The role of forest conversion, degradation, and disturbance in the carbon dynamics of Amazon indigenous territories and protected areas.

Maintaining the abundance of carbon stored aboveground in Amazon forests is central to any comprehensive climate stabilization strategy. Growing evidence points to indigenous peoples and local communities (IPLCs) as buffers against large-scale carbon emissions across a nine-nation network of indigenous territories (ITs) and protected natural areas (PNAs). Previous studies have demonstrated a link between indigenous land management and avoided deforestation, yet few have accounted for forest degradation and natural disturbances-processes that occur without forest clearing but are increasingly important drivers of biomass loss. Here we provide a comprehensive accounting of aboveground carbon dynamics inside and outside Amazon protected lands. Using published data on changes in aboveground carbon density and forest cover, we track gains and losses in carbon density from forest conversion and degradation/disturbance. We find that ITs and PNAs stored more than one-half (58%; 41,991 MtC) of the region's carbon in 2016 but were responsible for just 10% (-130 MtC) of the net change (-1,290 MtC). Nevertheless, nearly one-half billion tons of carbon were lost from both ITs and PNAs (-434 MtC and -423 MtC, respectively), with degradation/disturbance accounting for >75% of the losses in 7 countries. With deforestation increasing, and degradation/disturbance a neglected but significant source of region-wide emissions (47%), our results suggest that sustained support for IPLC stewardship of Amazon forests is critical. IPLCs provide a global environmental service that merits increased political protection and financial support, particularly if Amazon Basin countries are to achieve their commitments under the Paris Climate Agreement.

Are indigenous territories effective natural climate solutions? A neotropical analysis using matching methods and geographic discontinuity designs.

Indigenous Territories (ITs) with less centralized forest governance than Protected Areas (PAs) may represent cost-effective natural climate solutions to meet the Paris agreement. However, the literature has been limited to examining the effect of ITs on deforestation, despite the influence of anthropogenic degradation. Thus, little is known about the temporal and spatial effect of allocating ITs on carbon stocks dynamics that account for losses from deforestation and degradation. Using Amazon Basin countries and Panama, this study aims to estimate the temporal and spatial effects of ITs and PAs on carbon stocks. To estimate the temporal effects, we use annual carbon density maps, matching analysis, and linear mixed models. Furthermore, we explore the spatial heterogeneity of these estimates through geographic discontinuity designs, allowing us to assess the spatial effect of ITs and PAs boundaries on carbon stocks. The temporal effects highlight that allocating ITs preserves carbon stocks and buffer losses as well as allocating PAs in Panama and Amazon Basin countries. The geographic discontinuity designs reveal that ITs' boundaries secure more extensive carbon stocks than their surroundings, and this difference tends to increase towards the least accessible areas, suggesting that indigenous land use in neotropical forests may have a temporarily and spatially stable impact on carbon stocks. Our findings imply that ITs in neotropical forests support Nationally Determined Contributions (NDCs) under the Paris Agreement. Thus, Indigenous peoples must become recipients of countries' results-based payments.

Evaluation of end-tidal carbon dioxide gradient as a predictor of volume responsiveness in spontaneously breathing healthy adults.

BACKGROUND: Methods to guide fluid therapy in spontaneously breathing patients are scarce. No studies have reported the accuracy of end-tidal CO2 (ET-CO2) to predict volume responsiveness in these patients. We sought to evaluate the ET-CO2 gradient (ΔET-CO2) after a passive leg rise (PLR) maneuver to predict volume responsiveness in spontaneously breathing healthy adults. METHODS: We conducted a prospective study in healthy adult human volunteers. A PLR maneuver was performed and cardiac output (CO) was measured by transthoracic echocardiography. ET-CO2 was measured with non-invasive capnographs. Volume responsiveness was defined as an increase in cardiac output (CO) > 12% at 90 s after PLR. RESULTS: Of the 50 volunteers, 32% were classified as volume responders. In this group, the left ventricle outflow tract velocity time integral (VTILVOT) increased from 17.9 ± 3.0 to 20.4 ± 3.4 (p = 0.0004), CO increased from 4.4 ± 1.5 to 5.5 ± 1.6 (p = 0.0), and ET-CO2 rose from 32 ± 4.84 to 33 ± 5.07 (p = 0.135). Within the entire population, PLR-induced percentage ∆CO was not correlated with percentage ∆ET-CO2 (R2 = 0.13; p = 0.36). The area under the receiver operating curve for the ability of ET-CO2 to discriminate responders from non-responders was of 0.67 ± 0.09 (95% CI 0.498-0.853). A ΔET-CO2 ≥ 2 mmHg had a sensitivity of 50%, specificity of 97.06%, positive likelihood ratio of 17.00, negative likelihood ratio of 0.51, positive predictive value of 88.9%, and negative predictive value of 80.5% for the prediction of fluid responsiveness. CONCLUSIONS: ΔET-CO2 after a PLR has limited utility to discriminate responders from non-responders among healthy spontaneously breathing adults.

