RESUMO
INTRODUCTION: Limited information exists on the prevalence and outcomes of patients undergoing surgical aortic valve replacement (SAVR) for aortic stenosis (AS) with reduced left ventricular ejection fraction (LVEF). This study aims to describe the number of AS patients undergoing SAVR with LVEF less than 55 % and quantify LVEF improvement at follow-up. MATERIAL AND METHODS: We analyzed patients undergoing SAVR with LVEF less than 55 % and the number of patients that improved the LVEF at 6 months. We defined 'improved LVEF' as a 10 % increase of LVEF compared to baseline. RESULTS: Out of 685 patients, 11.4 % (n = 78) had SAVR with LVEF <55 %. The median pre-surgery LVEF was 45 % [IQR 37-51]. In-hospital mortality was 5.1 % (n = 4). Follow-up data for 69 patients showed 50.7 % (n = 35) had improved LVEF. CONCLUSIONS: In our cohort, 10 % of severe AS patients underwent SAVR with LVEF <55 %, with half showing LVEF improvement at follow-up.
Assuntos
Estenose da Valva Aórtica , Valva Aórtica , Implante de Prótese de Valva Cardíaca , Volume Sistólico , Humanos , Masculino , Feminino , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/epidemiologia , Volume Sistólico/fisiologia , Idoso , Implante de Prótese de Valva Cardíaca/métodos , Prevalência , Seguimentos , Valva Aórtica/cirurgia , Valva Aórtica/fisiopatologia , Função Ventricular Esquerda/fisiologia , Mortalidade Hospitalar/tendências , Resultado do Tratamento , Estudos Retrospectivos , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/epidemiologia , Pessoa de Meia-Idade , Idoso de 80 Anos ou maisRESUMO
A dataset about three topics is provided, as a follow-up to the article "Mexico's forest diversity: common tree species and proposed forest-vegetation provinces" by Ricker et al. [1]. Firstly, 6927 site locations are provided for 22,532 trees of 1452 species. Secondly, measurements of basic wood-densities are reported for 779 tree species, obtained from 5256 trunk-core samples from Mexico's national forest inventory, and ranging from 0.05 to 0.93 g/cm3. Third, the data and maps of the forest-vegetation provinces from [1] were updated with the new cartography of Mexico's vegetation and land use (base year 2018). The maps are available now in an adjusted presentation as a shapefile-set for ArcGIS, as well as map-package and image files.
RESUMO
Payments for Ecosystem Services (PES) provide conditional incentives for forest conservation. PES short-term effects on deforestation are well-documented, but we know less about program effectiveness when participation is sustained over time. Here, we assess the impact of consecutive renewals of PES contracts on deforestation and forest degradation in three municipalities of the Selva Lacandona (Chiapas, Mexico). PES reduced deforestation both after a single 5-year contract and after two consecutive contracts, but the impacts are only detectable in higher deforestation-risk parcels. Enrollment duration increases PES impact in these parcels, which suggests a positive cumulative effect over time. These findings suggest that improved spatial targeting and longer-term enrollment are key enabling factors to improve forest conservation outcomes in agricultural frontiers.
Assuntos
Conservação dos Recursos Naturais , Florestas , Agricultura , Conservação dos Recursos Naturais/economia , Ecossistema , México , MotivaçãoRESUMO
Abstract Objective: The objective of this study was to describe the clinical and imaging characteristics and the evolution of heart transplantation patients due to anthracycline-induced cardiomyopathy Methods: Patients with a diagnosis of ACM who received a heart transplantation in our institution in the period of November 2009-April 2021 were included. Clinical characteristics, pre-transplant studies, and clinical outcomes after transplantation were collected retrospectively from the electronic medical record. Results: A total of 11 patients were included in the study. The median age at the time of cancer diagnosis was 15 years (IQR 10-37 years), while the median age at the time of heart transplant was 56 years (IQR 39-62 years). Regarding post-transplant outcomes, three patients died in the post-operative period. One died 4 years after the intervention due to chronic rejection, while the other seven had a favorable evolution. No oncological relapse was observed with a median follow-up of 2.5 years (IQR 1.86-3.85 years). Conclusion: End-stage anthracycline-induced cardiomyopathy can occur many years after chemotherapy treatment, so close cardiovascular follow-up is extremely important. Heart transplantation is a treatment option after an exhaustive multidisciplinary evaluation, to minimize the risk of oncological relapse.
