An assessment of the economic impact Of climate change on the health sector in Saint Lucia

Climate change has the potential to impact on global, regional, and national disease burdens both directly and indirectly. Projecting and valuing these health impacts is important not only in terms of assessing the overall impact of climate change on various parts of the world, but also of ensuring that national and regional decision-making institutions have access to the data necessary to guide investment decisions and future policy design. This report contributes to the research focusing on projecting and valuing the impacts of climate change in the Caribbean by projecting the climate change-induced excess disease burden for two climate change scenarios in Saint Lucia for the period 2010 - 2050, and by estimating the non-market, statistical life-based costs associated with this excess disease burden. The diseases initially considered in this report are a variety of vector and water-borne impacts and other miscellaneous conditions; specifically, malaria, dengue fever, gastroenteritis/diarrhoeal disease, schistosomiasis, leptospirosis, ciguatera poisoning, meningococcal meningitis, and cardio-respiratory diseases. Disease projections were based on derived baseline incidence and mortality rates, available dose-response relationships found in the published literature, climate change scenario population projections for the A2 and B2 IPCC SRES scenario families, and annual temperature and precipitation anomalies as projected by the downscaled ECHAM4 global climate model. Monetary valuation was based on a transfer value of statistical life approach with a modification for morbidity. Using discount rates of 1, 2, and 4%, results show mean annual costs (morbidity and mortality) ranges of $80.2 million (in the B2 scenario, discounted at 4% annually) -$182.4 million (in the A2 scenario, discounted at 1% annually) for St. Lucia.1 These costs are compared to adaptation cost scenarios involving direct and indirect interventions in health care. This comparison reveals a high benefit-cost ratio suggesting that moderate costs will deliver significant benefit in terms of avoided health costs from 2010-2050. In this context indirect interventions target sectors other than healthcare (e.g. water supply). It is also important to highlight that interventions can target both the supply of health infrastructure (including health status and disease monitoring), and households. It is suggested that a focus on coordinated data collection and improved monitoring represents a potentially important no regrets adaptation strategy for St Lucia. Also, the need for this to be part of a coordinated regional response that avoids duplication in spending is highlighted.

Individuazione dei valori ottimali di crescita di dinoflagellate bentoniche, valutazione della tossicità e di interazioni allopatiche.

