The socioecological benefits and consequences of oil palm cultivation in its native range: The Sustainable Oil Palm in West Africa (SOPWA) Project.

Agriculture is expanding rapidly across the tropics. While cultivation can boost socioeconomic conditions and food security, it also threatens native ecosystems. Oil palm (Elaeis guineensis), which is grown pantropically, is the most productive vegetable oil crop worldwide. The impacts of oil palm cultivation have been studied extensively in Southeast Asia and - to a lesser extent - in Latin America but, in comparison, very little is known about its impacts in Africa: oil palm's native range, and where cultivation is expanding rapidly. In this paper, we introduce a large-scale research programme - the Sustainable Oil Palm in West Africa (SOPWA) Project - that is evaluating the relative ecological impacts of oil palm cultivation under traditional (i.e., by local people) and industrial (i.e., by a large-scale corporation) management in Liberia. Our paper is twofold in focus. First, we use systematic mapping to appraise the literature on oil palm research in an African context, assessing the geographic and disciplinary focus of existing research. We found 757 publications occurring in 36 African countries. Studies tended to focus on the impacts of palm oil consumption on human health and wellbeing. We found no research that has evaluated the whole-ecosystem (i.e., multiple taxa and ecosystem functions) impacts of oil palm cultivation in Africa, a knowledge gap which the SOPWA Project directly addresses. Second, we describe the SOPWA Project's study design and-using canopy cover, ground vegetation cover, and soil temperature data as a case study-demonstrate its utility for assessing differences between areas of rainforest and oil palm agriculture. We outline the socioecological data collected by the SOPWA Project to date and describe the potential for future research, to encourage new collaborations and additional similar projects of its kind in West Africa. Increased research in Africa is needed urgently to understand the combined ecological and sociocultural impacts of oil palm and other agriculture in this unique region. This will help to ensure long-term sustainability of the oil palm industry-and, indeed, all tropical agricultural activity-in Africa.

Bradycardia in anorexia nervosa.

We present a case of a 24-year-old woman initially referred for a permanent pacemaker for symptomatic sinus bradycardia. Further consultations revealed significant weight loss and subsequent psychiatric review confirmed a diagnosis of anorexia nervosa.

Contralateral transvenous left ventricular lead placement of implantable devices with pre-sternal tunnelling in chronically obstructed subclavian veins.

Cardiac resynchronisation therapy (CRT) is a recognised therapy for the management of severe left ventricular dysfunction, advanced congestive cardiac failure (NYHA III or IV), ventricular dyssynchrony (either broad LBBB or mechanical dyssynchrony on echocardiography) and failure of optimal medical therapy to achieve improvement in clinical status. Upgrading right ventricular pacemakers or defibrillators to biventricular devices is common and we describe here, 2 such cases of biventricular upgrade with blocked venous access on the ipsilateral side and successful placement of left ventricular leads following pre-sternal tunnelling from the contralateral side.

p.Y1449C SCN5A mutation associated with overlap disorder comprising conduction disease, Brugada syndrome, and atrial flutter.

Mutations in the SCN5A gene, which encodes the cardiac sodium channel, have been associated with cardiac arrhythmia syndromes and conduction disease. Specific SCN5A mutations had initially been considered to cause specific phenotypes. More recently, some SCN5A mutations have been associated with overlap syndromes, characterized by phenotypic heterogeneity within and between mutation carriers. Here we report and associate the presence of the p.Y1449C SCN5A mutation in a single family with a spectrum of cardiac phenotypes including conduction disease, Brugada syndrome and atrial arrhythmias, for the first time to our knowledge.

An unusual case of Butcher's Broom precipitating diabetic ketoacidosis.

BACKGROUND: Herbal medicines are readily available and commonly perceived to be relatively harmless. Butcher's Broom is used in various medicinal preparations and contains substances having α-adrenergic-stimulating properties. OBJECTIVE: Our aim was to report a case of toxicity associated with Butcher's Broom in a diabetic patient. CASE REPORT: A 39-year-old woman developed diabetic ketoacidosis 5 days after beginning therapy with Butcher's Broom for mild ankle swelling. Her diabetic ketoacidosis was complicated by hyperkalemia and acidosis with a pH of 7.02. After management with intravenous fluid, insulin, and calcium gluconate, her condition stabilized and she was discharged several days later. CONCLUSIONS: This case represents a small but potentially serious public health concern in a diabetic woman taking Butcher's Broom.