Resumen Objetivo: Describir las características clínicas, imagenológicas y la evolución de los pacientes trasplantados cardiacos por cardiotoxicidad inducida por antraciclinas. Métodos: Serie de casos descriptiva de pacientes consecutivos trasplantados cardiacos debido a cardiotoxicidad mediada por antraciclinas en el periodo de Noviembre de 2009 a Abril de 2021.Las características clínicas, los estudios complementarios pretrasplante y la información sobre la evolución posterior al trasplante fue recolectada de la historia clínica electrónica de forma retrospectiva. Resultados: Se incluyeron un total de 11 pacientes. La mediana de edad al diagnóstico de la patología oncológica fue de 15 años (RIC 10-37 años), mientras que la mediana de edad en la que recibieron el trasplante cardiaco fue de 56 años (RIC 39-62 años). Con respecto a la evolución posterior al trasplante, 3 pacientes murieron en el periodo del post operatorio inmediato. 1 paciente falleció a los 4 años del trasplante y los otros 7 pacientes tuvieron una evolución favorable. No se observó recaída oncológica en ningún paciente durante una mediana de seguimiento o de 2,5 años (RIC 1.86-3.85 años). Conclusión: La etapa final de la miocardiopatía inducida por antraciclinas puede ocurrir muchos años después del tratamiento con quimioterapia, por lo que es extremadamente importante un seguimiento cardiológico estricto. El trasplante cardiaco es una opción en este grupo de pacientes luego de una exhaustiva evaluación multidisciplinaria, con el fin de minimizar el riesgo de recaída oncológica.
RESUMO
OBJECTIVE: The objective of this study was to describe the clinical and imaging characteristics and the evolution of heart transplantation patients due to anthracycline-induced cardiomyopathy. METHODS: Patients with a diagnosis of ACM who received a heart transplantation in our institution in the period of November 2009-April 2021 were included. Clinical characteristics, pre-transplant studies, and clinical outcomes after transplantation were collected retrospectively from the electronic medical record. RESULTS: A total of 11 patients were included in the study. The median age at the time of cancer diagnosis was 15 years (IQR 10-37 years), while the median age at the time of heart transplant was 56 years (IQR 39-62 years). Regarding post-transplant outcomes, three patients died in the post-operative period. One died 4 years after the intervention due to chronic rejection, while the other seven had a favorable evolution. No oncological relapse was observed with a median follow-up of 2.5 years (IQR 1.86-3.85 years). CONCLUSION: End-stage anthracycline-induced cardiomyopathy can occur many years after chemotherapy treatment, so close cardiovascular follow-up is extremely important. Heart transplantation is a treatment option after an exhaustive multidisciplinary evaluation, to minimize the risk of oncological relapse.
OBJETIVO: Describir las características clínicas, imagenológicas y la evolución de los pacientes trasplantados cardiacos por cardiotoxicidad inducida por antraciclinas. MÉTODOS: Serie de casos descriptiva de pacientes consecutivos trasplantados cardiacos debido a cardiotoxicidad mediada por antraciclinas en el periodo de Noviembre de 2009 a Abril de 2021.Las características clínicas, los estudios complementarios pretrasplante y la información sobre la evolución posterior al trasplante fue recolectada de la historia clínica electrónica de forma retrospectiva. RESULTADOS: Se incluyeron un total de 11 pacientes. La mediana de edad al diagnóstico de la patología oncológica fue de 15 años (RIC 10-37 años), mientras que la mediana de edad en la que recibieron el trasplante cardiaco fue de 56 años (RIC 39-62 años). Con respecto a la evolución posterior al trasplante, 3 pacientes murieron en el periodo del post operatorio inmediato. 1 paciente falleció a los 4 años del trasplante y los otros 7 pacientes tuvieron una evolución favorable. No se observó recaída oncológica en ningún paciente durante una mediana de seguimiento o de 2,5 años (RIC 1.86-3.85 años). CONCLUSIÓN: La etapa final de la miocardiopatía inducida por antraciclinas puede ocurrir muchos años después del tratamiento con quimioterapia, por lo que es extremadamente importante un seguimiento cardiológico estricto. El trasplante cardiaco es una opción en este grupo de pacientes luego de una exhaustiva evaluación multidisciplinaria, con el fin de minimizar el riesgo de recaída oncológica.
