A young patient with concurrent splanchnic dynamic vascular compression syndromes

A thirty-year-old lady presented with chronic, postprandial abdominal pain associated with decreased appetite and weight loss. She had a past medical history of ulcerative colitis and past surgical history of Nissen fundoplication, hysterectomy and bilateral oophorectomy for endometriosis. Enhanced computed tomography (CT) of the abdomen/pelvis displayed severe narrowing of the celiac artery (CA) at the level of its ostium (Panel A) with post-stenotic dilatation. In an abdominal vascular ultrasound with respiratory maneuvers we saw a peak systolic velocity (PSV) in the CA during inspiration of 295 cm/s. The PSV was 108 cm/s during expiration for the CA. Peak systolic velocity in the superior mesenteric artery (SMA) was 424 cm/s during inspiration. Magnetic resonance angiogram (MRA, Panel B) showed compression of the SMA with post-stenotic dilatation. No signs of perivascular inflammation or fat stranding were appreciated. Serology studies workup showed only weakly positive anti nuclear antibody (ANA) titer. A mesenteric angiography (Panels C and D) illustrated progression to occlusion of the CA, a dynamic compression of the SMA with kinking mainly during expiration, and post-stenotic dilatation. The pre-operative suspicion for dynamic mesenteric vascular compression syndromes was intra-operatively confirmed with associated scarring along the CA and SMA via the arcuate ligament.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Influence of diabetes on ambulation and inflammation in men and women with symptomatic peripheral artery disease

AbstractObjectiveTo determine whether diabetes and sex were factors associated with ambulatory function, endothelial cell inflammation, oxidative stress, and apoptosis, and with circulating biomarkers of inflammation and antioxidant capacity in patients with peripheral artery disease (PAD) and claudication.Materials/MethodsAmbulatory function of 180 symptomatic men and women with PAD was assessed during a graded maximal treadmill test, 6-minute walk test, and 4-meter walk test. Patients were further characterized on endothelial effects of circulating factors present in the sera using a cell culture-based bioassay on primary human arterial endothelial cells, and on circulating inflammatory and vascular biomarkers.ResultsMen and women with diabetes had greater prevalence (p = 0.007 and p = 0.015, respectively) of coronary artery disease (CAD) than patients without diabetes. To assure that this difference did not influence planned comparisons, the data set was stratified on CAD. Diabetic men with CAD had a lower peak walking time (PWT) during the treadmill test and a slower 4-meter gait speed compared to non-diabetic men with CAD (p < 0.05). Diabetic women with CAD had a lower PWT compared to their non-diabetic counterparts (p < 0.01). Additionally, diabetic men with CAD had higher pigment epithelium-derived factor (p < 0.05) than their non-diabetic counterparts, and diabetic women with CAD had higher leptin (p < 0.01) and interleukin-8 levels (p < 0.05).ConclusionsIn patients with PAD, diabetic men and women with CAD had more severe claudication than their non-diabetic counterparts, as measured by shorter PWT, and the men had further ambulatory impairment manifested by slower 4-meter gait speed. Furthermore, the diabetic patients with CAD had elevations in interleukin-8, leptin, and PEDF

Taxing the Informal Economy: The Current State of Knowledge and Agendas for Future Research

This paper reviews the literature on taxation of the informal economy, taking stock of key debates and drawing attention to recent innovations. Conventionally, the debate on whether to tax has frequently focused on the limited revenue potential, high cost of collection, and potentially adverse impact on small firms. Recent arguments have increasingly emphasised the more indirect benefits of informal taxation in relation to economic growth, broader tax compliance, and governance. More research is needed, we argue, into the relevant costs and benefits for all, including quasi-voluntary compliance, political and administrative incentives for reform, and citizen-state bargaining over taxation

The Political Economy of Tax Reform in Bangladesh: Political Settlements, Informal Institutions and the Negotiation of Reform

political economy, tax reform, political settlementsThis paper explores the political economy of tax reform in Bangladesh over several decades, shedding light on the complex factors that account for unusually effective and sustained resistance to significant reform. We contend that it is necessary to understand both deep-seated formal and informal institutions and the micro-level incentives that shape the negotiation of short-term reform in order to comprehend tax outcomes. We describe a tax system that is highly informal, largely manual and characterised by high levels of discretion and corruption. However, despite appearing highly dysfunctional on the surface, this system serves the core interests of powerful political, economic and administrative actors. Underpinned by robust informal institutions, the current system delivers low and predictable tax rates to businesses, provides extensive discretion and opportunities for corruption to the tax administration, and acts as an important vehicle for political elites to raise funds and distribute patronage and economic rents. While the tax system has not been without reform, individual reform efforts have been constrained by the parameters of this broader settlement, leaving competing interest groups to pursue strategic gains at the margins while seeking to satisfy external reform demands. This tax bargain reflects Bangladesh’s broader political economy, which is characterised by entrenched informal institutions underpinning the combination of generally weak governance and high levels of economic growth – the so-called ‘paradox of Bangladesh’.DfID, NORA

Infarto del miocardio y su diagnóstico diferencial

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