The identification of fiscal and macroeconomic imbalances - unexploited synergies under the strengthened EU governance framework

In the light of the lessons learned from the euro area sovereign debt crisis, the EU fiscal and macroeconomic governance framework was overhauled in 2011. Against this background, this paper analyses whether the broadened surveillance of fiscal and macroeconomic indicators under the strengthened governance framework would have facilitated the identification of emerging imbalances, had it been in place before the crisis. The findings suggest that the strengthened governance framework would have given earlier signals about emerging excessive fiscal and macroeconomic imbalances. Euro area countries thus would have been obliged to take preventive and corrective action at an earlier stage, provided that the stricter rules had been effectively implemented. At the same time, the paper concludes that the increased reliance of the EU fiscal governance framework on unobservable magnitudes such as the structural budget balance, which are difficult to measure in real time, will continue to impede the timely identification of underlying fiscal imbalances. It is suggested that the new macroeconomic imbalance procedure could have given earlier indications about the emergence of excessive macroeconomic imbalances, which in turn posed risks for fiscal sustainability. Looking forward, these preliminary findings suggest possible synergies between the, until now largely unrelated, fiscal and macroeconomic governance frameworks

Debt sustainability analysis for euro area sovereigns: A methodological framework

The euro area sovereign debt crisis has highlighted the importance of reducing public debt levels and building up sufficient fiscal buffers during normal and good times. It has also reaffirmed the need for a thorough debt sustainability analysis (DSA) to act as a warning system for national policies. This paper introduces a comprehensive DSA framework for euro area sovereigns that could be used for analysis of fiscal risks and vulnerabilities. Specifically, this framework consists of three main building blocks: (i) a deterministic DSA, which embeds debt simulations under a benchmark and various narrative shock scenarios; (ii) a stochastic DSA, providing for a probabilistic approach to debt sustainability; and (iii) other relevant indicators capturing liquidity and solvency risks. The information embedded in the three main DSA blocks can be summarised in a heat map, which can provide guidance on the overall assessment of risks to debt sustainability. This method reflects the need to have a broad-based assessment, cross-checking information and perspectives from various sources with a view to deriving a robust debt sustainability assessment

An unusual case of bowel obstruction in emergency surgery: The heterotopic mesenteric ossification

The heterotopic mesenteric ossification, also known as myositis ossificans, is a rare form of heterotopic ossification, a metaplastic phenomenon where new bone is formed in the mesenteric base, generally after abdominal trauma (surgical or other). The pathophysiology of heterotopic mesenteric ossification is unknown; clinical presentation is not specific, with vague abdominal symptoms, uncertain radiological findings, and often regular laboratory exams. No consensus exists on the best possible approach, although it might well be both medical and surgical. We reviewed the clinical history of a 28-year-old man with a recent motor vehicle accident who was admitted to our surgical unit with symptoms consistent with a small bowel obstruction; after surgery, a diagnosis of myositis ossificans was surprisingly made

Molecular detection of Leishmania infantum, Babesia vogeli, and Rangelia vitalii in dogs from the Embu-Guaçú municipality around the Guarapiranga Reservoir, São Paulo / Detecção molecular de Leishmania infantum, Babesia vogeli e Rangelia vitalii em cães do municipio de Embú-Guaçú no entorno da represa Guarapiranga, São Paulo

Vector-borne diseases are of great importance worldwide in human and veterinary medicine, as several parasites can cause disease in multiple different hosts. In this work, we investigated the prevalence of some vector-borne parasitic diseases in dogs in Embu-Guaçú, São Paulo, Brazil. Molecular diagnosis was performed by PCR using oligonucleotide markers specific for protozoans with significance in both animal and human health, such as Leishmania infantum, Rangelia vitalii, and Babesia vogeli. Molecular diagnostic results showed a high occurrence (16.25%, 13/80) of Babesia vogeli, but negative results for Leishmania infantum and Rangelia vitalii. Further studies should be conducted with a larger number of dogs, and vector control and educational measures should be implemented within the population to minimize the impact of vector-borne diseases on animal health

Magnetic resonance imaging findings of the posterior fossa in 47 patients with mucopolysaccharidoses : a cross-sectional analysis

Background: Mucopolysaccharidoses (MPS) is a group of hereditary multisystemic lysosomal disorders. Most neuroimaging studies in MPS have focused on the supratentorial compartment and craniocervical junction abnormalities, and data regarding posterior fossa findings are scarce in the literature. Thus, our purpose is to describe posterior fossa findings on magnetic resonance imaging (MRI) of MPS patients. Methods: We reviewed routine MRI scans of MPS patients being followed up at our institution (types I, II, III, IV, and VI), focusing on posterior fossa structures. Results: Forty-seven MPS patients were included. MRI-visible perivascular spaces were commonly found in the midbrain and adjacent to the dentate nuclei (85% and 55% of patients, respectively). White-matter lesion was not identified in most cases. Its most frequent localizations were in the pons and cerebellum (34% and 30% of patients, respectively). Enlargement of cerebrospinal fluid (CSF) spaces in the posterior fossa was present in 55% of individuals and was more frequent in neuronopathic patients (73% vs 40%; P = .02). Cerebellar volume was classified as normal, apparent macrocerebellum, atrophic, and hypoplastic in 38%, 38%, 21%, and 3% of patients, respectively. A depression of the posterior fossa floor in the midline sagittal plane was found in 22 patients (47%), which was statistical significantly associated with enlargement of CSF spaces (P = .02) and with apparent macrocerebellum (P = .03). Conclusion: The present study compiled the main posterior fossa findings in MPS patients. Classically described in the supratentorial compartment, MRI-visible perivascular spaces, white matter lesions, and enlarged perivascular spaces were also found in the posterior fossa. However, atrophy, which commonly affects cerebral hemispheres, was not the most frequent cerebellar morphology found in our study. Moreover, potential findings for future research were described