Assuntos
Cardiomiopatias , Transplante de Coração , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Antraciclinas/efeitos adversos , Estudos Retrospectivos , Cardiomiopatias/induzido quimicamente , RecidivaRESUMO
BACKGROUND AND AIMS: Differences among populations in pollinator assemblages can lead to local adaptation mosaics in which plants evolve different floral morphologies and attractive traits. Mountain habitats may promote local adaptation because of differences in environmental conditions with altitude, causing changes in pollinators, and because mountaintops can act as isolated habitats. We studied if the differences in floral shape, size and nectar traits in Salvia stachydifolia can be attributed to variations in the relative contribution of hummingbirds and insects. METHODS: We studied eight populations of S. stachydifolia in natural and under common garden conditions, to assess whether population differences have a genetic component. We recorded pollinators, their behaviour and visitation rates, and characterized pollinator assemblages. In addition, we measured nectar volume and concentration, and collected flowers to describe floral shape and size variation using geometric morphometric methods. We then applied an unsupervised learning algorithm to identify ecotypes based on morphometric traits. Finally, we explored whether populations with different pollinator assemblages had different climatic and/or elevation preferences. KEY RESULTS: We found that variation in the identity of the main pollinators was associated with differences among populations in all traits, as expected under a local adaptation scenario. These differences persisted in the common garden, suggesting that they were not due to phenotypic plasticity. We found S. stachydifolia populations were pollinated either by bees, by hummingbirds or had mixed pollination. We identified two ecotypes that correspond to the identity of the main pollinator guilds, irrespective of climate or altitude. CONCLUSIONS: Variation in S. stachydifolia floral traits did not follow any evident association with bioclimatic factors, suggesting that populations may have diverged as the product of historical isolation on mountaintops. We suggest that differences among populations point to incipient speciation and an ongoing pollinator shift.
Assuntos
Néctar de Plantas , Salvia , Abelhas , Animais , Polinização , Flores , InsetosAssuntos
Cardiopatias , Inibidores de Hidroximetilglutaril-CoA Redutases , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Antraciclinas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Cardiopatias/induzido quimicamente , Antibióticos AntineoplásicosRESUMO
RESUMEN Introducción: La utilidad de la resonancia magnética cardíaca (RMC) ha crecido ampliamente en los últimos años, en los cuales se han publicado distintos registros internacionales sobre su uso e impacto clínico. Sin embargo, no contamos con este tipo de información en Argentina. Objetivo: Evaluar indicaciones, protocolos utilizados, seguridad y consecuencias terapéuticas de la RMC en la República Argentina. Material y métodos: Se diseñó un registro prospectivo a nivel nacional con recolección de datos demográficos, indicaciones de RMC, complicaciones asociadas, diagnósticos y consecuencias terapéuticas. Resultados: Participaron 34 centros de 10 provincias de Argentina (85% centros privados, 59% centros con internación). Se incluyeron 1131 pacientes (edad 54 ± 18 años, 61% varones). Las principales indicaciones para el estudio de RMC fueron la miocardiopatía hipertrófica (13,9%) y la arritmia ventricular (12,3%). El 99,7% de los estudios fueron reportados sin complicaciones. Los resultados más frecuentes de la RMC fueron: normal (31,2%), miocardiopatía no isquémica (14,7%), miocardiopatía isquémico-necrótica (11,6%) y miocardiopatía hipertrófica (8,9%). La sospecha clínica fue confirmada en el 23,6% de los casos y la RMC generó un diagnóstico nuevo no sospechado en el 48,7% de los casos. Las consecuencias terapéuticas más frecuentes fueron el alta hospitalaria (31,6%) seguida por el cambio en la medicación (28,1%). Conclusiones: La RMC es un estudio ampliamente utilizado en Argentina, principalmente en centros privados, con un número muy bajo de complicaciones. Las principales indicaciones son las miocardiopatías (hipertrófica y dilatada) y la arritmia ventricular, y provee un diagnóstico nuevo no sospechado en casi la mitad de los casos. Se requieren de otros estudios en el futuro para evaluar las implicancias clínicas y terapéuticas.
ABSTRACT Background: The usefulness of cardiac magnetic resonance imaging (MRI) has greatly increased in the last years. Different international registries have been published on its use; however, there is no data available from Argentina. Objective: The aim of this study was to evaluate different indications, protocols, safety and therapeutic consequences of cardiac MRI in Argentina. Methods: A prospective national registry was designed with collection of demographic data, indications for cardiac MRI, associated complications, diagnoses and therapeutic consequences. Results: A total of 34 centers from 10 provinces of Argentina (85% private and 59% with inpatient capacity) participated in the study, including 1131 patients (mean age 54±18 years and 61% males). The main indications for cardiac MRI were hypertrophic cardiomyopathy (13.9%), and ventricular arrhythmia (12.3%). In 99.7% of cases, no study complications were reported. The most frequent results of cardiac MRI were: normal (31.2%), non-ischemic cardiomyopathy (14.7%), ischemic-necrotic cardiomyopathy (11.6%) and hypertrophic cardiomyopathy (8.9%). Clinical suspicion was confirmed in 23.6% of cases and cardiac MRI generated an unsuspected new diagnosis in 48.7% of cases. The main therapeutic consequences were hospital discharge (31.6%) followed by change in medication (28.1%). Conclusions: Cardiac MRI is widely used in Argentina, mainly in private centers with a very low incidence of complications. Cardiomyopathies (hypertrophic and dilated) and ventricular arrhythmia are its main indication, and it provides a new unsuspected diagnosis in almost half of the cases. Further studies are required to assess its clinical and therapeutic impact.
