Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Efecto del cultivo bajo sombra en parámetros estructurales del totumo (Crescentia cujete) en el Caribe seco de Colombia

International audienceEl totumo (Crescentia cujete) es una leñosa forrajera propia del trópico seco americano cuyos frutos se aprovechan para suplementar al ganado durante la estación seca. En sistemas silvopastorales, se encuentra como árboles dispersos en potreros o en cercas vivas. Al ser un árbol de porte pequeño también puede plantarse a la sombra de árboles mayores. Sin embargo, poco se conoce del efecto de la sombra en el desarrollo de esta especie. En ese trabajo se compararon los datos de altura y diámetro del tronco a la altura del pecho de una plantación de 4 años de edad, establecida en una parcela de 6 ha a 80 m.s.n.m. del Caribe seco colombiano (coordenadas 10°60’00’’N 73°23’55’’W). Para el estudio se tomaron datos de 120 árboles situados a pleno sol y 120 situados bajo la sombra de árboles mayores (Leucaena leucocephala). Los datos se sometieron a un análisis de varianza y un test Fisher's PLSD. Los resultados mostraron que los árboles que han crecido bajo sombra son más altos en comparación a los que crecieron al sol (5,7 ± 0,8m vs. 5,2 ± 0,9m, p < .0001) y también más gruesos (10,4 ± 2,6cmvs. 9,4 ± 3,2m, p = 0,0021). Se concluye que el cultivo del totumo bajo sombra incrementa el valor de ambos parámetros estructurales

Potential of Calabash tree (Crescentia cujete) as a local resource to enhance sustainable livestock farming in the dry Caribbean region

International audienceA multidisciplinary and participative project (i.e. including farmers, technician, researchers and other local actors) is being carried out under the dry Caribbean region of Colombia. The aim is to get new and deep insights in the actual potential of Calabash tree (CT; Crescentia cujete) for contributing to the sustainable development goals of livestock production in the local context, with native and well-adapted resources. For this, a series of protocols have been placed under real-farm conditions (Farm El Porvenir-10°05'57" N 73°23'53" W). A previously established CT plantation (field layout: 4 m × 4 m) was used. A two-year monitoring protocol was settled (2022-2023) to follow how forage and fruit production and quality are affected by year season, sun exposure (total sun or penumbra) and pruning. Four treatments were allocated 1) Sun-Intact, SI; 2) Sun-Pruned, SP; 3) Penumbra-Intact, PI; 4) Penumbra-Pruned, PP). Representative samples were collected (almost bimonthly) in previously selected adult trees (n= 50 per treatment). The agronomic parameters include number of branches (young, medium and adult), forage production (fresh and dry matter per tree and hectare, ha), fruit production (i.e. per tree and per ha, number and weight of fruits, green or ripe). The kinetic of production and nutritive value are followed for each plant component. The meteorological local conditions are permanently monitored (i.e. T°C, relative humidity, rainfall, etc.). Thereafter, and considering the great potential of the CT fruit, the project includes the evaluation of different conservation strategies for using this resource in the ruminant feeding systems mainly during the dry season. First of all, the saline silage alternative is considered, as this is a common practice established by local farmers in their herds (i.e. other conservation methods are included, such as: fruit dehydration, natural conservation and mixing fruit pulp with fodder-CT leaves and grasses and/or with hay). Furthermore, a key component of the project is related to assessing the role of CT in the feeding, nutrition and metabolism, as well as anti-parasitic and enteric methane mitigation potentials when local ruminants (crossed Bos indicus cattle) are fed diets composed by CT forage, fresh and/or conserved pulp mixed with other local on-farm produced resources (e.g. Megathyrsus maximus cv. Tanzania). Protocols combine in vitro (Theodorou, 1994; Tilley and Terry, 1963; Bambou, et al., 2009 and RUSITEC ® technics), in situ (Orskov and McDonald, 1979) and in vivo methods (palatability, acceptability, voluntary intake and digestibility trials). Key physiological stages are considered in the in vivo trials under silvopastoral conditions of the farm (e.g. around calving) as well as feeding practices during dry season. Datasets are built for each variable, and multivariate analyses, multiple regression and other sound statistical procedures are carried out. The R software is used. Preliminary results until now demonstrate significant (P< 0.05) seasonal effects on forage and fruit production, as well as a significant effects (P< 0.05) of sunshine gradient and pruning on fruit production. Interpretation of results will be carried with a holistic, systemic, participatory approach, thus considering priorities of local farmers for their final adoption of results on their practical and day-today contexts