Individuazione dei valori ottimali di crescita di dinoflagellate bentoniche, valutazione della tossicità e di interazioni allelopatiche. Il fitoplancton rappresenta la base della catena trofica in ambiente marino, nonché oltre la metà  della produzione primaria a livello mondiale. Le dinoflagellate, assieme alle diatomee, costituiscono la maggior parte del fitoplancton, comprendendo numerose e diversificate specie di microalghe dalla differente distribuzione, ecologia e fisiologia. Alcune specie appartenenti a tale gruppo sono in grado di dare luogo, in determinate condizioni, a estesi fenomeni di fioriture algali, che diventano particolarmente impattanti se le specie coinvolte sono responsabili della produzione di biotossine, le quali possono direttamente uccidere altri organismi o accumularsi nei loro tessuti. Gli effetti nocivi di questi fenomeni si ripercuotono pesantemente sull'ecosistema marino, con ingenti morie di organismi acquatici (da pesci a molluschi, dal bentos al necton) e profonde alterazioni nelle comunità specifiche. Un forte coinvolgimento si ha di conseguenza anche per le attività umane, in seguito a forti esternalità negative su pesca, turismo, attività ricreative, o spesso con rischi direttamente correlati alla salute umana, dovuti perlopiù ad ingestione di organismi contaminati o all'inalazione di tossine per via aerea. Negli ultimi anni le fioriture algali tossiche si sono fortemente intensificate in distribuzione, estensione e frequenza, attirando l'interesse globale della comunità scientifica. Diversi studi condotti in questo senso hanno portato all'identificazione di numerose specie di dinoflagellate tossiche e all'isolamento di una lunga serie di composti chimici con effetti dannosi da esse sintetizzate. Tuttavia si conosce ancora ben poco sull'ecologia di queste specie, in particolare su quali siano i fattori che possano indurre o regolare la proliferazione e lo sviluppo di un bloom algale. Questo studio si è focalizzato su due specie di dinoflagellate bentoniche tossiche, Ostreopsis ovata e Coolia monotis, entrambe appartenenti alla famiglia Ostreopsidaceae, note già da tempo nei paesi tropicali poiché associate alla sindrome da ciguatera. Negli ultimi anni, Ostreopsis ovata è stata oggetto di numerose ricerche in Europa, poiché ha dato luogo a fenomeni di bloom, collegati con danni respiratori nell'uomo, anche lungo i litorali italiani; soltanto recentemente grazie ad una tecnica analitica basata sulla combinazione di cromatografia liquida e spettrometria di massa (LC-MS), è stato possibile isolare la diverse tossine responsabili. Durante i vari monitoraggi e campionamenti delle acque, questa dinoflagellata è stata sempre riscontrata in presenza di Coolia monotis (e Prorocentrum lima), di cui invece si conosce ben poco, visto che la sua tossicità in Mediterraneo non è ancora stata dimostrata, né la sua tossina caratterizzata. Il primo step di questo studio è stato quello di valutare, attraverso il mantenimento di colture in vitro, l'importanza della temperatura nella crescita di O. ovata e C. monotis (singolarmente) provenienti dalla zona del monte Conero (Ancona, Marche). Esistono già studi di questo tipo su ceppi adriatici di O. ovata, tuttavia è stato effettuato un esperimento similare utilizzando un nuovo ceppo, isolato in anni recenti; per C. monotis invece non sono presenti molti studi in letteratura, in particolare nessuno riguardante ceppi italiani. La valutazione della crescita è stata effettuata attraverso conteggio delle cellule, misura dell'efficienza fotosintetica e consumo dei macronutrienti. Quindi, visto che le due specie vivono in associazione nell'ambiente marino, si è cercato di evidenziare l'instaurarsi di eventuali processi competitivi o di fenomeni di allelopatia. Dall'analisi dei risultati è emerso che, se coltivate individualmente, sia C. monotis che O. ovata mostrano un optimum di crescita alla temperatura di 20°C, con tasso di crescita, numero di cellule e rendimento fotosintetico raggiunti più elevati, seppure non di molto rispetto alle colture a 25°C. Le colture a 30°C al contrario hanno mostrato valori sensibilmente inferiori. Se fatte crescere assieme, invece, C. monotis mantiene lo stesso pattern riscontrato nella monoculture a 20 e 25°C, seppur raggiungendo numeri di cellule inferiori, mentre a 30°C ha una crescita bassissima. Al contrario, O. ovata alla temperatura più elevata raggiunge lo stesso numero di cellule della monocultura, alla temperatura intermedia registra il tasso di crescita, ma non il numero di cellule, più elevato, mentre alla temperatura più bassa (che era l'optimum per la monocultura) si ha il maggior stress per la specie, evidenziando forti fenomeni di competizione. Esperimenti su C. monotis fatta crescere in un filtrato di O. ovata non hanno invece chiarito l'esistenza o meno di eventuali effetti allelopatici di Ostreopsis su Coolia, dato che non sono apparse differenze evidenti tra il controllo e il filtrato, mentre hanno messo in luce l'importanza dei batteri associati alle microalghe come supporto alla loro crescita, poiché le colture cresciute in filtrato sterile hanno manifestato tutte quante un rendimento quantico fotosintetico inferiore.

Neuroprotectant effects of iso-osmolar D-mannitol to prevent Pacific ciguatoxin-1 induced alterations in neuronal excitability: A comparison with other osmotic agents and free radical scavengers

