Estrategias y enfoques pertinentes al espacio público para hacer frente a las inundaciones

Climate change and disasters are fast emerging as the most defining challenge of the 21st century as global risk. Changes in many extreme weather and climate events have been observed and linked with human influences, including an increase in extreme high sea levels and an increase in the number of heavy precipitation events. About 70 percent of the coastlines worldwide are projected to experience sea level change within 20 percent of the global mean. India, a developing country of global south and a major global contributor, is among the first ten countries in climate risk index. The country is witnessing average sea level rise of 1.7 mm/ year with rising sea projections in coastal cities. Further, India host a large percentage of urban population living in slums. Dharavi slum, Asia's biggest slum, located in the centre of Mumbai along the coast, host a population of more than a million in just 2.1 square kilometre. Slums are located at land which is usually unsuitable for formal development, being the low lying marshy areas along the river basins or coastal mangroves. As a direct cause, the physical location of the slums in developing world, makes them at a greater risk of flooding. Urban slums of metropolitan Mumbai, Kolkata and Surat in India, along with many others, are vulnerable to flooding. The present policy framework lack in providing for climate resilience and has thus compelled the slum dwellers to adapt to the risk of flooding with local community based measures involving public space retrofits. The paper assess these adaptation measures and strategies from different coastal urban slums in India and aims to create a theoretical framework of measures and elements. Case study analysis approach is used to generate for adaptation strategies and presented in the parameters (type – time – role – intent and scale of adaptation). Results showcases a framework of adaptive and mitigation measures pertinent to local participation and public space retrofits for coastal urban slums. It enables the generation of a typology, lexicon of measures and elements, a toolkit to face extreme floods. Community mobilization with public space retrofits open new possibilities for addressing future floods and in gaining resilience.El cambio climático y las catástrofes se están convirtiendo rápidamente en el reto más definitorio del siglo XXI como riesgo global. Se han observado cambios en muchos fenómenos meteorológicos y climáticos extremos y se han relacionado con la influencia humana, como el aumento del nivel del mar extremadamente alto y el incremento del número de precipitaciones intensas. Se prevé que alrededor del 70% de las costas de todo el mundo experimenten un cambio en el nivel del mar dentro del 20% de la media mundial. India, un país en desarrollo del sur global y uno de los principales contribuyentes mundiales, se encuentra entre los diez primeros países en el índice de riesgo climático. El país está experimentando una subida media del nivel del mar de 1,7 mm/año con proyecciones de aumento del mar en las ciudades costeras. Además, India alberga un gran porcentaje de población urbana que vive en barrios marginales. El barrio marginal de Dharavi, el más grande de Asia, situado en el centro de Bombay a lo largo de la costa, alberga una población de más de un millón de personas en sólo 2,1 kilómetros cuadrados. Los barrios marginales están situados en terrenos que suelen ser inadecuados para el desarrollo formal, ya que son zonas pantanosas bajas a lo largo de las cuencas de los ríos o de los manglares costeros. Como causa directa, la ubicación física de los barrios marginales en el mundo en desarrollo hace que corran un mayor riesgo de inundación. Los barrios marginales del área metropolitana de Mumbai, Calcuta y Surat en India, junto con muchos otros, son vulnerables a las inundaciones. El marco político actual carece de resiliencia climática y, por tanto, ha obligado a los habitantes de los barrios marginales a adaptarse al riesgo de inundaciones con medidas locales basadas en la comunidad que implican la readaptación del espacio público. El documento evalúa estas medidas y estrategias de adaptación de diferentes barrios marginales costeros de la India y pretende crear un marco teórico de medidas y elementos. Se utiliza un enfoque de análisis de casos para generar estrategias de adaptación y se presentan los parámetros (tipo - tiempo - función - intención y escala de la adaptación). Los resultados muestran un marco de medidas de adaptación y mitigación pertinentes para la participación local y la reconversión del espacio público para los barrios marginales urbanos de la costa. Permite generar una tipología, un léxico de medidas y elementos, una caja de herramientas para hacer frente a las inundaciones extremas. La movilización de la comunidad con la readaptación del espacio público abre nuevas posibilidades para hacer frente a futuras inundaciones y para ganar resiliencia.Peer Reviewe

Potential of Post-Industrial Waste Landscape in Addressing Floods in Coastal Urban Slums

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Vogt-Koyanagi-Harada Disease: Current Diagnosis and Management

