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A recently developed preparation of C1 inhibitor concentrate was evaluated in patients with hereditary angioedema in two trials. In the acute-attack treatment trial, the time to relief of an acute attack of angioedema was significantly shorter with the C1 inhibitor than with placebo. In the prophylaxis trial, the attack rate over a 12-week period was significantly lower with the C1 inhibitor than with placebo. Hereditary angioedema due to C1 inhibitor deficiency is an autosomal dominant disorder characterized by recurrent episodes of angioedema that typically involve the extremities, abdomen, external genitalia, face, or oropharynx. 1 Abdominal attacks of angioedema, which are caused by local mucosal swelling, are often associated with severe abdominal pain, nausea, and vomiting. Such attacks frequently lead to hospitalization and occasionally to unnecessary exploratory surgery. 2 Laryngeal attacks are associated with a substantial risk of death. 2 Two forms of hereditary angioedema have been defined: type I (accounting for 85% of cases) is characterized by low antigenic and functional levels of C1 inhibitor, whereas type . . .

According to her, the disappearance of La Paz's native population was not the result of intermarriage and attrition, but of the loss of collective land ownership and of the social systems that allowed people to identify as Indians. According to Mitchell, \"they also helped change Carnival from something in which people participated on an individual basis into something in which audience and actors were clearly delineated\" (1995:60). According to his own account, \"that lucky day, I went out to the street for no reason beyond a strange impulse, as if some unknown force was driving me from inside.\" According to Vilela del Villar: It was retouched by two inexperienced foreign painters who had lived a somewhat loose life.

To assess the impact of helical computed tomography (HCT) on the rate of negative appendicitis (NA). A before-and-after comparison study comparing data from a prospective consecutive case series to data from a retrospective chart review. The prospective series included all patients presenting to the ED during a 19-month period, during which patients with suspected appendicitis were managed in accordance with a guideline that stipulated HCT in selected cases. The retrospective group included patients taken to the operating room (OR) with a preoperative diagnosis of appendicitis over a 4-year time frame before the use of HCT. The primary outcome variable was the rate of NA. During the HCT era, 104 of 310 patients, 71 (68%; 95% confidence interval [CI], 59-76) men and 33 (32%; 95% CI, 24-41) women, were taken to the OR with a diagnosis of appendicitis. Fourteen (13.5%; 95% CI, 8-21) were NA. During the pre-HCT period, 445 patients, 280 (62.9%; 95% CI, 58-67) men and 165 (37.1%; 95% CI, 33-42) women were taken to the OR with the preoperative diagnosis of appendicitis, and 66 (14.8%; 95% CI, 12-19) were NA. At the study institution, the selective use of HCT did not result in a significant decline in the rate of NA.

Fifty years later, the population had soared to more than 1,135,000 people, making it the nation's largest city.1 These figures, so disproportionate to the country's general rate of growth, underline what has been the driving demographic in Bolivia for the last half century: the migration of rural indigenous populations to the cities. [...]he calls it a bisagra, a \"hinge\" turning both ways, toward the more urbane city below and toward the impoverished Aymara villages that supply it with hopeful immigrants. The principal source of the country's important natural gas reserves as well as its growing agribusiness, Santa Cruz, along with neighboring Tarija, provides a full 40 percent of the nation's tax base and an even greater share of its GDP.3 This wealth, combined with the availability of arable land, has attracted enormous numbers of indigenous migrants from the Andes. According to Daniel Goldstein and Fatimah Williams Castro, these horrific events are also an expressive means through which an ignored and invisible part of the population is given a voice.

If, as David Guss argues, culture is a contested terrain with constantly changing contours, then festivals are its battlegrounds, where people come to fight and dispute in large acts of public display. Festive behavior, long seen by anthropologists and folklorists as the \"uniform expression of a collective consciousness, is contentious and often subversive,\" and The Festive State is an eye-opening guide to its workings. Guss investigates \"the ideology of tradition,\" combining four case studies in a radical multisite ethnography to demonstrate how in each instance concepts of race, ethnicity, history, gender, and nationhood are challenged and redefined. In a narrative as colorful as the events themselves, Guss presents the Afro-Venezuelan celebration of San Juan, the \"neo-Indian\" Day of the Monkey, the mestizo ritual of Tamunangue, and the cultural policies and products of a British multinational tobacco corporation. All these illustrate the remarkable fluidity of festive behavior as well as its importance in articulating different cultural interests. Many titles in the Voices Revived program are also newly available as ebooks, offered at a discounted price to support wider access to scholarly work.