RESUMO
Microplastics debris in the marine environment have been widely studied across the globe. Within these particles, the most abundant and prevalent type in the oceans are anthropogenic microfibers (MFs), although they have been historically overlooked mostly due to methodological constraints. MFs are currently considered omnipresent in natural environments, however, contrary to the Northern Hemisphere, data on their abundance and distribution in Southern Oceans ecosystems are still scarce, in particular for sub-Antarctic regions. Using Niskin bottles we've explored microfibers abundance and distribution in the water column (3-2450 m depth) at the Burdwood Bank (BB), a seamount located at the southern extreme of the Patagonian shelf, in the Southwestern Atlantic Ocean. The MFs detected from filtered water samples were photographed and measured using ImageJ software, to estimate length, width, and the projected surface area of each particle. Our results indicate that small pieces of fibers are widespread in the water column at the BB (mean of 17.4 ± 12.6 MFs.L-1), from which, 10.6 ± 5.3 MFs.L-1 were at the surface (3-10 m depth), 20 ± 9 MFs.L-1 in intermediate waters (41-97 m), 24.6 ± 17.3 MFs.L-1 in deeper waters (102-164 m), and 9.2 ± 5.3 MFs.L-1 within the slope break of the seamount. Approximately 76.1% of the MFs were composed of Polyethylene terephthalate, and the abundance was dominated by the size fraction from 0.1 to 0.3 mm of length. Given the high relative abundance of small and aged MFs, and the oceanographic complexity of the study area, we postulate that MFs are most likely transported to the BB via the Antarctic Circumpolar Current. Our findings imply that this sub-Antarctic protected ecosystem is highly exposed to microplastic pollution, and this threat could be spreading towards the highly productive waters, north of the study area.
Assuntos
Plásticos , Poluentes Químicos da Água , Regiões Antárticas , Oceano Atlântico , Ecossistema , Monitoramento Ambiental , Microplásticos , Água , Poluentes Químicos da Água/análiseRESUMO
Introducción: La evaluación anatómica músculo esquelética por imagen en la exploración clínica del pie diabético es la fotografía digital que evalúa la morfología superficial. Objetivos: Validar la obtención de las imágenes fotográficas del pie, calcular las mediciones longitudinales, angulares y el índice del arco plantar, de las imágenes fotográficas del pie por fotogrametría, y basados en estas, categorizar la normalidad de la forma en sujetos sanos. Métodos: Estudio exploratorio en 30 individuos sanos evaluados en la Unidad clínica de pie diabético en la ciudad de Trujillo, mediante un prototipo de cámaras alrededor de un podoscopio y un software de análisis de imágenes. La imagen fotográfica fue evaluada por mediciones longitudinales, angulares y el índice del arco plantar. Resultados: Los pacientes evaluados tenían una edad media de 25,06+/-11,95 años, y predominaron las mujeres. La longitud total del pie y anchura del metatarso en el lado derecho fue de 226,55 ± 36,49 mm y 98,99 ± 22,71 mm respectivamente; y en el lado izquierdo fue de 229,81 ± 42,25 mm y 104,49 ± 16,84 mm respectivamente. El ángulo intermetatarsal del 1-2 rayo, ángulo intermetatarsal del 4-5 rayo y ángulo del retropié para el lado derecho fueron 14 ± 4º, 11 ± 3º y 2 ± 2º respectivamente; para el lado izquierdo 14 ± 3º, 9 ± 3º y 2 ± 2º respectivamente, y el índice plantar del arco derecho e izquierdo fueron 0,23 ± 0,2 y 0,22 ± 0,1 respectivamente. La variabilidad solo se presentó en el antepie en el 20 percent de los casos. Conclusiones: La obtención de las imágenes fotográficas del pie fueron válidas, las mediciones fueron menores o similares a otros estudios. La variabilidad de la normalidad solo se presentó en el antepie(AU)
Introduction: The musculoskeletal anatomical evaluation by imaging in the clinical examination of the diabetic foot is digital photography that assesses the superficial morphology. Objectives: To validate the obtaining of photographic images of the foot, to calculate the longitudinal and angular measurements and the index of the plantar arch, from the photographic images of the foot by photogrammetry, and to categorize the normality of the shape in healthy subjects, based on these photographic images. Methods: This an exploratory study in 30 healthy individuals evaluated at the Diabetic Foot Clinical Unit in Trujillo city, using a prototype of cameras around a podoscope and image analysis software. The photographic image was evaluated by longitudinal and angular measurements and the plantar arch index. Results: The patients evaluated had a mean age of 25.06+/-11.95 years, and women predominated. Total foot length and metatarsal width on the right side were 226.55 ± 36.49 mm and 98.99 ± 22.71 mm, respectively; and on the left side it was 229.81 ± 42.25 mm and 104.49 ± 16.84 mm, respectively. The 1st-2nd ray intermetatarsal angle, 4th-5th ray intermetatarsal angle and hindfoot angle for the right side were 14 ± 4º, 11 ± 3º and 2 ± 2º respectively; for the left side 14 ± 3º, 9 ± 3º and 2 ± 2º respectively, and the plantar index of the right and left arch were 0.23 ± 0.2 and 0.22 ± 0.1 respectively. Variability only occurred in the forefoot in 20 percent of cases. Conclusions: Obtaining of the photographic images of the foot was valid, measurements were smaller or similar to other studies. The variability of normality only appeared in the forefoot(AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Fotogrametria/métodos , Técnicas e Procedimentos Diagnósticos , Pé/anatomia & histologia , Exame Físico/métodos , Deformidades do Pé/etiologia , Epidemiologia Descritiva , Pé DiabéticoRESUMO