Vogt-Koyanagi-Harada (VKH) disease is a rare granulomatous inflammatory disease that affects pigmented structures, such as eye, inner ear, meninges, skin, and hair. This disease is mainly a T1 lymphocyte-mediated aggression to melanocytes. The availability of new investigational methods has improved our knowledge of the pathogenesis, clinical approach, diagnosis, and management of VKH disease. The disease has an acute onset of bilateral blurred vision with hyperemia in the absence of prior ocular trauma or any previous intraocular surgery. The chronic phase comprises of ocular and integumentary system pigmentary changes. Ocular findings may be accompanied by meningismus, hearing impairment, and skin lesions in a variable proportion of patients. Prompt diagnosis with early, aggressive, and long-term treatment of high-dose corticosteroids ensures good visual outcomes. The aim of this chapter is to present the clinicopathology, classification, recent imaging, investigations, and management of VKH disease

Role of Brain Angiotensin-II in Development of Experimental Diabetic Nephropathy in Wistar Rats

Abstract The renin-angiotensin-aldosterone system (RAAS) plays a key role in diabetic nephropathy (DN). Angiotensin-II secreted during the RAAS pathway increases nephropathy. It stimulates oxidative stress which can quench nitric oxide. Reduced nitric oxide level aggravates Ang-II-induced vasoconstriction. Ang-II has also emerged as a central mediator of the glomerular hemodynamic changes that are associated with renal injury. Deletion of ACE2 is also noted due to increased Ang-II level which leads to the development of DN. We hypothesize that nephropathy caused by Ang-II in the periphery may be controlled by brain RAAS. ACE inhibitors and ARBs may show the renoprotective effect when administered through ICV without crossing the blood-brain barrier. DN was observed after 8 weeks of diabetes induction through alloxan. Administration of captopril and valsartan once and in combined therapy for 2 weeks, significantly reduced urine output, blood urea nitrogen, total protein in the urine, serum cholesterol, serum creatinine, serum triglycerides, and kidney/body weight ratio as compared to diabetic control rats. Further, combination therapy significantly increased the body weight and serum nitrate level as compared to diabetic control animals. However, increased ACE2 levels in the brain may reduce the sympathetic outflow and might have decreased the peripheral activity of Ang-II which shows beneficial effects in DN

Livelihood strategies to address water induced vulnerability on marginal settlements: Lessons from Northern Mozambique and Mumbai

AbstractIncrease in water induced risks are realized with marginal settlements being more vulnerable due to limited adaptive capacity. The challenge put forward by climate change, in absence of adequate formal strategies, has forced the dwellers of marginal settlements, over the years, to adopt local adaptation strategies to survive the risk and live in harmony with water. The highly diverse characteristics based on livelihoods and social networks provide for adaptive capacity of the dwellers. The objective of the paper is to identify these strategies based on livelihoods or the daily activities of the dwellers within the marginal settlements in different territories. Rural marginal communities in Northern Mozambique and urban in Mumbai are assessed by direct observations, interpretation from collected images and literature review to present a framework of strategies based on livelihoods. Result provides for holistic findings that contribute to the lexicon of water-risk adaptation for marginal settlements in developing countries

Livelihood strategies to address water induced vulnerability on marginal settlements: Lessons from Northern Mozambique and Mumbai

Abstract Increase in water induced risks are realized with marginal settlements being more vulnerable due to limited adaptive capacity. The challenge put forward by climate change, in absence of adequate formal strategies, has forced the dwellers of marginal settlements, over the years, to adopt local adaptation strategies to survive the risk and live in harmony with water. The highly diverse characteristics based on livelihoods and social networks provide for adaptive capacity of the dwellers. The objective of the paper is to identify these strategies based on livelihoods or the daily activities of the dwellers within the marginal settlements in different territories. Rural marginal communities in Northern Mozambique and urban in Mumbai are assessed by direct observations, interpretation from collected images and literature review to present a framework of strategies based on livelihoods. Result provides for holistic findings that contribute to the lexicon of water-risk adaptation for marginal settlements in developing countries

