Gastrointestinal Behçet's disease: Manifestations, diagnosis, and management.

Behçet's disease (BD) is a rare, inflammatory vascular disorder with recurrent oral and genital aphthous ulcers, along with ocular and cutaneous manifestations. Gastrointestinal (GI) BD may involve any portion of the GI tract. However, it is commonly described in the terminal ileum, followed by the ileocecal region. Diagnosis is challenging given lack of pathognomonic tests; therefore, it is based on clinical criteria. Management of intestinal BD includes different classes of medications including corticosteroids, 5-aminosalicylic acid, immunomodulators, and anti-tumor necrosis factor alpha monoclonal antibody agents. In this review, we aim to focus on intestinal BD and provide details of clinical manifestations, diagnosis and therapeutic options of intestinal BD from gastroenterology viewpoint.

Amazon deforestation causes strong regional warming.

Tropical deforestation impacts the climate through complex land-atmosphere interactions causing local and regional warming. However, whilst the impacts of deforestation on local temperature are well understood, the regional (nonlocal) response is poorly quantified. Here, we used remote-sensed observations of forest loss and dry season land-surface temperature during the period 2001 to 2020 to demonstrate that deforestation of the Amazon caused strong warming at distances up to 100 km away from the forest loss. We apply a machine learning approach to show nonlocal warming due to forest loss at 2-100 km length scales increases the warming due to deforestation by more than a factor 4, from 0.16 K to 0.71 K for each 10-percentage points of forest loss. We estimate that rapid future deforestation under a strong inequality scenario could cause dry season warming of 0.96 K across Mato Grosso state in southern Brazil over the period 2020 to 2050. Reducing deforestation could reduce future warming caused by forest loss to 0.4 K. Our results demonstrate the contribution of tropical deforestation to regional climate warming and the potential for reduced deforestation to deliver regional climate adaptation and resilience with important implications for sustainable management of the Amazon.

An Unusual Cause of Intractable Hiccups.

Hiccups are a minor nuisance for most people and usually resolve within minutes. However, for some, they can persist for years and result in severe symptoms and even death. This case report describes a patient found to have a mediastinal lipoma resulting in intractable hiccups. The discussion highlights the pathophysiology, etiologies, and treatments of hiccups.

Achieving Brazil's Deforestation Target Will Reduce Fire and Deliver Air Quality and Public Health Benefits.

Climate, deforestation, and forest fires are closely coupled in the Amazon, but models of fire that include these interactions are lacking. We trained machine learning models on temperature, rainfall, deforestation, land-use, and fire data to show that spatial and temporal patterns of fire in the Amazon are strongly modified by deforestation. We find that fire count across the Brazilian Amazon increases by 0.44 percentage points for each percentage point increase in deforestation rate. We used the model to predict that the increased deforestation rate in the Brazilian Amazon from 2013 to 2020 caused a 42% increase in fire counts in 2020. We predict that if Brazil had achieved the deforestation target under the National Policy on Climate Change, there would have been 32% fewer fire counts across the Brazilian Amazon in 2020. Using a regional chemistry-climate model and exposure-response associations, we estimate that the improved air quality due to reduced smoke emission under this scenario would have resulted in 2,300 fewer deaths due to reduced exposure to fine particulate matter. Our analysis demonstrates the air quality and public health benefits that would accrue from reducing deforestation in the Brazilian Amazon.

Impact of the 2019/2020 Australian Megafires on Air Quality and Health.

