El árbol Acacia mangium (Fabaceae) facilita la recuperación de áreas mineras en la selva lluviosa del Chocó, Colombia

Introducción: Las áreas impactadas por minería en bosques tropicales requieren de la aplicación de estrategias de restauración ecológica, pero este proceso, muchas veces involucra el uso de especies vegetales exóticas, desconociendo los efectos sobre la regeneración ecológica de los sitios donde se introducen. Objetivo: Evaluar el efecto de las plantaciones de Acacia mangium (planta exótica) sobre la rehabilitación ecológica temprana (suelo y vegetación) de áreas impactadas por minería de oro a cielo abierto en la selva pluvial tropical del Chocó, Colombia. Métodos: Se seleccionaron 16 áreas mineras como unidades de muestreo (ocho reforestadas con A. mangium y ocho en sucesión natural) en dos localidades. En cada unidad de muestreo se estableció una parcela de 2 × 50 m (cuatro parcelas por escenario de muestreo y localidad), donde se analizó la fertilidad del suelo (parámetros físicos y químicos) y se cuantificó el número de individuos de cada especie de planta vascular. Resultados: Se registraron 73 especies (69 géneros, 45 familias). La densidad de individuos fue mayor en áreas de sucesión natural que en aquellas reforestadas con A. mangium; por el contrario, la riqueza y diversidad de especies fueron superiores bajo las plantaciones de A. mangium. La similitud florística fue baja entre escenarios sucesionales (especies compartidas 35.6 %). El suelo mostró mejores condiciones (especialmente, N-NHO3) en áreas con A. mangium que en áreas en regeneración natural. Conclusiones: Las plantaciones de A. mangium parecen facilitar la rehabilitación temprana de la fertilidad del suelo y la vegetación en las minas abandonadas; por lo tanto, esta especie puede jugar un papel importante para la implementación de estrategias de restauración ecológica de áreas impactadas por minería de oro a cielo abierto en el Chocó y otros sistemas forestales tropicales con condiciones ambientales y de perturbación similares.

Introduction: Mining-impacted areas in tropical forests require the application of ecological restoration strategies, but this process often involves use of exotic plant species ignoring the effects on the ecological regeneration of the sites where they are introduced. Objective: To evaluate the effect of Acacia mangium plantations (exotic plant) on early ecological rehabilitation (soil and vegetation) of areas impacted by open-pit gold mining in the tropical rain forest of Chocó, Colombia. Methods: 16 mining areas were selected as sampling units (eight reforested with A. mangium and eight in natural succession) in two locations. In each sampling unit, a 2 × 50 m plot was established (four plots per sampling scenario and locality), where soil fertility (physical and chemical parameters) was analyzed and the number of individuals of each vascular plant species was quantified. Results: 73 species (69 genera, 45 families) were recorded. The density of individuals was higher in areas of natural succession than in those reforested with A. mangium; conversely, species richness and diversity were higher under the A. mangium plantations. Floristic similarity was low between successional scenarios (shared species 35.6 %). The soil showed better conditions (especially N-NHO3) in mining areas with A. mangium than in those in natural regeneration. Conclusions: A. mangium plantations appears to facilitate the early rehabilitation of soil fertility and vegetation in abandoned mines; therefore, this species can play an important role in the implementation of ecological restoration strategies in areas impacted by open-pit gold mining in the Chocó and other tropical forest systems with similar environmental and disturbance conditions.

Predictors of outcome in stable outpatients with peripheral artery disease.

Patients with peripheral artery disease (PAD) are at increased risk for subsequent ischemic events. We used data from the FRENA Registry to find predictors of subsequent myocardial infarction (MI), ischemic stroke, and limb amputation in stable outpatients with PAD. As of January 2012, 1,270 patients with PAD were recruited, of whom 1,042 (82 %) had Fontaine stage II; 113 (8.9 %) stage III; and 115 (9.1 %) stage IV. Over a mean follow-up of 14 months, 35 patients developed MI, 25 had stroke, 39 underwent limb amputation, and 91 died. Among patients with Fontaine stage II, the incidence of MI (2.09 events per 100 patient-years; 95 % CI 1.43-2.97) or stroke (0.93; 95 % CI 0.52-1.56) was similar to that of limb amputation (3.22; 95 % CI 2.37-4.29). On multivariate analysis, patients with diabetes [hazard ratio (HR) 2.09; 95 % CI 1.05-4.18], prior coronary disease (HR 5.35; 95 % CI 2.24-12.8), or atrial fibrillation (HR 3.11; 95 % CI 1.52-6.37) were at increased risk for MI; female (HR 2.94; 95 % CI 1.32-6.67), those with prior stroke (HR 5.21; 95 % CI 1.22-22.2) or atrial fibrillation (HR 3.37; 95 % CI 1.45-7.85) at increased risk for stroke; and female (HR 2.38; 95 % CI 1.23-4.55), those with diabetes (HR 3.50; 95 % CI 1.58-7.73) or advanced stages of PAD were at increased risk for limb amputation. Prior coronary artery disease, diabetes and atrial fibrillation predicted subsequent MI; female gender, prior stroke and atrial fibrillation predicted stroke; and female gender, diabetes, and advanced stages of PAD predicted limb amputation.