BACKGROUND: Reliable information about the spatial distribution of aboveground biomass (AGB) in tropical forests is fundamental for climate change mitigation and for maintaining carbon stocks. Recent AGB maps at continental and national scales have shown large uncertainties, particularly in tropical areas with high AGB values. Errors in AGB maps are linked to the quality of plot data used to calibrate remote sensing products, and the ability of radar data to map high AGB forest. Here we suggest an approach to improve the accuracy of AGB maps and test this approach with a case study of the tropical forests of the Yucatan peninsula, where the accuracy of AGB mapping is lower than other forest types in Mexico. To reduce the errors in field data, National Forest Inventory (NFI) plots were corrected to consider small trees. Temporal differences between NFI plots and imagery acquisition were addressed by considering biomass changes over time. To overcome issues related to saturation of radar backscatter, we incorporate radar texture metrics and climate data to improve the accuracy of AGB maps. Finally, we increased the number of sampling plots using biomass estimates derived from LiDAR data to assess if increasing sample size could improve the accuracy of AGB estimates. RESULTS: Correcting NFI plot data for both small trees and temporal differences between field and remotely sensed measurements reduced the relative error of biomass estimates by 12.2%. Using a machine learning algorithm, Random Forest, with corrected field plot data, backscatter and surface texture from the L-band synthetic aperture radar (PALSAR) installed on the on the Advanced Land Observing Satellite-1 (ALOS), and climatic water deficit data improved the accuracy of the maps obtained in this study as compared to previous studies (R2 = 0.44 vs R2 = 0.32). However, using sample plots derived from LiDAR data to increase sample size did not improve accuracy of AGB maps (R2 = 0.26). CONCLUSIONS: This study reveals that the suggested approach has the potential to improve AGB maps of tropical dry forests and shows predictors of AGB that should be considered in future studies. Our results highlight the importance of using ecological knowledge to correct errors associated with both the plot-level biomass estimates and the mismatch between field and remotely sensed data.
RESUMO
Quantifying patterns of deforestation and linking these patterns to potentially influencing variables is a key component of modelling and projecting land use change. Statistical methods based on null hypothesis testing are only partially successful for interpreting deforestation in the context of the processes that have led to their formation. Simplifications of cause-consequence relationships that are difficult to support empirically may influence environment and development policies because they suggest simple solutions to complex problems. Deforestation is a complex process driven by multiple proximate and underlying factors and a range of scales. In this study we use a multivariate statistical analysis to provide contextual explanation for deforestation in the Usumacinta River Basin based on partial pattern matching. Our approach avoided testing trivial null hypotheses of lack of association and investigated the strength and form of the response to drivers. As not all factors involved in deforestation are easily mapped as GIS layers, analytical challenges arise due to lack of a one to one correspondence between mappable attributes and drivers. We avoided testing simple statistical hypotheses such as the detectability of a significant linear relationship between deforestation and proximity to roads or water. We developed a series of informative generalised additive models based on combinations of layers that corresponded to hypotheses regarding processes. The importance of the variables representing accessibility was emphasised by the analysis. We provide evidence that land tenure is a critical factor in shaping the decision to deforest and that direct beam insolation has an effect associated with fire frequency and intensity. The effect of winter insolation was found to have many applied implications for land management. The methodology was useful for interpreting the relative importance of sets of variables representing drivers of deforestation. It was an informative approach, thus allowing the construction of a comprehensive understanding of its causes.
