Linking food security, climate change adaptation and mitigation: the case of sustainable land management in Malawi

Climate-smart agriculture (CSA) aims at enhancing the capacity of farming systems to sustainably support food security in the context of climatic changes (CC). Questions arise about the profitability of alternative farming options and their cost-effectiveness in mitigating CC. A large dataset has been built through household surveys, key informant interviews and focus group discussions conducted in different agro ecological zones of Malawi. Farmers adopt a wide combination of sustainable land management (SLM) practices, earning often higher yields, profits and returns to labor than under conventional farming. Differences are more significant in dry areas indicating potential for CC adaptation. However, this may come at excessive costs in terms of capital and labor. Negative marginal abatement costs for most SLM options show synergies between increased farm incomes and CC mitigation. Cost- effectiveness of agriculture management practices is proposed as policy decision criterion to prioritize CSA interventions on the basis of economic efficiency in greenhouse gases abatement

Guillain–Barré syndrome from an emergency department view: how to better predict the outcome?

Objective In Guillain–Barre syndrome (GBS), respiratory failure is the most serious manifestation and mechanical ventilation (MV) is required in approximately 20% of the patients. In this retrospective study, we aimed to evaluate clinical factors that can be evaluated in the Emergency Department which may influence the short-term prognosis of GBS patients. Methods Data were acquired regarding age, sex, antecedent infections, neurological signs and symptoms, cerebrospinal fluid examination, nerve conduction studies, treatment of GBS, need for MV, length of stay in the hospital, and discharge destination (home or rehabilitation). Charlson Comorbidity Index and modified Erasmus GBS outcome score (mEGOS) were collected on admission. Results Seventy-eight GBS patients were recruited with a mean age of 53.9 (range 19-81). Sixty-nine (88.46%) were diagnosed with GBS and nine (11.54%) had classic Miller-Fisher syndrome. Mean values for the Charlson Comorbidity index were 1.20 ± 1.81, and the values of mEGOS were 2.4 ± 1.6. The rate of home discharge and rehabilitation was similar between elderly and younger patients. Patients who required MV had higher mEGOS (p-value=0.061). Regarding the electrophysiological subtypes, we did not observe a significant difference between AIDP and AMAN/AMSAN concerning the need for MV, the type of discharge, values of mEGOS and Charlson Comorbidity Index. Discussion A significant correlation was found between mEGOS and the need for MV. Age did not influence the short-term prognosis of GBS patients. mEGOS may be a useful tool for predicting outcomes in patients with GBS and higher mEGOS scores on admission significantly correlated with poor outcomes

Nerve Biopsy in Peripheral Neuropathies: Not All Water Is under the Bridge

Sural nerve biopsy has long been a valuable diagnostic tool for the study of peripheral neuropathies, although the recent introduction of non-invasive techniques (e.g., neuroimaging techniques, skin biopsy) and advanced genetic and immunological testing has changed the diagnostic workup of peripheral nervous system diseases. [...

Root coverage with a coronally positioned flap used in combination with enamel matrix derivative: 18-month clinical evaluation

Background: Ginigival recession can be successfully treated with coronally positioned flaps. Twelve-month data failed to demonstrate that topical application of enamel matrix derivative (EMD) used in combination with the coronally positioned flap enhances clinical outcomes of the surgical technique used alone. This study was designed to examine the effects of EMD combined with the coronally positioned flap over an 18-month postoperative period. Methods: Thirty patients presenting with Miller Class I or 11 gingival recessions on single-rooted teeth participated in this parallel-design clinical study. Six weeks after phase I therapy, recession areas were surgically treated with a coronally positioned flap for root coverage. Teeth in the experimental group received EMD treatment of the exposed root, whereas control teeth did not. Clinical parameters evaluated at baseline and 18 months postoperatively included gingival recession, clinical attachment level, probing depth, and the apico-coronal dimension of the keratinized tissue. Results: Compared to baseline, 18-month measurements showed a significant reduction in probing depth, gain in attachment level, and decrease in gingival recession for control and experimental groups. When the results of the two treatment groups were compared, the experimental group presented with significantly greater root coverage than the control group (2.66 +/- 0.61 mm versus 1.73 +/- 0.70 mm, respectively), more gain in clinical attachment than the control group (2.80 +/- 0.76 mm versus 2.06 +/- 0.70 mm, respectively), and a greater gain in the apico-coronal dimension of the keratinized tissue than the control group (0.13 +/- 0.06 mm versus -0.06 +/- 0.01 mm, respectively). Conclusion: The results of this study indicate that topical application of EMD is beneficial in augmenting the effects of the coronally positioned flap in terms of amount of root coverage, gain in clinical attachment, and in increasing the apicocoronal dimension of the keratinized tissue