Real-world scenario of retinopathy of prematurity in Kerala

Objective: The objective was to study the incidence and risk factors predisposing to retinopathy of prematurity (ROP) and to assess the outcome after laser photocoagulation. Design: This was a retrospective cohort observational study. Materials and Methods: Infants admitted to a Neonatal Intensive Care Unit of 12 referral hospitals in Kerala between May 2015 and June 2016 were followed up till retinal vascularization completes. Preterm infants with birth weight 34 weeks were screened for ROP at 4 weeks after birth or 31–33 postconceptional age, whichever was later. Infants with birth weight> 1700 g and gestation> 35 weeks were screened only on neonatologist's discretion. All infants were screened according to the Indian guidelines of type 1 and 2 ROP. We treated both eyes of all infants showing threshold ROP. Statistical analysis was done using SPSS version 16 (SPSS Inc., Chicago, IL, USA). Results: The incidence of ROP in 622 infants screened was 158 (25.4%), of which threshold ROP was seen in 61 (9.80%). No ROP was found in infants weighing> 2000 g or with a gestational age> 36 weeks. Risk factors predisposing to ROP were hours on ventilator, hemoglobin%, oxygen therapy, and number of blood transfusions, which were more significant in infants with type 1 or threshold ROP than type 2 ROP. Out of 97 infants with type 2 ROP, we saw stage 1 in 31 (30.92%), stage 2 in 59 (60.82%), and stage 3 in 7 (7.21%) infants. 61 (9.80%) infants with threshold ROP were treated with laser photocoagulation. Aggressive posterior ROP or rush disease was seen in 29 (47.54%) of 61 infants with type 1 ROP. Only 2 (3.27%) infants showed falciform fold over macula and 1 (1.63%) infant was blind due to retinal detachment. Conclusion: One-fourth of the infants showed ROP, of which one-tenth needed laser photocoagulation, the outcome of which was good. Risk factors predisposing to ROP were low hemoglobin, high oxygen therapy, increased number of blood transfusions, and hours of ventilator

Focal choroidal excavation on spectral domain-optical coherence tomography

We report the imaging characteristics of focal choroidal excavation (FCE) and associated choroidal neovascular membrane (CNVM) and interpret the probable etiopathogenesis of FCE through findings detected by multimodal imaging. FCE was found as an acquired entity in our case subsequent to the treatment of CNVM. In addition, the association of FCE with pachychoroid spectrum is reaffirmed through this case

Half-fluence photodynamic therapy in chronic central serous chorioretinopathy

Purpose: The aim of this study is to investigate the effect of half-fluence photodynamic therapy (PDT) in chronic central serous chorioretinopathy (CSC). Materials and Methods: Forty-two eyes of 34 patients with chronic CSC and symptoms for at least 6 months were retrospectively reviewed. All eyes were treated with indocyanine green (ICG)-guided half-fluence PDT. The primary outcome measure was the proportion of eyes with complete resolution of subretinal fluid (SRF) on spectral domain-optical coherence tomography (SD-OCT). The secondary outcome measure was change in best corrected visual acuity (BCVA). SPSS v. 16 software was used for statistical analysis. Results: The mean follow-up period was 12.5 ± 4.3 months. Twenty six (78.78%) eyes showed complete resolution of SRF (P < 0.01). BCVA increased by a mean of 0.43 to 0.42 log MAR (P < 0.31) at 12-month follow-up. Serous macular detachment height reduced from a mean of 166 μ to 40 μ (P < 0.01), and BCVA improvement of ≥ 1 line was seen in 16 eyes at 12 month follow-up visit. Ellipsoid line improvement was seen in 12 (36.36%) eyes compared to 5 (15.15%) eyes at the baseline visit (P = 0.01). Eyes with SD-OCT features of idiopathic serous-pigment epithelial detachment showed improvement of 0.12 logMAR in BCVA, as compared to irregular retinal pigment epithelium (0.01 logMAR) in 12 months duration. Conclusion: Half-fluence PDT is an effective and safe method in the treatment of chronic CSC with stabilization or improvement of anatomical and functional outcomes

Retinopathy of Prematurity: A NICU Based Approach

Retinopathy of prematurity is a fibrovascular proliferative disorder affecting the peripheral retinal vasculature in premature infants. It is one of the leading causes of preventable childhood blindness across the globe. The world is currently experiencing ROP as third epidemic, where majority of the cases are from middle-income countries. With intensive use of in-vitro fertilisation (IVF) and multiple births, ROP emerging as a significant problem globally. High quality neonatal services, better equipment, improved training, evidence-based screening protocols and access to ROP specialists preventing blindness due to ROP in most of the countries. For more than three decades, improvement in treatment strategy for severe ROP markedly decrease the incidence of ROP related blindness. Current international screening guidelines recommend ROP screening for all premature infants based on birth weight of less than 1501 g or a gestational age of 30 weeks or less, while latest Indian screening guidelines includes all premature infants with birth weight of <2000 grams or gestational age of <34 weeks. Current strategies include adoption of newer screening guidelines, telemedicine and vision rehabilitation