Assuntos
Conservação dos Recursos Naturais/tendências , Florestas , Modelos Estatísticos , Análise Espacial , Conservação dos Recursos Naturais/estatística & dados numéricos , Previsões/métodos , México , RiosRESUMO
El vólvulo de la vesícula biliar es una enfermedad rara y poco frecuente de difícil diagnóstico de manera preoperatoria, ya que las manifestaciones clínicas son atribuidas a otras enfermedades. Se presenta un caso de una paciente femenina de 84años de edad que ingresó en el servicio de cirugía general con un cuadro de dolor abdominal a tipo cólico en hipocondrio derecho acompañado de náusea y vómitos con restos de alimentos. Se realizó examen físico y se indicó ultrasonido abdominal. Se interpretó como una colecistitis aguda litiásica. Se impuso un tratamiento con ceftriaxone. Dado su evolución no desfavorable, cinco días después de su ingreso se realizó la colecistectomía donde se encuentra órgano volvulado. La biopsia confirma colecistitis aguda gangrenada. La paciente evolucionó satisfactoriamente. Tres días posteriores a la cirugía egresó de la institución(AU)
Gallbladder volvulus is a rare and infrequent disease difficult to diagnose preoperatively, as clinical manifestations are attributed to other diseases. A case is presented of an 84-year-old female patient who entered the general surgery service with abdominal colicky pain to the right hypochondrium accompanied by nausea and vomiting with food remains. A physical examination was performed and abdominal ultrasound was indicated. It was interpreted as acute lithiasic cholecystitis. Ceftriaxone was prescribed. Given the unfavorable evolution five days after admission, the cholecystectomy was performed, where the volvulus was found. The biopsy confirms acute gangrenous cholecystitis. The patient evolved satisfactorily. Three days after the surgery he was discharged from the institution(AU)
Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Colecistectomia/métodos , Colecistolitíase/tratamento farmacológico , Colelitíase/diagnóstico , Vesícula Biliar/diagnóstico por imagem , Volvo Gástrico/diagnóstico por imagemRESUMO
Many studies have considered community-based forestry enterprises to be the best option for development of rural Mexican communities with forests. While some of Mexico's rural communities with forests receive significant economic and social benefits from having a community forestry enterprise, the majority have not formed such enterprises. The purpose of this article is to identify and describe factors limiting the formation of community forestry enterprise in rural communities with temperate forests in the Southern Mixteca region of Oaxaca, Mexico. The study involved fieldwork, surveys applied to Community Board members, and maps developed from satellite images in order to calculate the forested surface area. It was found that the majority of Southern Mixteca communities lack the natural and social conditions necessary for developing community forestry enterprise; in this region, commercial forestry is limited due to insufficient precipitation, scarcity of land or timber species, community members' wariness of commercial timber extraction projects, ineffective local governance, lack of capital, and certain cultural beliefs. Only three of the 25 communities surveyed have a community forestry enterprise; however, several communities have developed other ways of profiting from their forests, including pine resin extraction, payment for environmental services (PES), sale of spring water, and ecotourism. We conclude that community forestry enterprise are not the only option for rural communities to generate income from their forests; in recent years a variety of forest-related economic opportunities have arisen which are less demanding of communities' physical and social resources.
