Coccidioidomycosis (Valley Fever), Soil Moisture, and El Nino Southern Oscillation in California and Arizona.

The soil-borne fungal disease coccidioidomycosis (Valley fever) is prevalent across the southwestern United States (US). Previous studies have suggested that the occurrence of this infection is associated with anomalously wet or dry soil moisture states described by the "grow and blow" hypothesis. The growth of coccidioidomycosis is favored by moist conditions both at the surface and in the root zone. A statistical analysis identified two areas in Arizona and central California, with a moderate-to-high number of coccidioidomycosis cases. A Wavelet Transform Coherence (WTC) analysis between El Nino Southern Oscillation (ENSO), coccidioidomycosis cases, surface soil moisture (SSM; 0 to 5 cm) from European Space Agency-Climate Change Initiative (ESA-CCI), and shallow root zone soil moisture (RZSM; 0 to 40 cm depth) from Soil MERGE (SMERGE) was executed for twenty-four CA and AZ counties. In AZ, only SSM was modulated by ENSO. When case values were adjusted for overreporting between 2009 to 2012, a moderate but significant connection between ENSO and cases was observed at a short periodicity (2.1 years). In central CA, SSM, RZSM, and cases all had a significant link to ENSO at longer periodicities (5-to-7 years). This study provides an example of how oceanic-atmospheric teleconnections can impact human health.

Stable angina pectoris: what does the current clinical evidence tell us?

Coronary artery disease is the leading cause of death in the United States. The combination of noninvasive cardiovascular testing and invasive cardiac procedures accounts for a substantial portion of the yearly healthcare expenditure in the United States. Although the diagnosis of ischemically-driven chest pain may appear to be simple and straightforward, it often takes an astute clinician to confirm that clinically significant coronary artery blockage is the cause of a patient's chest pain. Cardiovascular research has provided convincing evidence that aggressive treatment of hypertension and hyperlipidemia--along with a management plan, based on the patient's combined risk factor profile, that includes blood glucose assessment, tobacco cessation, weight loss, healthy eating choices, and consistent aerobic exercise--must be provided to achieve optimal care for our patients. Over the ensuing decade, we will likely continue to see a shift away from routine percutaneous treatment of coronary lesions in favor of an aggressive assessment of a patient's cardiac risk profile followed by a treatment plan centered on active patient involvement including appropriate lifestyle changes and selective medications.

Application of a cardiac arrest score in patients with sudden death and ST segment elevation for triage to angiography and intervention.

The aim of this study was to test a previously validated, prognostic, cardiac arrest score in patients with ST segment elevation acute myocardial infarction (AMI) who suffered a witnessed cardiac arrest and survived to emergency department admission. A consecutive series constructed retrospectively from a sudden death database (n = 22) of patients with ST segment elevation AMI resuscitated from cardiac arrest underwent angiography and angioplasty of the culprit vessel within 24 hours of presentation. A cardiac arrest score was assigned to each case by explicit criteria present on evaluation. Primary outcomes were survival to hospital discharge and the degree of neurological recovery during the hospitalization. All patients underwent successful coronary angioplasty and 77% received adjunctive intraaortic balloon counterpulsation. The overall rate of survival to discharge was 41%. For cardiac arrest scores of 0, 1, 2, and 3, respectively, the rates of neurologic recovery were 0 (0%) of 4 (95% CI 0-53%), 3 (50%) of 6 (95% CI 15-85%), 2 (67%) of 3 (95% CI 13-98%), and 9 (100%) of 9 (95% CI 72-100%), and the rates of survival to discharge were 0 (0%) of 4, (95% CI 0-53%), 2 (33%) of 6 (95% CI 6-74%), 2 (67%) of 3 (95% CI 13-98%), and 9 (100%) of 9 (95% CI 72-100%), P < 0.01 for both outcomes over ascending scores. These results suggest appropriate patients for primary angioplasty after cardiac arrest are those with ST segment elevation AMI and an emergency department cardiac arrest score of > or = 2, thus predicting a 11 (92%) of 12 (95% CI 65-100%) chance of survival to discharge.