Precipitation is the main axis of tropical plant phylogenetic turnover across space and time.

Early natural historians-Comte de Buffon, von Humboldt, and De Candolle-established environment and geography as two principal axes determining the distribution of groups of organisms, laying the foundations for biogeography over the subsequent 200 years, yet the relative importance of these two axes remains unresolved. Leveraging phylogenomic and global species distribution data for Mimosoid legumes, a pantropical plant clade of c. 3500 species, we show that the water availability gradient from deserts to rain forests dictates turnover of lineages within continents across the tropics. We demonstrate that 95% of speciation occurs within a precipitation niche, showing profound phylogenetic niche conservatism, and that lineage turnover boundaries coincide with isohyets of precipitation. We reveal similar patterns on different continents, implying that evolution and dispersal follow universal processes.

Quantifying and mapping species threat abatement opportunities to support national target setting.

The successful implementation of the Convention on Biological Diversity's post-2020 Global Biodiversity Framework will rely on effective translation of targets from global to national level and increased engagement across diverse sectors of society. Species conservation targets require policy support measures that can be applied to a diversity of taxonomic groups, that link action targets to outcome goals, and that can be applied to both global and national data sets to account for national context, which the species threat abatement and restoration (STAR) metric does. To test the flexibility of STAR, we applied the metric to vascular plants listed on national red lists of Brazil, Norway, and South Africa. The STAR metric uses data on species' extinction risk, distributions, and threats, which we obtained from national red lists to quantify the contribution that threat abatement and habitat restoration activities could make to reducing species' extinction risk. Across all 3 countries, the greatest opportunity for reducing plant species' extinction risk was from abating threats from agricultural activities, which could reduce species' extinction risk by 54% in Norway, 36% in South Africa, and 29% in Brazil. Species extinction risk could be reduced by a further 21% in South Africa by abating threats from invasive species and by 21% in Brazil by abating threats from urban expansion. Even with different approaches to red-listing among countries, the STAR metric yielded informative results that identified where the greatest conservation gains could be made for species through threat-abatement and restoration activities. Quantifiably linking local taxonomic coverage and data collection to global processes with STAR would allow national target setting to align with global targets and enable state and nonstate actors to measure and report on their potential contributions to species conservation.

Haematological and biochemical profiles during the puerperium in dairy cows - Short communication.

The main aim of the current study was to assess the prevalence of anaemia in Holstein dairy cows during the puerperium, and the haematological and biochemical profile of dairy cows with and without anaemia. The study was conducted in seven dairy herds in São Paulo State, Brazil. The evaluated sample comprised a total of 336 Holstein cows. Blood samples were collected at postpartum day 25 ± 3. Haematological analysis included white blood cell, red blood cell and platelet count, haematocrit value, haemoglobin concentration, mean corpuscular volume, mean corpuscular haemoglobin and mean corpuscular haemoglobin concentration. The biochemical profile encompassed cholesterol, non-esterified fatty acids, ß-hydroxybutyrate, albumin, globulin, fibrinogen, calcium and total bilirubin concentrations. The prevalence of anaemia was 16.3% in all herds, and this was not affected by clinical diseases, milk production, parity and body score condition. Moreover, anaemic cows had lower red blood cell count, haematocrit, haemoglobin, serum cholesterol and calcium concentrations and higher white blood cell and platelet counts, mean corpuscular haemoglobin, red cell distribution width, non-esterified fatty acids, ß-hydroxybutyrate, fibrinogen and globulin concentrations when compared with non-anaemic cows. The results indicate changes in energy balance and an inflammatory process in anaemic cows.

Cause of death among HIV patients in London in 2016.