Concomitant use of proton pump inhibitors and clopidogrel in patients with coronary, cerebrovascular, or peripheral artery disease in the factores de Riesgo y ENfermedad Arterial (FRENA) registry.

BACKGROUND: Among patients receiving clopidogrel for coronary artery disease, concomitant therapy with proton pump inhibitors (PPIs) has been associated with an increased risk for recurrent coronary events. PATIENTS AND METHODS: Factores de Riesgo y ENfermedad Arterial (FRENA) is an ongoing, multicenter, observational registry of consecutive outpatients with coronary artery disease, cerebrovascular disease, or peripheral artery disease. We retrospectively examined the influence of concomitant use of PPIs on outcome in patients receiving clopidogrel. RESULTS: As of March 2009, 1222 patients were using clopidogrel: 595 had coronary artery disease, 329 cerebrovascular disease, and 298 had peripheral artery disease. Of these, 519 (42%) were concomitantly using PPIs. Over a mean follow-up of 15 months, 131 patients (11%) had 139 subsequent ischemic events: myocardial infarction 44, ischemic stroke 40, and critical limb ischemia 55. Seventeen of them (13%) died within 15 days of the subsequent event. PPI users had a higher incidence of myocardial infarction (rate ratio, 2.5; 95% confidence interval [CI], 1.3-4.8), ischemic stroke (rate ratio, 1.9; 95% CI, 1.03-3.7), and a nonsignificantly higher rate of critical limb ischemia (rate ratio, 1.6; 95% CI, 0.95-2.8) than nonusers. On multivariate analysis, concomitant use of clopidogrel and PPIs was independently associated with an increased risk for subsequent ischemic events both in the whole series of patients (hazard ratio, 1.8; 95% CI, 1.1-2.7) and in those with cerebrovascular disease or peripheral artery disease (hazard ratio, 1.5; 95% CI, 1.01-2.4). CONCLUSIONS: In patients with established arterial disease, concomitant use of PPIs and clopidogrel was associated with a nearly doubling of the incidence of subsequent myocardial infarction or ischemic stroke. This higher incidence persisted after multivariate adjustment.

Impact of a telemedicine system on acute stroke care in a community hospital.

In January 2007, a telestroke system was established between a community hospital lacking a neurologist on call and a stroke centre 70 km away. The telestroke system allowed urgent remote evaluation of the patient by a specialized neurologist, supervised thrombolytic treatment or a decision for urgent transfer to the stroke centre. During the first year of operation of the telestroke system, we studied all acute ischaemic stroke patients admitted to the community hospital and compared the results with the previous year. Approximately the same number of acute stroke patients were admitted to the community hospital in each year (201 cases in 2006 and 198 in 2007). The telestroke system was activated 75 times in 2007, the number of stroke patients evaluated by a specialized neurologist increased (17% vs. 38%, P > 0.001) and interhospital transfers were reduced (17% vs. 6%, P = 0.001). The number of thrombolytic treatments was doubled: 4.5% (n = 9) in 2006 vs. 9.6% (n = 19, 12 of them in the community hospital) in 2007 (P = 0.073). The telestroke system also reduced the time to tPA treatment from symptom onset (210 vs. 162 min, P = 0.05) and increased the number of patients treated in the 0-3 hours window (40% vs. 63%, P = 0.09). Telemedicine improved the quality of care administered to acute stroke patients admitted to a community hospital and reduced the number of inter-hospital transfers.

Metástasis muscular de una neoplasia de pulmón / Muscle metastasis of lung cancer

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Clinical outcome in patients with peripheral artery disease. Results from a prospective registry (FRENA).

BACKGROUND: The risk of future cardiovascular events in patients with peripheral artery disease (PAD) is often underestimated. PATIENTS AND METHODS: FRENA is an ongoing, observational registry of consecutive outpatients with symptomatic PAD, coronary artery disease (CAD) or cerebrovascular disease (CVD). We compared the incidence of major cardiovascular events (i.e., myocardial infarction, ischemic stroke, critical limb ischemia, or cardiovascular death) during a 12-month follow-up period in a series of consecutive outpatients with PAD, CAD or CVD. RESULTS: As of December 2006, 1265 patients had been enrolled in FRENA who completed the 12-month follow-up. Of these, 417 patients (33%) had PAD, 474 (37%) had CAD, 374 (30%) had CVD. Patients with PAD had an increased incidence of major cardiovascular events per 100 patient-years: 17 (95% CI: 13-22) vs. 7.9 (5.5-11) in those with CAD, or 8.9 (6.1-13) in those with CVD. Compared to patients with CAD or CVD those with PAD had a similar incidence of myocardial infarction or stroke, but a higher incidence of critical limb ischemia, limb amputation and death. This incidence increased with the severity of the symptoms: 8.7 (95% CI: 5.3-13) in patients in Fontaine stage IIa; 25 (95% CI: 16-38) in stage IIb; 26 (95% CI: 13-47) in stage III; 42 (95% CI: 24-67) in stage IV. CONCLUSIONS: Our data confirm a higher incidence of major cardiovascular events for patients with PAD, as well as a correlation of these events with the severity of PAD.