The Australian 2019/2020 bushfires were unprecedented in their extent and intensity, causing a catastrophic loss of habitat, human and animal life across eastern-Australia. We use a regional air quality model to assess the impact of the bushfires on particulate matter with a diameter less than 2.5 µm (PM2.5) concentrations and the associated health impact from short-term population exposure to bushfire PM2.5. The mean population Air Quality Index (AQI) exposure between September and February in the fires and no fires simulations indicates an additional ∼437,000 people were exposed to "Poor" or worse AQI levels due to the fires. The AQ impact was concentrated in the cities of Sydney, Newcastle-Maitland, Canberra-Queanbeyan and Melbourne. Between October and February 171 (95% CI: 66-291) deaths were brought forward due to short-term exposure to bushfire PM2.5. The health burden was largest in New South Wales (NSW) (109 (95% CI: 41-176) deaths brought forward), Queensland (15 (95% CI: 5-24)), and Victoria (35 (95% CI: 13-56)). This represents 38%, 13% and 30% of the total deaths brought forward by short-term exposure to all PM2.5. At a city-level 65 (95% CI: 24-105), 23 (95% CI: 9-38) and 9 (95% CI: 4-14) deaths were brought forward from short-term exposure to bushfire PM2.5, accounting for 36%, 20%, and 64% of the total deaths brought forward from all PM2.5. Thus, the bushfires caused substantial AQ and health impacts across eastern-Australia. Climate change is projected to increase bushfire risk, therefore future fire management policies should consider this.

Large Air Quality and Public Health Impacts due to Amazonian Deforestation Fires in 2019.

Air pollution from Amazon fires has adverse impacts on human health. The number of fires in the Amazon has increased in recent years, but whether this increase was driven by deforestation or climate has not been assessed. We analyzed relationships between fire, deforestation, and climate for the period 2003 to 2019 among selected states across the Brazilian Legal Amazon (BLA). A statistical model including deforestation, precipitation and temperature explained ∼80% of the variability in dry season fire count across states when totaled across the BLA, with positive relationships between fire count and deforestation. We estimate that the increase in deforestation since 2012 increased the dry season fire count in 2019 by 39%. Using a regional chemistry-climate model combined with exposure-response associations, we estimate this increase in fire resulted in 3,400 (95UI: 3,300-3,550) additional deaths in 2019 due to increased exposure to particulate air pollution. If deforestation in 2019 had increased to the maximum recorded during 2003-2019, the number of active fire counts would have increased by an additional factor of 2 resulting in 7,900 (95UI: 7,600-8,200) additional premature deaths. Our analysis demonstrates the strong benefits of reduced deforestation on air quality and public health across the Amazon.

An Unusual Case of Heart Failure: Sometimes When You Hear Hoof Beats You Should Think of Zebras.

This case describes a 74-year-old male who was hospitalized with hyponatremia and worsening systolic and new diastolic heart failure. Workup showed low voltage QRS complexes on electrocardiogram and new diastolic dysfunction on echocardiogram. Because of this clinical scenario amyloidosis was suspected. ATTR amyloidosis was confirmed without doing an invasive endocardial biopsy by the use of immunofixation studies and Technetium 99 PYPm scan, and abdominal fat pad biopsy. The types and manifestations of amyloidosis in general and cardiac amyloidosis, in particular, are reviewed as well as the diagnostic test available to the clinician to confirm this diagnosis.

Residential energy use emissions dominate health impacts from exposure to ambient particulate matter in India.

Exposure to ambient fine particulate matter (PM2.5) is a leading contributor to diseases in India. Previous studies analysing emission source attributions were restricted by coarse model resolution and limited PM2.5 observations. We use a regional model informed by new observations to make the first high-resolution study of the sector-specific disease burden from ambient PM2.5 exposure in India. Observed annual mean PM2.5 concentrations exceed 100 µg m-3 and are well simulated by the model. We calculate that the emissions from residential energy use dominate (52%) population-weighted annual mean PM2.5 concentrations, and are attributed to 511,000 (95UI: 340,000-697,000) premature mortalities annually. However, removing residential energy use emissions would avert only 256,000 (95UI: 162,000-340,000), due to the non-linear exposure-response relationship causing health effects to saturate at high PM2.5 concentrations. Consequently, large reductions in emissions will be required to reduce the health burden from ambient PM2.5 exposure in India.

Current and Future Disease Burden From Ambient Ozone Exposure in India.