OBJECTIVES: Since 2013, the London HIV Mortality Review Group has conducted annual reviews of deaths among people with HIV to reduce avoidable mortality. METHODS: All London HIV care Trusts reported data on 2016 patient deaths in 2017. Deaths were submitted using a modified Causes of Death in HIV reporting form and categorized by a specialist HIV pathologist and two HIV clinicians. RESULTS: There were 206 deaths reported; 77% were among men. Median age at death was 56 years. Cause was established for 82% of deaths, with non-AIDS-related malignancies and AIDS-defining illnesses being the most common causes reported. Risk factors in the year before death included: tobacco smoking (37%), excessive alcohol consumption (19%), non-injecting drug use (10%), injecting drug use (7%) and opioid substitution therapy (6%). Thirty-nine per cent of patients had a history of depression, 33% chronic hypertension, 27% dyslipidaemia, 17% coinfection with hepatitis B virus and/or hepatitis C virus and 14% diabetes mellitus. At the time of death, 81% of patients were on antiretroviral therapy (ART), 61% had a CD4 count < 350 cells/µL, and 24% had a viral load ≥ 200 HIV-1 RNA copies/mL. Thirty-six per cent of deaths were unexpected; 61% of expected deaths were in hospital. Two-thirds of expected deaths had a prior end-of-life care discussion documented. CONCLUSIONS: In 2016, most deaths were attributable to non-AIDS-related conditions and the majority of patients were on ART and virally suppressed. However, several potentially preventable deaths were identified and underlying risk factors were common. As London HIV patients are not representative of people with HIV in the UK, a national mortality review is warranted.

Invasive aspergillosis associated with pulmonary hydatid disease.

A patient presented with a cavitating lung lesion. Serology and sputum microscopy led to the diagnosis of pulmonary hydatid disease. However, histology of the operative samples revealed aspergillosis in the cavity and surrounding lung tissue. This is the first report of invasive aspergillosis occurring as a consequence of spontaneous hydatid cyst rupture.

Lymphogranuloma venereum proctitis masquerading as inflammatory bowel disease in 12 homosexual men.

BACKGROUND: Lymphogranuloma venereum (LGV) is a recognized cause of proctitis. Symptoms, endoscopy and histology findings are similar in IBD and LGV proctitis. AIMS: To characterize the clinical, endoscopic and histological features seen in men diagnosed initially with IBD and subsequently with LGV proctitis, and to attempt isolation of Chlamydia trachomatis DNA from the stored rectal biopsy specimens of these patients using real-time PCR. METHODS: Clinical data were collated from confirmed or suspected cases of LGV proctitis where endoscopy and biopsy had been performed as part of the investigation of clinical symptoms. LGV was confirmed by the detection of LGV-specific DNA from rectal swab specimens, with supportive evidence from Chlamydial serology. Stored histological specimens from rectal biopsies were analysed retrospectively for LGV-specific DNA with molecular techniques. RESULTS: Rectal biopsies had been obtained from twelve cases of LGV proctitis. Mucosal ulcers, cryptitis, crypt abscesses and granulomas were common histological findings. Extraction of LGV-specific DNA from rectal biopsy specimens enabled confirmation of three suspected cases. CONCLUSIONS: During the recent LGV proctitis epidemic among UK men who have sex with men, it has become apparent that this infection may closely resemble IBD. Gastroenterologists should remain alert to LGV as a cause of proctitis in this group.

Pregnancy with epilepsy: obstetric and neonatal outcome of a controlled study.

