A Regional Review of Marine and Coastal Impacts of Climate Change on the ROPME Sea Area

The Regional Organization for the Protection of the Marine Environment (ROPME) Sea Area (RSA) in the northern Indian Ocean, which comprises the Gulf, the Gulf of Oman and the northern Arabian Sea, already experiences naturally extreme environmental conditions and incorporates one of the world’s warmest seas. There is growing evidence that climate change is already affecting the environmental conditions of the RSA, in areas including sea temperature, salinity, dissolved oxygen, pH, and sea level, which are set to continue changing over time. The cumulative impacts of these changes on coastal and marine ecosystems and dependent societies are less well documented, but are likely to be significant, especially in the context of other human stressors. This review represents the first regional synthesis of observed and predicted climate change impacts on marine and coastal ecosystems across the ROPME Sea Area and their implications for dependent societies. Climate-driven ecological changes include loss of coral reefs due to bleaching and the decline of fish populations, while socio-economic impacts include physical impacts from sea-level rise and cyclones, risk to commercial wild capture fisheries, disruption to desalination systems and loss of tourism. The compilation of this review is aimed to support the development of targeted adaptation actions and to direct future research within the RSA.Science, Faculty ofNon UBCOceans and Fisheries, Institute for theReviewedFacultyResearcherOthe

Optimal use and interpretation of the aldosterone renin ratio to detect aldosterone excess in hypertension

With the introduction of the aldosterone/renin ratio as a screening test, the detection rate of primary aldosteronism has increased considerably. Nevertheless, no consensus has so far been reached regarding the cutoff points, operating characteristics or indeed even the reference values for reporting the aldosterone/renin ratio using plasma active renin (ng/l or mU/l) measured by immunoradiometric assay. We review the characteristics of this ratio in normal individuals, essential hypertension and primary hyperaldosteronism in an attempt to reach an agreement regarding its optimum use and interpretation - both using the renin activity or concentration. It seems that the optimal cutoff for patients with primary aldosteronism is above 30 ng/dl per mug/l/h or 800 pmol/l per mug/l/h or 130 pmol/ng or 80 pmol/mU. We explore enhancing measures such as captopril loading or use with a plasma aldosterone cutoff as well as pitfalls with the test such as confounding medications or the need for confirmatory testing. For the latter, demonstration of autonomous aldosterone production via salt loading is widely used, but may not be most advantageous and may even be contraindicated in patients with severe hypertension. The renin stimulation test may be an alternative being safe, well tolerated, and cost effective