The basis for the neuroprotectant effect of D-mannitol in reducing the sensory neurological disturbances seen in ciguatera poisoning, is unclear. Pacific ciguatoxin-1 (P-CTX-1), at a concentration 10 nM, caused a statistically significant swelling of rat sensory dorsal root ganglia (DRG) neurons that was reversed by hyperosmolar 50 MM D-mannitol. However, using electron paramagnetic resonance (EPR) spectroscopy, it was found that P-CTX-1 failed to generate hydroxyl free radicals at concentrations of toxin that caused profound effects on neuronal excitability. Whole-cell patch-clamp recordings from DRG neurons revealed that both hyper- and iso-osmolar 50 MM D-mannitol prevented the membrane depolarisation and repetitive firing of action potentials induced by P-CTX-1. In addition, both hyper- and iso-osmolar 50 MM D-mannitol prevented the hyperpolarising shift in steady-state inactivation and the rise in leakage current through tetrodotoxin (TTX)-sensitive Na-v channels, as well as the increased rate of recovery from inactivation of TTX-resistant Nav channels induced by P-CTX-1. D-Mannitol also reduced, but did not prevent, the inhibition of peak TTX-sensitive and TTX-resistant I-Na amplitude by P-CTX-1. Additional experiments using hyper- and isoosmolar D-sorbitol, hyperosmolar sucrose and the free radical scavenging agents Trolox (R) and L-ascorbic acid showed that these agents, unlike D-mannitol, failed to prevent the effects of P-CTX-1 on spike electrogenesis and Na-v channel gating. These selective actions of D-mannitol indicate that it does not act purely as an osmotic agent to reduce swelling of nerves, but involves a more complex action dependent on the Nav channel subtype, possibly to alter or reduce toxin association. (c) 2005 Elsevier Ltd. All rights reserved.

Block of voltage-gated potassium channels by Pacific ciguatoxin-1 contributes to increased neuronal excitability in rat sensory neurons

The present study investigated the actions of the polyether marine toxin Pacific ciguatoxin-1 (P-CTX-1) on neuronal excitability in rat dorsal root ganglion (DRG) neurons using patch-clamp recording techniques. Under current-clamp conditions, bath application of 2-20 nM P-CTX-1 caused a rapid, concentration-dependent depolarization of the resting membrane potential in neurons expressing tetrodotoxin (TTX)-sensitive voltage-gated sodium (Na-v,.) channels. This action was completely suppressed by the addition of 200 nM TTX to the external solution, indicating that this effect was mediated through TTX-sensitive Na-v channels. In addition, P-CTX-1 also prolonged action potential and afterhyperpolarization (AHP) duration. In a subpopulation of neurons, P-CTX-1 also produced tonic action potential firing, an effect that was not accompanied by significant oscillation of the resting membrane potential. Conversely, in neurons expressing TTX-resistant Na-v currents, P-CTX-1 failed to alter any parameter of neuronal excitability examined in this study. Under voltage-clamp conditions in rat DRG neurons, P-CTX-1 inhibited both delayed-rectifier and 'A-type' potassium currents in a dose-dependent manner, actions that Occurred in the absence of alterations to the voltage dependence of activation. These actions appear to underlie the prolongation of the action potential and AHP. and contribute to repetitive firing. These data indicate that a block of potassium channels contributes to the increase in neuronal excitability, associated with a modulation of Na-v. channel gating, observed clinically in response to ciguatera poisoning. (c) 2004 Elsevier Inc. All rights reserved.

Ciguatoxins: Cyclic polyether modulators of voltage-gated Iion channel function

Ciguatoxins are cyclic polyether toxins, derived from marine dinoflagellates, which are responsible for the symptoms of ciguatera poisoning. Ingestion of tropical and subtropical fin fish contaminated by ciguatoxins results in an illness characterised by neurological, cardiovascular and gastrointestinal disorders. The pharmacology of ciguatoxins is characterised by their ability to cause persistent activation of voltage-gated sodium channels, to increase neuronal excitability and neurotransmitter release, to impair synaptic vesicle recycling, and to cause cell swelling. It is these effects, in combination with an action to block voltage-gated potassium channels at high doses, which are believed to underlie the complex of symptoms associated with ciguatera. This review examines the sources, structures and pharmacology of ciguatoxins. In particular, attention is placed on their cellular modes of actions to modulate voltage-gated ion channels and other Na+-dependent mechanisms in numerous cell types and to current approaches for detection and treatment of ciguatera.