Aim To illustrate the pre‐hospital management arsenals and protocols in different EMS units, and to estimate the perceived difficulty of diagnosing suspected acute heart failure (AHF) compared with other common pre‐hospital conditions. Methods and results A multinational survey included 104 emergency medical service (EMS) regions from 18 countries. Diagnostic and therapeutic arsenals related to AHF management were reported for each type of EMS unit. The prevalence and contents of management protocols for common medical conditions treated pre‐hospitally was collected. The perceived difficulty of diagnosing AHF and other medical conditions by emergency medical dispatchers and EMS personnel was interrogated. Ultrasound devices and point‐of‐care testing were available in advanced life support and helicopter EMS units in fewer than 25% of EMS regions. AHF protocols were present in 80.8% of regions. Protocols for ST‐elevation myocardial infarction, chest pain, and dyspnoea were present in 95.2, 80.8, and 76.0% of EMS regions, respectively. Protocolized diagnostic actions for AHF management included 12‐lead electrocardiogram (92.1% of regions), ultrasound examination (16.0%), and point‐of‐care testings for troponin and BNP (6.0 and 3.5%). Therapeutic actions included supplementary oxygen (93.2%), non‐invasive ventilation (80.7%), intravenous furosemide, opiates, nitroglycerine (69.0, 68.6, and 57.0%), and intubation 71.5%. Diagnosing suspected AHF was considered easy to moderate by EMS personnel and moderate to difficult by emergency medical dispatchers (without significant differences between de novo and decompensated heart failure). In both settings, diagnosis of suspected AHF was considered easier than pulmonary embolism and more difficult than ST‐elevation myocardial infarction, asthma, and stroke. Conclusions The prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre‐hospital conditions.

By viewing the Afro-Venezuelan Festival of San Juan in the historical context of a 45-year period, we can see the manner in which this celebration has articulated the changing social and political realities of those who have performed it. From the growth of nationalism and the consolidation of the Venezuelan state during the first years of democracy in the late 1940s, to the developmental fever generated by the oil boom of the 1970s, to the emergence of a new African consciousness in the present, the festival, like all cultural performances, has mirrored transformations within the community itself. Most recently, the celebration of San Juan has served to reconsolidate the community in a time of tremendous social turmoil and has also permitted those participating in it to speak about a subject few Venezuelans have ever wished to address--that of race. [festivals, cultural performance, resistance, Afro-American history, Latin America, Venezuela]

The study purpose was to examine “gray zone” B-type natriuretic peptide (BNP) levels (100-500 pg/mL) in terms of associated clinical factors, perceived severity, and outcomes in patients with established congestive heart failure (CHF). Although gray zone BNP levels may have diagnostic ambiguity, the implications of these levels in patients with an established diagnosis of CHF have not been examined. REDHOT was a national prospective study in which 464 patients seen in the emergency department with dyspnea had BNP levels drawn. Entrance criteria included a BNP >100 pg/mL; however, physicians were blinded to the actual BNP level. Patients were followed up for 90 days. Thirty-three percent had gray zone BNP levels. There was no difference in perceived New York Heart Association class ( P = .32) or admission rates ( P = .76) between the gray zone and non–gray zone groups; 62% of patients with a gray zone BNP were identified as class III or IV CHF. Despite this perceived severity, the 90-day event rate was lower in the gray zone group (19.2% vs 32.9%, respectively, P = .002). Although patients in the gray zone had more symptoms of concomitant pulmonary disease, multivariate analysis could not demonstrate any variable that worsened the prognosis of patients with a gray zone BNP level. In patients with established CHF, those with gray zone BNP levels have a better prognosis than those with non–gray zone levels despite being perceived by physicians as having New York Heart Association class III or IV CHF.