Assuntos
Conservação dos Recursos Naturais/métodos , Agricultura Florestal/métodos , Florestas , Planejamento Social , Árvores/crescimento & desenvolvimento , Conservação dos Recursos Naturais/economia , Conservação dos Recursos Naturais/legislação & jurisprudência , Agricultura Florestal/economia , Agricultura Florestal/legislação & jurisprudência , Programas Governamentais , MéxicoRESUMO
Resumen Introducción Hay controversia en relación con el ácido láctico luego del trasplante cardíaco. Objetivo Evaluar el patrón plasmático del ácido láctico y su valor pronóstico luego del trasplante cardíaco. Métodos Entre el 2011 y el 2014 se incluyeron 127 pacientes luego de cirugía cardíaca, 71 pertenecieron al grupo trasplante y 56 al grupo "control", conformado por pacientes sometidos a cirugía de revascularización miocárdica. Se compararon los niveles de ácido láctico antes de la cirugía, al ingreso en la Unidad Coronaria, y a las 6, 12 y 24 h en los 2 grupos. Dentro del grupo trasplante se realizó un análisis uni y bivariado entre niveles de ácido láctico y mortalidad hospitalaria. Resultados La media de edad fue de 57 años. Los niveles de ácido láctico fueron significativamente mayores durante y luego de la cirugía cardíaca en los pacientes del grupo trasplante respecto a los pacientes del grupo control (p<0.001), pero no existieron diferencias significativas en los valores antes de la cirugía (p=0.143; comparaciones no ajustadas). En los trasplantados, los niveles de ácido láctico se asociaron de forma significativa a una mayor mortalidad durante la cirugía, al ingreso, y a las 6, 12 y 24 h. El ácido láctico al ingreso fue un predictor de muerte ajustado por volumen minuto postoperatorio (p=0.011), uso de ≥ 2 inotrópicos (p=0.033), glucemia al ingreso (p=0.004), edad ≥ 60 años (p=0.015), tiempo de bomba (p=0.027) y pH (p=0.017). Conclusiones Los niveles de ácido láctico fueron mayores en los trasplantados y se asociaron a una mayor mortalidad hospitalaria.
Abstract Introduction It is not well established the prognostic value of elevated lactic acid after heart transplantation. Objective To evaluate the plasmatic pattern and the prognostic value of elevated lactate after heart transplantation. Methods One-hundred and twenty seven patients were included between 2011 and 2014, 71 comprising the transplantation group and 56 the control group, represented by on pump coronary artery by-pass surgery patients. Lactic acid levels were compared between groups before, within and after surgery upon Coronary Care Unit admission, at 6, 12 and 24 h. In addition, in the transplantation group univariate and bivariate analysis were performed between lactic acid levels and in-hospital mortality. Results The mean age of the entire cohort was 57 years. Among transplanted patients, lactic acid levels were significantly higher over control group: within the surgery; and after surgery (P<.001), but not before surgery (P=.143; unadjusted comparisons). In transplanted patients, lactic acid levels were significantly associated with in-hospital mortality during surgery, at admission, and thereafter but not before surgery. Lactic acid at admission was associated with in-hospital mortality after adjustment of postoperative cardiac output (P=.011), ≥ 2 inotropic drug support within 24 h (P=.033), glycemic level at admission (P=.004), age ≥ 60 years (P=.015), on pump time (P=.027), and pH (P=.017). Conclusions Acid lactic levels were higher in transplanted patients than in the control group and was associated to higher in-hospital mortality.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Transplante de Coração/mortalidade , Ácido Láctico/sangue , Prognóstico , Estudos Retrospectivos , Mortalidade HospitalarRESUMO
INTRODUCTION: It is not well established the prognostic value of elevated lactic acid after heart transplantation. OBJECTIVE: To evaluate the plasmatic pattern and the prognostic value of elevated lactate after heart transplantation. METHODS: One-hundred and twenty seven patients were included between 2011 and 2014, 71 comprising the transplantation group and 56 the control group, represented by on pump coronary artery by-pass surgery patients. Lactic acid levels were compared between groups before, within and after surgery upon Coronary Care Unit admission, at 6, 12 and 24h. In addition, in the transplantation group univariate and bivariate analysis were performed between lactic acid levels and in-hospital mortality. RESULTS: The mean age of the entire cohort was 57 years. Among transplanted patients, lactic acid levels were significantly higher over control group: within the surgery; and after surgery (P<.001), but not before surgery (P=.143; unadjusted comparisons). In transplanted patients, lactic acid levels were significantly associated with in-hospital mortality during surgery, at admission, and thereafter but not before surgery. Lactic acid at admission was associated with in-hospital mortality after adjustment of postoperative cardiac output (P=.011),≥2 inotropic drug support within 24h (P=.033), glycemic level at admission (P=.004), age≥60 years (P=.015), on pump time (P=.027), and pH (P=.017). CONCLUSIONS: Acid lactic levels were higher in transplanted patients than in the control group and was associated to higher in-hospital mortality.
