Participatory analysis of sustainable land and water management practices for integrated rural development in Myanmar

Besides providing reliable water resources for agricultural production, rural development efforts in Myanmar should target rural water security in terms of safe water supply and sanitation, and by mitigating water-related hazards. However, very few studies are available over the status of water-related development in rural areas of the country, and consequently on suitable practical solutions. The present paper describes a participatory workshop undertaken involving 45 rural development officers of the Department of Rural Development (DRD) of the Ministry of Agriculture, Livestock and Irrigation (MOALI), aimed at identifying suitable sustainable land and water management (SLWM) practices to be developed in rural areas of the country. Adoption of water safety plans (WSP), water harvesting, and soil and water bioengineering were strongly supported, while the need for improving water sanitation, especially in the poorest areas, was made evident. Insights of the participatory process confirmed that the poorest regions of Myanmar have also the worst water management structures. The results of the present work can represent baseline information and a needs assessment for future development projects in the country. However, there is a strong need for more studies and reports targeting marginalized rural contexts of Myanmar, to support equitable development

Infliximab- and Immunosuppressant-Resistant Crohn's Disease Successfully Treated with Adsorptive Granulocyte Apheresis Combined with Prednisolone

Activated granulocytes, monocytes, and platelets appear to be closely involved in active Crohn's disease (CD). Adsorptive granulocyte apheresis (GCAP) is a new treatment for inflammatory bowel disease. GCAP was used to treat a 23-year-old female patient with CD resistant to both infliximab (IFX) and azathioprine (AZA). At 16 years of age, the patient underwent a partial ileal resection for peritonitis caused by perforative ileitis. On pathological examination of the resected specimen, the diagnosis was CD. Mesalazine was started, but the patient did not comply with therapy. She was admitted to our hospital again in 2007 due to an acute exacerbation. IFX induction therapy was started. The combination of both AZA daily and IFX every 8 weeks was continued as maintenance therapy. However, she developed severe abdominal pain in September 2009. Computed tomography revealed ileitis and ascending colitis, and blood tests showed high inflammatory response marker levels. She was considered to have IFX- and AZA-resistant CD. Initial intravenous steroid therapy did not result in any improvement. Therefore, weekly GCAP therapy was given for 5 weeks, which immediately improved the inflammatory response markers. GCAP combined with prednisolone could be effective for IFX- and AZA-refractory CD

Mortality rate of patients with cystic fibrosis on the waiting list and within one year after lung transplantation : a survey of Italian CF centers

Background: Cystic Fibrosis (CF) Centers are involved in the decisions regarding the eligibility of CF patients with end-stage lung disease and timing for inclusion on waiting lists (WL) for lung transplantation (LT). There are currently no data on the mortality rates of Italian CF patients on WL and during the first year after LT and we aimed to assess these outcomes by surveying the CF Centers. Methods: A survey was sent to Italian CF Centers which were requested to report the age at which all CF subjects included on the WL between 2010 and 2014 were included on the list, admitted to either standard or urgent LT, or had died either while on the WL or within the first 3 and 12 months after LT. All outcomes were recorded by December 31, 2015. Results: Two hundred fifty-nine CF subjects were included on the WL during the 5-year study period. The mortality rate during the WL was 19.3% and was not associated with sex, age at inclusion on the WL or standard or urgent access to LT. 159 (61.4%) subjects underwent LT, 46 (28.9%) with urgent procedure. Deaths within the first 3 and 12 months after LT were significantly more prevalent in individuals who underwent urgent LT compared to those with standard LT (p < 0.01). Conclusions: The mortality of Italian CF patients, included in our survey, was about twice that reported by the National Transplant Center for all LT indications, including CF, during the same time period and despite the introduction of urgent LT. The latter was associated with an unfavorable early outcome compared to standard LT

Phlegmonous colitis: another source of sepsis in cirrhotic patients?