Genetic diversity of Piracanjuba populations in fish stocking programs in the Tietê River, Brazil

Abstract Background: Piracanjuba (Brycon orbignyanus) is a fish species highly affected by anthropogenic actions such as overfishing, water pollution, and hydroelectric developments. This species is currently considered in danger of extinction. Objective: To analyze the genetic diversity of a natural population (NP) and two captive broodstocks (SA and SB) of B. orbignyanus. Methods: Samples of caudal fins (NP: 24, SA: 30, and SB: 30) were collected. DNA was extracted and amplified for six RAPD primers and four microsatellite loci. Results: Sixty polymorphic fragments and 17 microsatellite alleles were detected. High intrapopulation heterozygosity (NP: 0.692, SA: 0.724, and SB: 0.686) was observed. Thirty-eight fragments and six alleles were shared among NP, SA, and SB. The FIS and Shannon’s Index of diversity revealed a lack of inbreeding within groups. AMOVA analyses and FST indicated very high (NP vs SA and SB) and small (SA vs SB) genetic differentiation, confirmed by genetic distance and identity, number of migrants and a dendrogram, which revealed the formation of two genetic groups. Conclusions: The two marker types showed similar variability. The groups have adequate genetic variability, with high differentiation between NP and SA-SB, and similarity between broodstocks.Resumo Antecedentes: Piracanjuba (Brycon orbignyanus) é uma espécie peixe fortemente impactada por ações antrópicas como sobrepesca, poluição e construção de hidrelétricas. Atualmente, essa espécie engloba a lista de peixes que correm perigo de extinção. Objetivo: Analisar a diversidade genética de uma população natural (NP) e de dois estoques de reprodutores em cativeiro (SA e SB) de B. orbignyanus. Métodos: Foram coletadas amostras de nadadeira caudal de 84 indivíduos (NP: 24, SA: 30 e SB: 30). O DNA foi extraido e amplificado para seis primers RAPD e quatro loci microssatélites. Resultados: Foram obtidos 60 fragmentos polimórficos e 17 alelos microssatélites. Foi observada uma alta heterozigosidade intra-populacional (NP: 0,692; SA: 0,724 e SB: 0,686). Trinta e oito fragmentos e seis alelos foram compartilhados entre NP, SA e SB. Os valores de FIS e índice de Shannon demonstraram ausência de endogamia entre os grupos. As análises de AMOVA e FST indicaram alta (NP vs SA e SB) e pequena (SA vs SB) diferenciação genética, resultados confirmados pela distância e identidade genética, número de migrantes e dendrograma, que evidenciaram a formação de dois grupamentos genéticos. Conclusões: Os grupos possuem adequada variabilidade genética, com alta diferenciação entre NP e SA-SB e similaridade entre os estoques de reprodutores.Resumen Antecedentes: Piracanjuba (Brycon orbignyanus) es una especie de pez fuertemente impactada por acciones antrópicas como sobrepesca, contaminación del agua y proyectos hidroeléctricos. Esta especie está considerada en peligro de extinción. Objetivo: Analizar la diversidad genética de una población natural (NP) y de dos lotes de reproductores (SA y SB) de B. orbignyanus en cautiverio. Métodos: Se colectaron 84 muestras de aleta caudal (NP: 24, SA: 30 y SB: 30). El ADN fue extraído y amplificado para seis cebadores RAPD y cuatro loci microsatélites. Resultados: Se obtuvieron 60 fragmentos polimórficos y 17 alelos microsatélites. Se observó alta heterocigosidad intra-poblacional (NP: 0,692; SA: 0,724 y SB: 0,686). Treinta y ocho fragmentos y seis alelos fueron compartidos entre NP, SA y SB. Los valores de FIS e índice de Shannon mostraron ausencia de endogamia entre los grupos. Los análisis de ANOVA y FST indicaron alta (NP vs SA y SB) y pequeña (SA vs SB) diferenciación genética; resultados confirmados por la distancia e identidad genética, número de migrantes y dendograma, evidenciando la formación de dos grupos genéticos. Conclusiones: Los grupos poseen adecuada variabilidad genética, con alta diferenciación entre NP vs SA-SB y similitud entre los lotes de reproductores