Long-term ambient ozone (O3) exposure is a risk factor for human health. We estimate the source-specific disease burden associated with long-term O3 exposure in India at high spatial resolution using updated risk functions from the American Cancer Society Cancer Prevention Study II. We estimate 374,000 (95UI: 140,000-554,000) annual premature mortalities using the updated risk function in India in 2015, 200% larger than estimates using the earlier American Cancer Society Cancer Prevention Study II risk function. We find that land transport emissions dominate the source contribution to this disease burden (35%), followed by emissions from power generation (23%). With no change in emissions by 2050, we estimate 1,126,000 (95UI: 421,000-1,667,000) annual premature mortalities, an increase of 200% relative to 2015 due to population aging and growth increasing the number of people susceptible to air pollution. We find that the International Energy Agency New Policy Scenario provides small changes (+1%) to this increasing disease burden from the demographic transition. Under the International Energy Agency Clean Air Scenario we estimate 791,000 (95UI: 202,000-1,336,000) annual premature mortalities in 2050, avoiding 335,000 annual premature mortalities (45% of the increase) compared to the scenario of no emission change. Our study highlights that critical public health benefits are possible with stringent emission reductions, despite population growth and aging increasing the attributable disease burden from O3 exposure even under such strong emission reductions. The disease burden attributable to ambient fine particulate matter exposure dominates that from ambient O3 exposure in the present day, while in the future, they may be similar in magnitude.

Stringent Emission Control Policies Can Provide Large Improvements in Air Quality and Public Health in India.

Exposure to high concentrations of ambient fine particulate matter (PM2.5) is a leading risk factor for public health in India causing a large burden of disease. Business-as-usual economic and industrial growth in India is predicted to increase emissions, worsen air quality, and increase the associated disease burden in future decades. Here we use a high-resolution online-coupled model to estimate the impacts of different air pollution control pathways on ambient PM2.5 concentrations and human health in India. We find that with no change in emissions, the disease burden from exposure to ambient PM2.5 in 2050 will increase by 75% relative to 2015, due to population aging and growth increasing the number of people susceptible to air pollution. We estimate that the International Energy Agencies New Policy Scenario (NPS) and Clean Air Scenario (CAS) in 2050 can reduce ambient PM2.5 concentrations below 2015 levels by 9% and 68%, respectively, offsetting 61,000 and 610,000 premature mortalities a year, which is 9% and 91% of the projected increase in premature mortalities due to population growth and aging. Throughout India, the CAS stands out as the most effective scenario to reduce ambient PM2.5 concentrations and the associated disease burden, reducing the 2050 mortality rate per 100,000 below 2015 control levels by 15%. However, even under such stringent emission control policies, population growth and aging results in premature mortality estimates from exposure to particulate air pollution to increase by 7% compared to 2015, highlighting the challenge facing efforts to improve public health in India.

Lessons from community-based payment for ecosystem service schemes: from forests to rangelands.

Climate finance investments and international policy are driving new community-based projects incorporating payments for ecosystem services (PES) to simultaneously store carbon and generate livelihood benefits. Most community-based PES (CB-PES) research focuses on forest areas. Rangelands, which store globally significant quantities of carbon and support many of the world's poor, have seen little CB-PES research attention, despite benefitting from several decades of community-based natural resource management (CBNRM) projects. Lessons from CBNRM suggest institutional considerations are vital in underpinning the design and implementation of successful community projects. This study uses documentary analysis to explore the institutional characteristics of three African community-based forest projects that seek to deliver carbon-storage and poverty-reduction benefits. Strong existing local institutions, clear land tenure, community control over land management decision-making and up-front, flexible payment schemes are found to be vital. Additionally, we undertake a global review of rangeland CBNRM literature and identify that alongside the lessons learned from forest projects, rangeland CB-PES project design requires specific consideration of project boundaries, benefit distribution, capacity building for community monitoring of carbon storage together with awareness-raising using decision-support tools to display the benefits of carbon-friendly land management. We highlight that institutional analyses must be undertaken alongside improved scientific studies of the carbon cycle to enable links to payment schemes, and for them to contribute to poverty alleviation in rangelands.