated conceptual framework, researchers’ and health professionals’ expertise, and a pilot study. It is the first time that a SA tool has been created for the dengue mortality context. Our work furthers the study on SDH and how these are applied to neglected tropical diseases, like dengue. This tool could be integrated in surveillance systems to provide complementary information on the modifiable and avoidable death-related factors and therefore, be able to formulate interventions for dengue mortality reduction.     

Widespread Environmental Contamination with Mycobacterium tuberculosis Complex Revealed by a Molecular Detection Protocol

Environmental contamination with Mycobacterium tuberculosis complex (MTC) has been considered crucial for bovine tuberculosis persistence in multi-host-pathogen systems. However, MTC contamination has been difficult to detect due to methodological issues. In an attempt to overcome this limitation we developed an improved protocol for the detection of MTC DNA. MTC DNA concentration was estimated by the Most Probable Number (MPN) method. Making use of this protocol we showed that MTC contamination is widespread in different types of environmental samples from the Iberian Peninsula, which supports indirect transmission as a contributing mechanism for the maintenance of bovine tuberculosis in this multi-host-pathogen system. The proportion of MTC DNA positive samples was higher in the bovine tuberculosis-infected than in presumed negative area (0.32 and 0.18, respectively). Detection varied with the type of environmental sample and was more frequent in sediment from dams and less frequent in water also from dams (0.22 and 0.05, respectively). The proportion of MTC-positive samples was significantly higher in spring (p<0.001), but MTC DNA concentration per sample was higher in autumn and lower in summer. The average MTC DNA concentration in positive samples was 0.82 MPN/g (CI₉₅ 0.70–0.98 MPN/g). We were further able to amplify a DNA sequence specific of Mycobacterium bovis/caprae in 4 environmental samples from the bTB-infected area.     

Assessment of Wall Elasticity Variations on Intraluminal Haemodynamics in Descending Aortic Dissections Using a Lumped-Parameter Model

Descending aortic dissection (DAD) is associated with high morbidity and mortality rates. Aortic wall stiffness is a variable often altered in DAD patients and potentially involved in long-term outcome. However, its relevance is still mostly unknown. To gain more detailed knowledge of how wall elasticity (compliance) might influence intraluminal haemodynamics in DAD, a lumped-parameter model was developed based on experimental data from a pulsatile hydraulic circuit and validated for 8 clinical scenarios. Next, the variations of intraluminal pressures and flows were assessed as a function of wall elasticity. In comparison with the most rigid-wall case, an increase in elasticity to physiological values was associated with a decrease in systolic and increase in diastolic pressures of up to 33% and 63% respectively, with a subsequent decrease in the pressure wave amplitude of up to 86%. Moreover, it was related to an increase in multidirectional intraluminal flows and transition of behaviour as 2 parallel vessels towards a vessel with a side-chamber. The model supports the extremely important role of wall elasticity as determinant of intraluminal pressures and flow patterns for DAD, and thus, the relevance of considering it during clinical assessment and computational modelling of the disease.     

Carbon Sequestration of Caesalpinia platyloba S. Watt (Leguminosae) (Lott 1985) in the Tropical Deciduous Forest

Caesalpinia platyloba was evaluated as an alternative for the retention of atmospheric carbon and as a feasible and viable economic activity in terms of income for tropical deciduous forest (TDF) peasants in the carbon markets. A total of 110 trees of C. platyloba from plantations and a TDF in the Northwest of Mexico were sampled. Growth (increase in height, diameter, and volume curves) was adjusted to assess their growth. Growth of individuals (height, diameter at breast height [DBH], age, and tree crown cover) was recorded. The Schumacher model (H = β₀e^β₁•E-1), by means of the guided curve method, was used to adjust growth models. Information analysis was made through the non-linear procedure with the multivariate secant or false position (DUD) method using the SAS software. Growth and increase models revealed acceptable adjustments (pseudo R²>0.8). C. platyloba reaches >8m of height with 12cm in diameter and 550cm³ of volume, presenting the highest increase at 11 years considered as basal age. Highest significant density of wood was in good quality sites (0.80g•cm^-3), with a carbon content (average of 99.15tC•ha^-1) at the highest density of 2500 trees•ha^-1 (without thinning). Average incomes of US$483.33tC•ha^-1 are expected. The profitability values (NPW = US$81,646.65, IRR = 472%, and B/C = 0.82) for C. platyloba make its cultivation a viable and profitable activity, considering a management scheme of the income derived from wood selling and from carbon credits.     

Does Environmental Instability Favor the Production and Horizontal Transmission of Knowledge regarding Medicinal Plants? A Study in Southeast Brazil

Greater socio-environmental instability favors the individual production of knowledge because innovations are adapted to new circumstances. Furthermore, instability stimulates the horizontal transmission of knowledge because this mechanism disseminates adapted information. This study investigates the following hypothesis: Greater socio-environmental instability favors the production of knowledge (innovation) to adapt to new situations, and socio-environmental instability stimulates the horizontal transmission of knowledge, which is a mechanism that diffuses adapted information. In addition, the present study describes “how”, “when”, “from whom” and the “stimulus/context”, in which knowledge regarding medicinal plants is gained or transferred. Data were collected through semi-structured interviews from three groups that represented different levels of socio-environmental instability. Socio-environmental instability did not favor individual knowledge production or any cultural transmission modes, including vertical to horizontal, despite increasing the frequency of horizontal pathways. Vertical transmission was the most important knowledge transmission strategy in all of the groups in which mothers were the most common models (knowledge sources). Significantly, childhood was the most important learning stage, although learning also occurred throughout life. Direct teaching using language was notable as a knowledge transmission strategy. Illness was the main stimulus that triggered local learning. Learning modes about medicinal plants were influenced by the knowledge itself, particularly the dynamic uses of therapeutic resources.     

Shading and Watering as a Tool to Mitigate the Impacts of Climate Change in Sea Turtle Nests

Increasing sand temperatures resulting from climate change may negatively impact sea turtle nests by altering sex ratios and decreasing reproductive output. We analyzed the effect of nest shading and watering on sand temperatures as climate mitigation strategies in a beach hatchery at Playa Grande, Costa Rica. We set up plots and placed thermocouples at depths of 45cm and 75cm. Half of the plots were shaded and half were exposed to the sun. Within these exposure treatments, we applied three watering treatments over one month, replicating local climatic conditions experienced in this area. We also examined gravimetric water content of sand by collecting sand samples the day before watering began, the day after watering was complete, and one month after completion. Shading had the largest impact on sand temperature, followed by watering and depth. All watering treatments lowered sand temperature, but the effect varied with depth. Temperatures in plots that received water returned to control levels within 10 days after watering stopped. Water content increased at both depths in the two highest water treatments, and 30 days after the end of water application remained higher than plots with low water. While the impacts of watering on sand temperature dissipate rapidly after the end of application, the impacts on water content are much more lasting. Although less effective at lowering sand temperatures than shading, watering may benefit sea turtle clutches by offsetting negative impacts of low levels of rain in particularly dry areas. Prior to implementing such strategies, the natural conditions at the location of interest (e.g. clutch depth, environmental conditions, and beach characteristics) and natural hatchling sex ratios should be taken into consideration. These results provide insight into the effectiveness of nest shading and watering as climate mitigation techniques and illustrate important points of consideration in the crafting of such strategies.