Unraveling transboundary water security in the arid Americas

Transboundary waters are characterized by diverse and complex socio-politico-economic obstacles to effective water management. We examine five distinct cases in the arid Americas–in locations from the US–Mexico border to the Andes mountains–employing water security as a conceptual prism to unravel the multiple and varied attributes of transboundary water challenges. We describe how borders complicate water security in arid regions and explore how institutional arrangements and practices–within and across jurisdictions–respond to these challenges. We find that institutional capacity is needed on multiple levels for effective water management, and institutions must be responsive and flexible to change.Fil: Albrecht, Tamee R.. University of Arizona; Estados UnidosFil: Varady, Robert G.. University of Arizona; Estados UnidosFil: Zuniga Teran, Adriana A.. University of Arizona; Estados UnidosFil: Gerlak, Andrea K.. University of Arizona; Estados UnidosFil: Routson De Grenade, Rafael. University of Arizona; Estados UnidosFil: Lutz Ley, América. El Colegio de Sonora; MéxicoFil: Martin, Facundo Damian. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Ciencias Humanas, Sociales y Ambientales; ArgentinaFil: Megdal, Sharon B.. University of Arizona; Estados UnidosFil: Meza, Francisco. Pontificia Universidad Católica de Chile; ChileFil: Ocampo Melgar, Diego. Pontificia Universidad Católica de Chile; ChileFil: Pineda, Nicolás. Colegio de Sonora; MéxicoFil: Rojas, Juan Facundo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Provincia de Mendoza. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales. Universidad Nacional de Cuyo. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales; ArgentinaFil: Taboada Hermoza, Rossi. Universidad Nacional Mayor de San Marcos; PerúFil: Willems, Bram. Universidad Nacional Mayor de San Marcos; Per

Efficacy and safety of two whole IgG polyvalent antivenoms, refined by caprylic acid fractionation with or without β-propiolactone, in the treatment of Bothrops asper bites in Colombia

The efficacy and safety of two whole IgG polyvalent antivenoms (A and B) were compared in a randomised, blinded clinical trial in 67 patients systemically envenomed by Bothrops asper in Colombia. Both antivenoms were fractionated by caprylic acid precipitation and had similar neutralising potencies, protein concentrations and aggregate contents. Antivenom B was additionally treated with β-propiolactone to lower its anticomplementary activity. Analysing all treatment regimens together, there were no significant differences between the two antivenoms (A = 34 patients; B = 33 patients) in the time taken to reverse venom-induced bleeding and coagulopathy, to restore physiological fibrinogen concentrations and to clear serum venom antigenaemia. Blood coagulability was restored within 6–24 h in 97% of patients, all of whom had normal coagulation and plasma fibrinogen levels 48 h after the start of antivenom treatment. Two patients (3.0%) had recurrent coagulopathy and eight patients suffered recurrence of antigenaemia within 72 h of treatment. None of the dosage regimens of either antivenom used guaranteed resolution of venom-induced coagulopathy within 6 h, nor did they prevent recurrences. A further dose of antivenom at 6 h also did not guarantee resolution of coagulopathy within 12–24 h in all patients. The incidence of early adverse reactions (all mild) was similar for both antivenoms (15% and 24%; P > 0.05).Instituto Colombiano para el Desarrollo de la Ciencia y la Tecnología Francisco José de Caldas//COLCIENCIAS/ColombiaUniversidad de Antioquia/[206PI0281]/CYTED/ColombiaUniversidad de Costa Rica//UCR/Costa RicaUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto Clodomiro Picado (ICP