Descripción clínica y epidemiológica de pacientes con pancreatitis crónica en un hospital de alta complejidad en Cali, 2011 a 2017 / Clinical and epidemiological description of patients with chronic pancreatitis treated at a quaternary care hospital in Cali, 2011-2017

Resumen Introducción: la pancreatitis crónica (PC) es una inflamación progresiva del páncreas que puede llevar a su destrucción e insuficiencia irreversibles. Es una patología desafiante para el médico, debido a que establecer su diagnóstico puede tomar meses e incluso años, el seguimiento de pacientes suele ser problemático y el conocimiento sobre la clínica y epidemiología en Colombia es incompleto. Este estudio pretende hacer una descripción de pacientes con PC en un centro de referencia en gastroenterología de Cali, Colombia. Metodología: estudio de corte transversal de pacientes adultos con PC confirmada por criterios clínicos y radiológicos entre 2011 y 2017. Resultados: se incluyeron 36 pacientes con PC. La mayoría fueron hombres (72,2%) y la media de edad fue 56 (+ 15,1) años. El dolor abdominal crónico fue la presentación clínica más común (83,3%). Cerca de un cuarto de pacientes presentaba diabetes mellitus (22,2%). Se consideró etiología idiopática en 58,3%, alcohólica en el 11,0% y biliar en el 11,0%. La tomografía axial computarizada (TAC), resonancia magnética (RMN) y colangiopancreatografía por RMN fueron los métodos diagnósticos más usados (60,5%), con los que en su mayoría se visualizó atrofia (53,1%), dilatación de conductos (49,0%) y calcificaciones del páncreas (34,7%). Conclusión: los síntomas inespecíficos de la PC en fases iniciales y su largo curso clínico favorecen al subdiagnóstico de esta patología. Los resultados presentados pueden contribuir a la futura creación de escalas clínicas locales que orienten estudios radiológicos y genéticos tempranos, con el fin de lograr un diagnóstico oportuno y mejorar la calidad de vida de estos pacientes.

Abstract Introduction: Chronic pancreatitis (CP) is a progressive inflammation of the pancreas that can lead to irreversible damage and failure. This condition poses great challenges to physicians since its diagnosis can take months or even years. Patient follow-up is often problematic and knowledge about its clinical presentation and epidemiology in Colombia is scarce. This study aims to describe patients with CP treated at a gastroenterology reference center in Cali, Colombia. Methodology: Cross-sectional study in adult patients with CP confirmed based on clinical and radiological criteria between 2011 and 2017. Results: 36 patients with CP were included. The majority were men (72.2%), and the mean age was 56 (+15.1) years. Chronic abdominal pain was the most common clinical presentation (83.3%). About a quarter of patients had diabetes mellitus (22.2%). Etiology was idiopathic in 58.3%, alcoholic in 11.0%, and biliary in 11.0%. Computed tomography (CT), magnetic resonance imaging (MRI), and MRI cholangiopancreatography were the most commonly used diagnostic methods (60.5%), showing mostly atrophy (53.1%), duct dilation (49.0%), and pancreatic calcifications (34.7%). Conclusion: Nonspecific symptoms of CP in early stages and its long clinical course favor the underdiagnosis of this condition. The results presented may contribute to the future creation of local clinical scales that guide early radiological and genetic studies to achieve a timely diagnosis and improve the quality of life of these patients.

Un ensayo clínico piloto de la efectividad clínica de dos presentaciones de esomeprazol / Clinical effectiveness of two esomeprazole presentations in a pilot trial

Resumen Introducción: el presente estudio tuvo como fin investigar la efectividad clínica de dos presentaciones de esomeprazol en pacientes con dispepsia de causa no estudiada. Métodos: se realizó un ensayo clínico piloto de dos presentaciones de esomeprazol de 40 mg recibidos diariamente por 28 días. Se eligieron pacientes con diagnóstico de dispepsia no estudiada que asistieron a consulta de gastroenterología en un hospital de referencia. Se evaluaron a los pacientes inicialmente con endoscopia y biopsia, el seguimiento a 2 y 4 semanas con escalas clínicas de síntomas y calidad de vida con cuestionarios validados en español (SODA y QoL-PEI) y eventos adversos. Además, se midieron los niveles de pH gástrico con pH-metrías en 24 horas al día 14 de tratamiento. Se tomaron niveles séricos del medicamento al momento de la evaluación de la pH-metría. Para las escalas clínicas se aplicó un análisis de varianza (ANOVA) de dos factores con medidas repetidas y al encontrar diferencias significativas en los tiempos se realizó una corrección de Bonferroni. Resultados: se aleatorizó un total de 33 pacientes, 16 y 17 pacientes en cada grupo. No hubo diferencias en el porcentaje de inhibición del pH gástrico al día 14 de tratamiento (p = 0,9795). No hubo diferencias en concentraciones de niveles séricos el día 14 (p = 0,2199). No se encontraron diferencias significativas en las escalas de gravedad y calidad de vida en las dos primeras semanas de tratamiento, pero sí en las últimas dos semanas, en las cuales el producto de prueba demostró mayor disminución del dolor (p = 0,0048) y superioridad en conformidad (p = 0,01) en la subescala SODA. No se presentaron eventos adversos serios y no hubo diferencias estadísticas entre la presentación eventos adversos no serios. Conclusiones: los productos de prueba y el de referencia mostraron efectos similares en variables clínicamente relevantes.