Toxinology in Australia's colonial era: A chronology and perspective of human envenomation in 19th century Australia

The medical management of those envenomed by snakes, spiders and poisonous fish in Australia featured extensively in the writings 19th century doctors, expeditioners and anthropologists. Against the background of this introduced medical doctrine there already existed an extensive tradition of Aboriginal medical lore; techniques of heat treatment, suction, incision and the application of plant-derived pharmacological substances featured extensively in the management of envenomed victims. The application of a hair-string or grass-string ligature, suctioning of the bite-site and incision were practised in a variety of combinations. Such evolved independently of and pre-dated such practices, which were promoted extensively by immigrant European doctors in the late 19th century. Pacific scientific toxinology began in the 17th century with Don Diego de Prado y Tovar's 1606 account of ciguatera. By the end of the 19th century more than 30 papers and books had defined the natural history of Australian elapid poisoning. The medical management of snakebite in Australia was the focus of great controversy from 1860 to 1900. Dogmatic claims of the supposed antidote efficacy of intravenous ammonia by Professor G.B. Halford, and that of strychnine by Dr. Augustus Mueller, claimed mainstream medical attention. This era of potential iatrogenic disaster and dogma was brought to a conclusion by the objective experiments of Joseph Lauterer and Thomas Lane Bancroft in 1890 in Brisbane; and by those of C.J. Martin (from 1893) and Frank Tidswell (from 1898), both of Sydney. The modern era of Australian toxinology developed as a direct consequence of Calmette's discovery, in Paris in 1894, of immune serum, which was protective against snakebite. We review the key contributors and discoveries of toxinology in colonial Australia.

First report of Ciguatoxins in two starfish species: Ophidiaster ophidianus and Marthasterias glacialis

Ciguatera fish poisoning (CFP) is a syndrome caused by the ingestion of fish contaminated with Ciguatoxins (CTXs). These phycotoxins are produced mainly by dinoflagellates that belong to the genus Gambierdiscus that are transformed in more toxic forms in predatory fish guts, and are more present in the Indo-Pacific and Caribbean areas. It is estimated that CFP causes per year more than 10,000 intoxications worldwide. With the rise of water temperature and anthropogenic intervention, it is important to study the prevalence of CFP in more temperate waters. Through inter- and subtidal sampling, 22 species of organisms were collected, in Madeira and Azores archipelagos and in the northwestern Moroccan coast, during September of 2012 and June and July of 2013. A total of 94 samples of 22 different species of bivalves, gastropods, echinoderms and crustaceans where analyzed by Ultra Performance Liquid Chromatography-Mass Spectometry-Ion Trap-Time of Flight (UPLC-MS-IT-TOF) and Ultra Performance Chromatography- Mass Spectrometry (UPLC-MS). Our main aim was to detect new vectors and ascertain if there were some geographical differences. We detected for the first time putative CTXs in echinoderms, in two starfish species—M. glacialis and O. ophidianus. We detected differences regarding uptake values by organisms and geographical location. Toxin amounts were significant, showing the importance and the need for continuity of these studies to gain more knowledge about the prevalence of these toxins, in order to better access human health risk. In addition, we suggest monitoring of these toxins should be extended to other vectors, starfish being a good alternative for protecting and accessing human health risk.

First report of Ciguatoxins in two starfish species: Ophidiaster ophidianus and Marthasterias glacialis

Ciguatera fish poisoning (CFP) is a syndrome caused by the ingestion of fish contaminated with Ciguatoxins (CTXs). These phycotoxins are produced mainly by dinoflagellates that belong to the genus Gambierdiscus that are transformed in more toxic forms in predatory fish guts, and are more present in the Indo-Pacific and Caribbean areas. It is estimated that CFP causes per year more than 10,000 intoxications worldwide. With the rise of water temperature and anthropogenic intervention, it is important to study the prevalence of CFP in more temperate waters. Through inter- and subtidal sampling, 22 species of organisms were collected, in Madeira and Azores archipelagos and in the northwestern Moroccan coast, during September of 2012 and June and July of 2013. A total of 94 samples of 22 different species of bivalves, gastropods, echinoderms and crustaceans where analyzed by Ultra Performance Liquid Chromatography-Mass Spectometry-Ion Trap-Time of Flight (UPLC-MS-IT-TOF) and Ultra Performance Chromatography- Mass Spectrometry (UPLC-MS). Our main aim was to detect new vectors and ascertain if there were some geographical differences. We detected for the first time putative CTXs in echinoderms, in two starfish species—M. glacialis and O. ophidianus. We detected differences regarding uptake values by organisms and geographical location. Toxin amounts were significant, showing the importance and the need for continuity of these studies to gain more knowledge about the prevalence of these toxins, in order to better access human health risk. In addition, we suggest monitoring of these toxins should be extended to other vectors, starfish being a good alternative for protecting and accessing human health risk.