Extreme hydroclimatic events in rural communities of the Brazilian Amazon: local perceptions of change, impacts, and adaptation.

The Intergovernmental Panel on Climate Change Fifth Assessment Report reveals vast evidence of increasing climate variability and a higher frequency and intensity of extreme events. Vulnerable regions to such disturbances have been widely studied in some areas, but considerably less is known about other vulnerable regions that are key to global climatic regulation, such as Amazonia. In terms of the human dimensions of climate impacts, rural and indigenous communities in developing regions are among the most vulnerable due to their limited economic capital and direct reliance on natural resources. The purpose of this research was to reveal local perceptions about the impacts of, and adaptations to, recent climatic and associated hydrological changes caused by extreme events in the Brazilian Amazon. We worked in severely impacted rural Amazonian riverine communities utilizing a qualitative case study approach that included interviews, observation while living in the community, and participatory mapping. Our results indicate that participants perceived that there has been an increased occurrence and intensity of hydroclimatic events in the last decade, especially extreme floods. Findings also show that the repeated occurrence of extreme floods resulted in severe impacts, including some that had never been experienced by the local communities, such as the complete loss of perennials. We found that a wide range of locally devised responses was implemented, despite incipient governmental support. Data also showed that responses have evolved significantly over time due to local experience with repeated extreme events. A variety of factors also affected participants' abilities to respond to hydroclimatic changes, notably information exchange among farmers and access to technological advancements. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10113-021-01857-0.

Outbreak of carbapenem-resistant Pseudomonas aeruginosa producing VIM-8, a novel metallo-beta-lactamase, in a tertiary care center in Cali, Colombia.

The prevalence of imipenem resistance among Pseudomonas aeruginosa isolates at a 195-bed tertiary care medical center in Cali, Colombia, rose from 2% in 1996 to 28% in 1997 and to over 40% in 2003. Many isolates showed high-level multiresistance, and phenotypic characterization suggested the spread of a predominant strain with minor variants. Sixty-six resistant isolates collected between February 1999 and July 2003 from hospitalized patients (n = 54) and environmental samples (n = 12) were subjected to a fuller analysis. Genetic fingerprints were compared by pulsed-field gel electrophoresis (PFGE) of SpeI-digested genomic DNA, and bla(IMP) and bla(VIM) genes were sought by PCR. PFGE and serotyping indicated that 52 of the 66 isolates belonged to a single strain, with 82% similarity; the PFGE pattern for this organism was designated pattern A. Two further pairs of isolates represented single strains; the remaining nine isolates were unique, and in the case of one isolate, no satisfactory PFGE profile could be obtained. The pattern A isolates were mostly of serotype O12 and were highly resistant to imipenem (MICs, 32 to >256 microg/ml), with this resistance decreased eightfold or more in the presence of EDTA. They yielded amplicons with bla(VIM)-specific primers, and sequencing of DNA from a representative isolate revealed bla(VIM-8), a novel allele with three polymorphisms compared with the sequence of bla(VIM-2). Two of these nucleotide changes were silent, but the third determined a Thr139Ala substitution. Only 4 of 13 resistant isolates (2 clinical isolates and 2 environmental isolates) assigned to other PFGE types carried bla(VIM) alleles, whereas the others were less multiresistant and mostly had lower levels of imipenem resistance (MICs, < or =32 microg/ml) which was not significantly reduced by EDTA. No bla(IMP) alleles were detected. During 2003, when the environmental study was undertaken, serotype O12 isolates with bla(VIM) were recovered from sinks and stethoscopes in the most-affected units, although not from the hands of staff; the problem declined once these reservoirs were disinfected and hygienic precautions were reinforced.

Hysterosalpingography at the University Hospital of the West Indies

One hundred consecutively done hysterosalpingograms are analysed and compared with recent reports in the literature. These hysterosalpingograms were done primarily as part of an infertility investigation. A high rate of tubal occlusion was noted (51 per cent). Uterine fibroids did not adversely affect tubal patency, and there is a significantly high risk of contralateral tubal pregnancies. Because of the high rate of occlusion, hysterosalpingography may be used as a cost-efficient screening test in infertility investigation (AU)