Objective quantification of global and regional left ventricular systolic function by endocardial tracking of contrast echocardiographic sequences.

BACKGROUND: Echocardiographic assessment of LV wall motion is still most frequently done visually. This study was designed to validate a new system for semi-automatic quantification of global and regional LV systolic function from contrast-enhanced cross-sectional echocardiograms. METHODS: Measurements of LV volumes were validated in 50 patients using magnetic resonance (MR) as reference. The regional identification of the endocardial boundary was validated frame-by-frame against the visually identified border in another 27 patients. Finally, the applicability of the system for quantifying stress-echocardiographic exams was assessed in 52 patients undergoing dobutamine interventions. Echocardiographic sequences were digitally processed using custom-built algorithms, based on local phase feature descriptors, deformable contour fitting, and prospective training. RESULTS: Compared to MR, the tracing system showed reasonable accuracy, with relative errors for end-diastolic volume, end-systolic volume, and EF of 21+/-20%, 27+/-33%, and--4+/-18%, respectively. Regional agreement of the instantaneous contours with visually traced borders was within the limits of visual reproducibility. The system was suitable for tracking stress-echo studies from all patients except two (96%). Quantification of regional radial shortening allowed to discriminate segments showing an abnormal regional wall motion with an overall area under the ROC curve of 0.87. CONCLUSIONS: A reliable and accurate quantification of LV systolic function can be obtained by processing contrast echocardiograms. Values of LV volumes, ejection fraction, and regional endocardial shortening adequately correlate with currently available reference methods. Readily applicable to baseline and stress studies, endocardial tracking techniques increase the reliability of echocardiography for the assessment of global and regional systolic function.

Ventricular septal rupture following abciximab infusion.

Ventricular septal rupture is a rare complication of myocardial infarction. Despite a significant reduction in its incidence with reperfusion therapy, thrombolysis has been implicated in the pathogenesis of septal rupture. There is little information regarding the impact of glycoprotein IIb-IIIa receptor blockers on ventricular septal rupture. We report a case of rupture of the ventricular septum occurring after treatment with the glycoprotein IIb-IIIa receptor blocker abciximab, in the absence of thrombolysis.

Atrial septal endocarditis.

Atrial septal endocarditis can occur as an isolated event or in association with valvular endocarditis. It is also reported following percutaneous device closure of atrial septal defects. We present the echocardiography findings from a young man presenting with endocarditis of an abnormal mitral valve in whom endocarditis was demonstrated associated with an atrial septal defect.

Intracardiac echocardiography to guide myocardial biopsy of a primary cardiac tumour.

A 61-year-old man presented with recurrent ventricular tachycardia (left bundle branch block morphology, superior axis). Magnetic resonance imaging (Fig. 1) and contrast-enhanced transthoracic echocardiography (Fig. 2) demonstrated an ill-defined mass in the right heart along the free wall of the right atrium, involving the tricuspid valve and extending into the right ventricle. Extensive investigation showed no evidence of extra-cardiac involvement and a tissue diagnosis was recommended. Accordingly, we elected to proceed to myocardial biopsy and, to facilitate accurate tissue localisation, we performed the procedure under guidance with intracardiac echocardiography.

Percutaneous closure of an atrial septal defect in a patient with congenitally corrected transposition.

Congenitally corrected transposition of the great arteries can be associated with other congenital cardiac abnormalities. The development of percutaneous closure devices potentially offers the opportunity to close related cardiac defects without exposing patients to the increased risks of cardiac surgery. This case report describes the successful closure of an atrial septal defect in a patient with congenitally corrected transposition of the great arteries using an Amplatzer septal occluder.

Flecainide overdose--support using an intra-aortic balloon pump.

BACKGROUND: Flecainide is an antiarrhythmic agent which is being used increasingly for the management of super-ventricular arrhythmias. Overdose with flecainide is frequently fatal with mortality reported as high as 22% due to arrhythmias, myocardial depression and conduction defects leading to electro-mechanical dissociation and asytole. Supportive measures are often required during the case and previously have included inotropes, extracorporeal membrane oxygenation and cardiopulmonary bypass. CASE PRESENTATION: A 47 year old lady presented to the emergency department with a four hour history of severe central chest pain. Her ECG showed atrial fibrillation and broad QRS complexes with a sine wave appearance. She had a past history of paroxysmal atrial fibrillation and significant psychiatric history. Following thrombolysis for a presumed myocardial infarction she developed cardiogenic shock with severely impaired left ventricular function. An intra-aortic balloon pump was inserted and coronary angiography demonstrated normal coronary arteries. With inotropic support she improved over 48 hours, with both her QRS duration and left ventricular function returning to normal. Biochemical testing following her discharge demonstrated significantly elevated levels of flecainide. CONCLUSION: The use of an intra-aortic balloon pump is a useful supportive measure during the acute phase of flecainide overdose associated with severe myocardial depression.