Abstract Introduction: This pilot studied the clinical effectiveness of two presentations of esomeprazole in patients with dyspepsia with undiagnosed causes. Methods: We conducted a pilot clinical trial of two 40 mg Esomeprazole presentations. Patients with dyspepsia of unknown cause at a gastroenterology clinic in a referral hospital were included. They received one or the other presentation daily for 28 days. Patients were initially evaluated with endoscopy and biopsy and received follow-up examinations at two and four weeks. Adverse events were recorded, and clinical symptom scales and quality of life questionnaires validated in Spanish (SODA and QoL-PEI) were used. In addition, gastric pH levels were measured continuously for 24 hours on day 14 of treatment. Serum levels of the medication administered were also measured on day 14 of treatment. A two-way repeated measures ANOVA was used to compare mean differences between the two groups. When significant differences in times were found, a Bonferroni correction was made. Results: A total of 33 patients were randomized into two groups: 16 patients in one group and 17 in the other. There were no differences in the percentages of gastric pH inhibition at day 14 of treatment (p = 0.9795). There were no differences in serum level concentrations on day 14 (p = 0.2199). No significant differences were found in severity and quality of life scales in the first two weeks of treatment. However, in the last two weeks of treatment the test product showed a larger decrease in pain (p = 0.0048) and superiority in compliance (p = 0.01) on the SODA subscale. There were no serious adverse events, and there were no statistical differences between the presentations of non-serious adverse events. Conclusions: The Test product and the Reference product showed similar effects on clinically relevant variables.

Comparación del efecto del tratamiento con inhaladores frente a las nebulizaciones en el manejo de las crisis de asma en niños menores de cinco años en el Servicio de Emergencia Pediátrica del Hospital Nacional Dos de Mayo / Comparison of the effect of treatment with inhalers front to nebulisation in the management of asthma crisis in children less than five years in the Pediatric Emergency Service at the National Hospital Dos de Mayo

Objetivo: Comparar el efecto del tratamiento con inhaladores versus nebulizadores de las crisis asmáticas leves y moderadas en niños menores de cinco años. Metodología: Se escogieron al azar dos grupos de niños menores de cinco años con crisis de asma leve y moderada según el score de Bierman y Pierson modificado por Tal. A un grupo se aplicó tratamiento con Inhaladores de dosis medida (Ventolín) con aerocámara a 2 puffs cada 20 minutos por 3 veces y a otro grupo se aplicó el tratamiento estándar de Nebulizaciones con Salbutamol (Ventolín) a 0.15mg/kg/dosis cada 20 minutos por 3 dosis. Luego se recogieron los hallazgos en una ficha de recolección de datos(la ficha de investigación de Asma-SOBA del servicio de Pediatría del Hospital Nacional Dos de Mayo) para analizarlos y compararlos. Resultados: Encontramos que después de aplicar el tratamiento de B2 agonistas tanto con Inhaladores de dosis medida como con Nebulizaciones hubo mejoría clínica No hubo ninguna hospitalización a causa de las crisis. Conclusiones: El efecto del tratamiento tanto con inhaladores de dosis medida como con nebulizaciones fue similar. La tasa de hospitalización fue de cero.

Objective: To compare the efficacy of the treatment of mild and moderate asthma attack using metered dose inhalers (MDI) versus nebulizers for children under five years old in Pediatric Emergency Hospital Nacional Dos de Mayo, Lima, Peru. Methods: Two groups of children under five years old with acute mild to moderate asthma were chosen at random, according to Bierman and Pierson score modified by Tal. One group was given treatment with metered dose inhalers (MDI) (Ventolin) with holding chamber 2 puffs every 20 minutes three times and the other received standard treatment with nebulizers Salbutamol (Ventolin) to 0.15 mg/kg/ dose every 20 minutes for three times with the possibility of moving to a second phase if necessary. Findings were collected in a data collection sheet then analyze and compare them. Results: We found that after applying both MDI as nebulizers was clinical improvement with a slight advantage of inhalers. Hospitalization rate was zero. Conclusions: Treatment with MDI is statistically similar to that of nebulizers in asthma attacks mild to moderate in children under five years in the service of Pediatric Emergency Hospital Nacional Dos de Mayo. Lima, Peru.