Naturaleza urbana. Plataforma de experiencias

Naturaleza Urbana presenta experiencias autogestionadas que, con el tiempo, se han posicionado como ejercicios alternativos de identificación, monitoreo y recuperación de la biodiversidad urbana. En otros casos, el modelo comunidad-gobierno ha permitido desarrollar diagnósticos y propuestas de gestión corresponsables y sistémicas, entendiendo por esto último iniciativas que nacen desde los valores mismos que cada comunidad le atribuye a su biodiversidad. Del mismo modo, se presentan esfuerzos gubernamentales que han enriquecido la visión ambiental de los principales instrumentos de planificación urbana, por ejemplo, integrando la condición propiamente urbana como oportunidad para aumentar la oferta ambiental de la ciudad, fortaleciendo las funciones y procesos de la biodiversidad y revitalizando, con ello, la calidad de vida del entorno urbano. Por su parte, las universidades y los centros de investigación se han sumado a la ola emergente de generación de conocimiento en biodiversidad urbana (fenómeno nacional e internacional), han brindado evidencia científica de su valor para el bienestar humano y han propuesto reflexiones y lineamientos cualitativos de biodiversidad, con miras a hacer del ordenamiento un ejercicio más coherente con cada contexto territorial en particular.Bogotá, D. C., ColombiaInstituto de Investigación de Recursos Biológicos Alexander von Humbold

Urban Nature

Preservation, restoration, monitoring of biodiversity and promotion of native species, in their strict and classical sense, could be unviable strategies in the cities. Management systems such as the protected areas acquire profoundly different connotations and objectives from the traditional ones when thought of in the context of a city. Similarly, although ecological restoration seeks to return to a baseline ecosystem, there is little that we know about the vegetation present on the urban borders of the main Colombian cities prior to the 20th century. Finally, the models for potential distribution of species could produce unreliable results, because their methodological bases were not conceived based on urban dynamics. In this context, to de ne urban biodiversity and what strategy must be applied for its conservation implies a challenge that, beyond being scienti c, is necessarily social and cultural and involves planning and design. Innovation is inevitable.Bogotá, D. C

Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

Item does not contain fulltextOBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the ICU Study (EPIC II). Demographic, physiological, infection-related and therapeutic data were collected. Patients were grouped as having Candida, Gram-positive, Gram-negative, and combined Candida/bacterial bloodstream infection. Outcome data were assessed at intensive care unit and hospital discharge. SETTING: EPIC II included 1265 intensive care units in 76 countries. PATIENTS: Patients in participating intensive care units on study day. INTERVENTIONS: None. MEASUREMENT AND MAIN RESULTS: Of the 14,414 patients in EPIC II, 99 patients had Candida bloodstream infections for a prevalence of 6.9 per 1000 patients. Sixty-one patients had candidemia alone and 38 patients had combined bloodstream infections. Candida albicans (n = 70) was the predominant species. Primary therapy included monotherapy with fluconazole (n = 39), caspofungin (n = 16), and a polyene-based product (n = 12). Combination therapy was infrequently used (n = 10). Compared with patients with Gram-positive (n = 420) and Gram-negative (n = 264) bloodstream infections, patients with candidemia were more likely to have solid tumors (p < .05) and appeared to have been in an intensive care unit longer (14 days [range, 5-25 days], 8 days [range, 3-20 days], and 10 days [range, 2-23 days], respectively), but this difference was not statistically significant. Severity of illness and organ dysfunction scores were similar between groups. Patients with Candida bloodstream infections, compared with patients with Gram-positive and Gram-negative bloodstream infections, had the greatest crude intensive care unit mortality rates (42.6%, 25.3%, and 29.1%, respectively) and longer intensive care unit lengths of stay (median [interquartile range]) (33 days [18-44], 20 days [9-43], and 21 days [8-46], respectively); however, these differences were not statistically significant. CONCLUSION: Candidemia remains a significant problem in intensive care units patients. In the EPIC II population, Candida albicans was the most common organism and fluconazole remained the predominant antifungal agent used. Candida bloodstream infections are associated with high intensive care unit and hospital mortality rates and resource use