<p>Abstract</p> <p>Background</p> <p>The clinical relevance of phlegmonous colitis (PC), a rare autopsy finding in cirrhotic patients, is poorly documented. We postulated that PC might be a source of sepsis in patients with portal hypertensive colopathy (PHC).</p> <p>Case presentation</p> <p>We report three cirrhotic patients who were admitted with abdominal sepsis and who illustrate, to various degrees, the clinico-pathological sequence of colonic alterations associated with portal hypertension. Two cirrhotic patients with PHC developed gram-negative bacteraemia and quickly responded to intravenous antibiotics. Another cirrhotic patient underwent emergency colectomy for PC, and subsequently died from multiple organ failure. Histological alterations in the operative specimen included: a) mucosal ulcerations; b) disseminated micro-abscesses in the submucosa; and c) a severe vasculopathy leading to complete obliteration of submucosal blood vessels.</p> <p>Conclusions</p> <p>These data suggest that cirrhotic patients with PHC may progress towards PC, which, in turn, may be the cause for life-threatening sepsis.</p

Recurrent lower gastrointestinal bleeding from idiopathic ileocolonic varices: a case report

<p>Abstract</p> <p>Introduction</p> <p>Varices of the colon are a rare cause of lower gastrointestinal bleeding, usually associated with portal hypertension due to liver cirrhosis or other causes of portal venous obstruction. Idiopathic colonic varices are extremely rare. Recognition of this condition is important as idiopathic colonic varices may be a cause of recurrent lower gastrointestinal bleeding.</p> <p>Case presentation</p> <p>We report the case of a 21-year-old Asian man from north India who presented with recurrent episodes of lower gastrointestinal bleeding. Colonoscopy revealed varices involving the terminal ileum and colon to the sigmoid. Thorough evaluation was undertaken to rule out any underlying portal hypertension. Our patient underwent subtotal colectomy including resection of involved terminal ileum and an ileorectal anastomosis.</p> <p>Conclusion</p> <p>Colonic varices are an uncommon cause of lower gastrointestinal bleeding. Idiopathic colonic varices are diagnosed after excluding underlying liver disease and portal hypertension. Recognition of this condition is important as prognosis is good in the absence of liver disease and is curable by resection of the involved bowel.</p

Impacts of climate change and vegetation response on future aridity in a Mediterranean catchment

The climate in the Mediterranean region is expected to become warmer and drier but future projections of precipitation are uncertain, especially in the Northern part. Additionally, the difficulty in determining the plant physiological responses caused by CO2 rising complicates the estimation of future evaporative demand, increasing the uncertainty of future aridity assessments. Vegetation responses to rising CO2 are expected to increase radiation use efficiency and reduce stomatal conductance, hence increasing plant's water use efficiency. These effects are often neglected when estimating future drought and aridity. Hence, the main objective of this study is to estimate the effect of climate change and vegetation stomatal conductance reduction on projected water balance components and the resulting impact on aridity in a medium-sized catchment of Central Italy. We validate and couple a hydrological model with climate projections from five regional climate models and perform simulations considering the vegetation responses or not. Results show that their inclusion significantly affects potential evapotranspiration. The other water balance components, namely actual evapotranspiration, water yield, percolation, and irrigation, are also influenced but with less significant changes. Considering or not the CO2 suppression effect on stomatal conductance, coupled with the uncertainty related to precipitation, highly affects the estimation of future aridity as the future climate classification ranges from “humid” to “semi-arid” depending on the simulation and climate model, even if model outputs need to be evaluated cautiously with CO2 concentration higher than 660 ppm

Soil and water bioengineering: practice and research needs for reconciling natural hazard control and ecological restoration

Soil and water bioengineering is a technology that encourages scientists and practitioners to combine their knowledge and skills in the management of ecosystems with a common goal to maximize benefits to both man and the natural environment. It involves techniques that use plants as living building materials, for: (i) natural hazard control (e.g., soil erosion, torrential floods and landslides) and (ii) ecological restoration or nature-based re-introduction of species on degraded lands, river embankments, and disturbed environments. For a bioengineering project to be successful, engineers are required to highlight all the potential benefits and ecosystem services by documenting the technical, ecological, economic and social values. The novel approaches used by bioengineers raise questions for researchers and necessitate innovation from practitioners to design bioengineering concepts and techniques. Our objective in this paper, therefore, is to highlight the practice and research needs in soil and water bioengineering for reconciling natural hazard control and ecological restoration. Firstly, we review the definition and development of bioengineering technology, while stressing issues concerning the design, implementation, and monitoring of bioengineering actions. Secondly, we highlight the need to reconcile natural hazard control and ecological restoration by posing novel practice and research questions