Assuntos
Transplante de Coração , Ácido Láctico/sangue , Idoso , Feminino , Transplante de Coração/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos RetrospectivosRESUMO
We assess the additional forest cover protected by 13 rural communities located in the southern state of Chiapas, Mexico, as a result of the economic incentives received through the country's national program of payments for biodiversity conservation. We use spatially explicit data at the intra-community level to define a credible counterfactual of conservation outcomes. We use covariate-matching specifications associated with spatially explicit variables and difference-in-difference estimators to determine the treatment effect. We estimate that the additional conservation represents between 12 and 14.7 percent of forest area enrolled in the program in comparison to control areas. Despite this high degree of additionality, we also observe lack of compliance in some plots participating in the PES program. This lack of compliance casts doubt on the ability of payments alone to guarantee long-term additionality in context of high deforestation rates, even with an augmented program budget or extension of participation to communities not yet enrolled.
Assuntos
Biodiversidade , Conservação dos Recursos Naturais/economia , Florestas , Humanos , MéxicoRESUMO
Introducción: El diagnóstico etiológico en pacientes con miocardiopatías en estadio avanzado puede ser un desafío. Un gran número de pacientes permanecen sin diagnóstico a pesar de una evaluación exhaustiva, por lo que quedan rotuladas como miocardiopatías dilatadas idiopáticas. Objetivos: Describir la etiología de la miocardiopatía en pacientes receptores de trasplante cardíaco según el diagnóstico clínico pretrasplante y su grado de concordancia con el diagnóstico anatomopatológico del corazón explantado. Material y métodos: Se realizó un análisis retrospectivo de pacientes consecutivos trasplantados en un hospital de alta complejidad de la Ciudad Autónoma de Buenos Aires desde 2003 hasta fines de 2013. Se efectuó un análisis de concordancia entre el diagnóstico clínico pretrasplante y el diagnóstico anatomopatológico del corazón explantado utilizando el coeficiente kappa. Resultados: Se analizaron 100 pacientes con una edad media en el momento del trasplante de 49,7 ± 12,5 años y una mediana de fracción de eyección del 26,6%. El diagnóstico clínico pretrasplante más frecuente fue el de miocardiopatía dilatada idiopática (37%), seguida por la miocardiopatía isquémico-necrótica (32%) y la miocardiopatía chagásica (10%). Entre los diagnósticos histopatológicos más frecuentes se encontraron el de miocardiopatía isquémico-necrótica (35%), de miocardiopatía hipertrófica (10%), de miocardiopatía chagásica (10%) y de miocarditis (8%); no se arribó a un diagnóstico causal en el 25% (miocardiopatía dilatada idiopática). El resultado del coeficiente kappa fue de 0,64 (IC 0,52-0,76). Conclusiones: Aproximadamente un tercio de los pacientes llegan al trasplante sin un diagnóstico etiológico. El análisis anatomopatológico permite identificar la causa en más de la mitad de estos pacientes. A pesar de que la concordancia entre el diagnóstico pretrasplante y la anatomía patológica fue estadísticamente buena, un porcentaje importante de pacientes podría beneficiarse con un diagnóstico etiológico más preciso, que podría tener implicaciones pronósticas, terapéuticas y/o en la evaluación de familiares.(AU)
Introduction: Etiologic diagnosis in patients with end-stage cardiomyopathy can be challenging. A large number of patients remain undiagnosed despite a thorough evaluation, so they are classified as idiopathic dilated cardiomyopathies. Objectives: To describe the etiology of cardiomyopathy in heart transplant recipients according to pretransplant clinical diagnosis and its degree of agreement with the anatomopathological diagnosis of the explanted heart. Methods: We performed a retrospective analysis of consecutively transplanted patients in a high complexity hospital of the Autonomous City of Buenos Aires from 2003 to the end of 2013. An agreement analysis between pretransplantation clinical diagnosis and anatomopathological diagnosis of the explanted heart was done using the kappa coefficient. Results: One-hundred patients with mean age of 49.7 ± 12.5 years at the time of transplantation and median ejection fraction of 26.6% were analyzed. The most common pretransplant clinical diagnosis was idiopathic dilated cardiomyopathy (37%), followed by ischemic-necrotic cardiomyopathy (32%) and Chagas cardiomyopathy (10%). The most common histopathological diagnoses were ischemic-necrotic cardiomyopathy (35%), hypertrophic cardiomyopathy (10%), Chagas cardiomyopathy (10%) and myocarditis (8%); a causal diagnosis was not reached in 25% of cases (idiopathic dilated cardiomyopathy). The kappa coefficient was 0.64 (CI 0.52-0.76). Conclusions: Approximately one third of patients reach transplantation without an etiologic diagnosis. Anatomopathological analysis allows identifying the cause in more than half of these patients. Although the correlation between pretransplant diagnosis and pathological anatomy was statistically adequate, a significant percentage of patients could benefit from a more specific etiologic diagnosis, which may have prognostic, therapeutic and/or family assessment implications.(AU)