PURPOSE: To determine the influence of epilepsy and its treatment on pregnancy and its outcome. DESIGN: Controlled, observational study. SETTING: National Health Service maternity hospitals in Liverpool and Manchester regions. POPULATION: 277 women with epilepsy (WWE) and 315 control women. METHODS: WWE were recruited from antenatal clinics. Controls were matched for age and parity but not gestational age. Information was obtained by interview and from clinical records. MAIN OUTCOME MEASURES: Obstetric complications, mode of delivery, condition of newborn. RESULTS: Distribution of epilepsy syndromes was similar to previous surveys. Most WWE (67%) received monotherapy with carbamazepine, sodium valproate or lamotrigine. Half WWE had no seizures during pregnancy but 34% had tonic clonic seizures. Seizure-related injuries were infrequent. Pregnancies with obstetric complications were increased in women with treated epilepsy (WWTE 45%, controls 33%; p=0.01). Most had normal vaginal delivery (WWTE 63%, controls 61%; p=0.65). Low birth weight was not increased (WWTE 6.2%, controls 5.2%; p=0.69). There were more major congenital malformations (MCM) (WWTE 6.6%, controls 2.1%; p=0.02) and fetal/infant deaths (WWTE 2.2%, controls 0.3%; p=0.09). Amongst monotherapies MCM prevalence was highest with valproate (11.3%; p=0.005). Lamotrigine (5.4%; p=0.23) and carbamazepine (3.0%; p=0.65) were closer to controls (2.1%). There was no association between MCM and dose of folic acid pre-conception. CONCLUSION: MCM were more prevalent in the babies of WWTE particularly amongst those receiving sodium valproate.

National review of deaths among HIV-infected adults.

This review describes patterns of mortality among adults infected with HIV in the UK and assesses the contributions of late diagnosis of HIV infection and non-HIV-related disease to such mortality. In total, 387 adults with HIV who died between 1 October 2004 and 30 September 2005 after receiving care at 90 clinical centres in the UK were reviewed. Causes of death and scenarios accounting for death were measured. Of the 387 deaths, 218 (56.3%) were readily attributable to infection with HIV. Only 123 (31.8%) deaths were considered not directly related to HIV. Late diagnosis of HIV accounted for 24.0% of all deaths and 35.2% of HIV-related deaths. Infection with HIV remains the main cause of mortality among infected patients in the era of highly active antiretroviral therapy. Late diagnosis of infection with HIV may be the largest potentially remediable factor for HIV-associated death.

The histological diagnosis of leprosy type 1 reactions: identification of key variables and an analysis of the process of histological diagnosis.

BACKGROUND: Type 1 leprosy reactions (T1R) are a major inflammatory complication of leprosy affecting 30% of patients with borderline leprosy, but there has been no diagnostic evaluation of the histological diagnosis of this entity. METHODS: In a prospective study based in India, skin biopsies were taken from 99 patients with clinically diagnosed T1R and 52 non-reactional controls. These were assessed histologically by four histopathologists whose assessments were then compared. RESULTS: Reactions were under-diagnosed, with 32-62% of clinically diagnosed reactions being given a histological diagnosis. The pathologists showed good specificities (range 72% to 93%) but much poorer sensitivities (range 42% to 78%). The most commonly reported histological features of TIR were cell maturity, oedema and giant cells. Five key variables were identified that the pathologists used in diagnosing a reaction: intra-granuloma oedema, giant cell size, giant cell numbers, dermal oedema and HLA-DR expression. A predictive model for the diagnosis of T1R was developed using stepwise logistic regression analysis, with clinical diagnosis of reaction as an outcome, and then identification of the key variables that each pathologist used in making the diagnosis of T1R. 34-53% of the variation between pathologists could be accounted for. The four pathologists used a similar diagnostic model and for all of them their estimations of epithelioid cell granuloma oedema, dermal oedema, plasma cells and granuloma fraction were significant variables in the diagnosis of T1R. Each pathologist then added in variables that were specific to themselves. CONCLUSIONS: This study has identified T1R as being under-diagnosed in comparison with clinical assessments. Key variables for diagnosing T1R were established. This comparative masked study highlights the need for such studies in other inflammatory conditions.

Fulminant toxoplasmosis causing fatal pneumonitis and myocarditis.