Quantitative analysis of myocardial perfusion in rats by contrast echocardiography.

BACKGROUND: The ability to assess myocardial perfusion in small animals is important, especially to investigate models of myocardial ischemia. Myocardial perfusion is usually assessed by postmortem techniques, eliminating the possibility of follow-up. We sought to evaluate whether contrast echocardiography was able to quantify myocardial perfusion in rats. METHODS: Twenty-four rats divided in 3 groups (sham-operated, and 8 and 21 days after left anterior descending coronary artery stenosis) underwent myocardial contrast echocardiography using intermittent triggered imaging. Peak plateau intensity and slope of refilling were compared with myocardial blood flow achieved with fluorescent microspheres. RESULTS: High-quality images were easily obtained for each experiment. Close correlation was found between myocardial contrast echocardiography and myocardial blood flow, especially for measurements of peak plateau intensity x slope of refilling relative to the control area (y = 1.15 x -0.14, r = 0.86). CONCLUSION: Quantification of myocardial perfusion in rats is feasible by myocardial contrast echocardiography using intermittent triggered imaging.

Can contrast dobutamine stress echocardiography be performed with standardized imaging settings for everybody?

OBJECTIVE: The objective was to assess a standardized imaging and contrast injection protocol for contrast-enhanced dobutamine stress echocardiography (DSE). METHODS: A total of 102 patients underwent DSE with tissue harmonic imaging and a standardized protocol with contrast power modulation. Contrast intensities in the left ventricular cavity and the myocardium were evaluated by a visual score and quantitative analysis. RESULTS: Of the contrast studies, 98% were diagnostic without modification of the settings. Excellent endocardial border definition was found in 93% of the segments with contrast versus 53% with tissue harmonic imaging (P < .05). The interobserver agreement in assessing segmental wall motion improved from 71.5% to 85.9%. There were no differences between the myocardial segments' video intensity in the four- and three-chamber views. In the two-chamber view video intensity was lower in the basal segments compared with the other segments. CONCLUSION: Power modulation contrast imaging can be applied with a completely standardized protocol for DSE in the majority of patients with excellent endocardial border definition.

Changes in intrathoracic impedance from a pneumothorax: insights from an implanted monitoring system.

The measurement of transthoracic impedance is now possible using new implantable cardioverter-defibrillators. This can be used to monitor fall in impedance associated with increasing pulmonary oedema. We describe a case of a large rapid increase of impedance and dyspnoea related to a pneumothorax.

Left ventricular pseudoaneurysm and rupture after limited myocardial infarction.

A 50-year-old man had a large lateral left ventricular wall pseudoaneurysm with rupture after a limited myocardial infarction. This was diagnosed by the combination of flow in and out of the aneurysm and pulsatile flow in the pericardial cavity using color flow and continuous wave Doppler ultrasound. This report describes the case management, the use of echocardiography in this setting, and the implications of pseudoaneurysm formation.

Safety of contrast dobutamine stress echocardiography: a single center experience.

BACKGROUND: Contrast is increasingly being used during dobutamine stress echocardiography. However, there are few data regarding the safety of this combination. METHODS: We retrospectively analyzed 751 consecutive stress echocardiograms, 332 without contrast and 419 with contrast (299 with Sonouve, 120 with Optison). Reported side effects and physiologic data were then compared. RESULTS: There were no fatalities. The incidence of side effects was similar in the 3 groups. The Optison group had a lower diastolic blood pressure compared with the noncontrast group ( P < .05) at rest, and the Sonovue group had a higher peak heart rate compared with the noncontrast group ( P < .001). Patients receiving Optison had more premature atrial contractions ( P < .05) but there was no difference in the incidence of ventricular tachycardia, supraventricular tachycardia, or vagally mediated episodes. CONCLUSION: The use of contrast during dobutamine stress echocardiography was not associated with an increased risk of side effects.