Cardiovascular aspects of COVID-19.

Coronavirus disease 2019 (COVID-19) is primarily a pulmonary disease, but also affects the cardiovascular system in multiple ways. In this review, we will summarise and put into perspective findings and debates relating to the diverse aspects of cardiovascular involvement of COVID-19. We will review evidence for the role of the renin-angiotensin-aldosterone system (RAAS), the risk of pre-existing cardiovascular disease in COVID-19 susceptibility and course, and the mechanism of acute and long-term myocardial injury. The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) uses membrane-bound angiotensin converting-enzyme-2 (ACE2) as a receptor for cell entry. ACE2 is part of an important counter-regulatory circuit antagonising the harmful effects of angiotensin II on lung and heart. Modulation of ACE2 may therefore affect disease susceptibility and disease course. However, observational clinical studies and one randomised trial have so far not yielded evidence for harmful or beneficial effects of blockers of the RAAS during COVID-19. Age, gender, and multi-morbidity all increase susceptibility to SARS-CoV-2. In contrast, pre-existing cardiovascular diseases do so only minimally, but they may aggravate the disease course. Direct SARS-CoV-2 infection of the heart tissue and myocytes is rare. Nevertheless, COVID-19 may lead to myocarditis-like acute cardiac injury, characterised by myocardial oedema, but lacking extensive myocyte loss and lymphocytic infiltration. Independent of this, increases in cardiac biomarkers (troponin, N-terminal pro-brain natriuretic peptide, D-dimer) are frequent, especially in the phase of severe systemic inflammation and acute respiratory distress syndrome, and quantitatively associated with poor outcome. The pulmonary infection may result initially in right ventricular dysfunction, but in cases with severe systemic infection hypoxia, hyperinflammation and cytokine storm heart failure may eventually ensue. Unlike other infections and inflammatory states, COVID-19 does not appear to trigger acute coronary syndromes. In children, even mild COVID-19 can induce a multisystem inflammatory syndrome with Kawasaki-like symptoms frequently accompanied by cardiogenic shock.

Transformation and endurance of Indigenous hunting: Kadazandusun‐Murut bearded pig hunting practices amidst oil palm expansion and urbanization in Sabah, Malaysia

Land‐use change and political–economic shifts have shaped hunting patterns globally, even as traditional hunting practices endure across many local socio‐cultural contexts. The widespread expansion of oil palm cultivation, and associated urbanization, alters land‐use patterns, ecological processes, economic relationships, access to land and social practices.In particular, we focus on the socio‐ecological dynamics between Kadazandusun‐Murut (KDM) hunters in Sabah, Malaysian Borneo, and bearded pigs (Sus barbatus;Malay: ‘babi hutan’), the favoured game animal for non‐Muslim communities throughout much of Borneo. We conducted 38 semi‐structured interviews spanning over 50 hr with bearded pig hunters, asking them about contemporary hunting practices and motivations, changes in hunting practices, changes in pig behaviour, and patterns of animal protein consumption in village and urban contexts.Amidst widespread land‐use change, primarily driven by oil palm expansion, respondents reported substantially different characteristics of hunting in oil palm plantations as compared to hunting in forests. Additionally, 17 of 38 hunters—including 71% (10/14) of hunters who started hunting before 1985, compared to 26% (6/23) of hunters who started hunting in 1985 or later—mentioned that bearded pigs are behaving in a more skittish or fearful way as compared to the past. Our respondents also reported reductions in hunting frequency and wild meat consumption in urban contexts as compared to rural contexts.However, despite these substantial changes in hunting and dietary practices, numerous KDM hunting motivations, hunting techniques and socio‐cultural traditions have endured over the last several decades. For some, bearded pig meat remains deeply tied to food provision, gifting and sharing customs, and cultural components of celebrations and feasts.Oil palm has cultivated new hunting practices that differ from those in forests, and has potentially contributed to altered bearded pig behaviour due to increased hunting accessibility. Together, oil palm and urbanization are helping reshape the KDM‐bearded pig socio‐ecological system. In light of these reshaped connections, we recommend location‐specific management approaches that ensure fair access to the dietary and social benefits of bearded pig hunting while preserving the critical conservation needs of bearded pig populations and habitat. These twin goals are particularly urgent given the confirmed outbreak of African Swine Fever (ASF), and mass deaths of domestic pigs and wild bearded pigs, in Sabah and Kalimantan in 2021.A free Plain Language Summary can be found within the Supporting Information of this article.