The obligate intracellular protozoa Toxoplasma gondii is a serious cause of morbidity and mortality in patients with AIDS. Toxoplasmosis most frequently manifests as life-threatening encephalitis, although extracerebral sites may be involved with or without toxoplasmic encephalitis. Consequently, toxoplasmosis can present in an unusual manner, and may not be included in the differential diagnosis in the absence of encephalitic symptoms. There are few reports of fulminant toxoplasmic myocarditis resulting in death. Toxoplasmic pneumonitis is responsible for less than 1% of HIV-related pulmonary complications, and can occasionally cause fatal septic shock. Two such clinicopathological presentations of toxoplasmosis are reported here. One patient presented with cardiorespiratory signs and symptoms, whilst the second patient presented with pneumonitis and renal failure. Neither patient was initially known to be HIV-infected, nor did they have clinical symptoms indicating toxoplasmic encephalitis. Toxoplasmosis was only diagnosed on autopsy and had resulted in death by causing a fulminant myocarditis and a pneumonitis. As overwhelming toxoplasmosis infection may prove rapidly fatal, these two case reports serve as a clinical reminder to consider toxoplasmosis in the differential diagnosis of HIV-infected patients who present with severe cardiorespiratory signs and symptoms. Furthermore, the cases emphasize the potential importance of early tissue biopsy in patients presenting with immunosuppression-associated organ failure, and show the importance of requesting a postmortem examination if the cause of death cannot be ascertained in vivo.

Corneo-conjunctival carcinoma in Uganda.

AIMS: Since 1990, the incidence of conjunctival neoplasia has more than tripled in Uganda. It is known to be associated with exposure to solar ultraviolet radiation and to infection with the human immunodeficiency virus-1 (HIV). However, little is known about the most effective treatments. In this study, we report surgical outcomes among people with corneo-conjunctival squamous neoplasia in Uganda and investigate the role of HIV infection and other factors in the aetiology of the tumour. METHODS: Country-wide enrolment of participants; removal and histology of suspect lesions; HIV counselling and testing; home visiting of participants to determine outcomes. RESULTS: In 67 months between 1995 and 2001, 476 participants were enrolled (262 female, 214 male, median age 32 years). A total of 463 (97%) had eye-conserving removal of the lesion and 13 had other surgery. For 414, the histology was squamous neoplasia (184 invasive carcinoma, 230 intraepithelial). The prevalence of HIV infection in cases was 64%. In all, 96% were followed up for a median period of 32 months (range 0-81) after eye-conserving surgery during which time 13 (3.2%) had a recurrence. CONCLUSIONS: Surgery resulted in a low recurrence rate during the follow-up period and had minimal complications. The prevalence of HIV among cases was higher than expected on the basis of data from the general population, although about a third of cases were HIV-negative and had normal CD4 counts. No new cofactors were identified.

Evaluating the role of human papillomaviruses in conjunctival neoplasia.

Mucosal, cutaneous and Epidermodysplasia verruciformis (EV)-related human papillomaviruses (HPVs) were searched by broad-spectrum PCR in 86 conjunctival neoplasia biopsies and 63 conjunctival non-neoplastic control tissue from Ugandan subjects. Seven different EV-related HPV types, including a putative new HPV, and two mucosal HPVs were detected in 25% (14 out of 56) of HIV-positive, in 10% (three out of 30) of HIV-negative conjunctival neoplasia samples, and rarely (0-1.6%) in control subjects. The absence of high-risk HPVs and the low detection frequency of EV-related HPV types in more advanced tumour stages (10%) raise doubts about their role in conjunctival carcinomas.

Acute myocardial infarction as a cause of death in palliated hypoplastic left heart syndrome.

A 20 month old child with hypoplastic left heart syndrome died suddenly from a massive myocardial infarction 15 months after a hemi-Fontan operation. This was confirmed at postmortem examination and histological examinations. The sites of surgical reconstruction were all in good condition, there were no gross anatomical coronary abnormalities, and the coronary ostia were unobstructed. On microscopy the internal coronary arteries had notable intimal and medial thickening with narrowing of the lumen, although no thrombotic occlusion was seen. To the authors' knowledge, this is the first published report of arteriosclerosis of the coronary arteries in hypoplastic left heart syndrome. It raises the question as to whether there may be a primary histological abnormality in some children with this condition or whether some mechanism of accelerated arteriosclerosis is at work.