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Patterns of commercial fish catches over the period from 1984 to 2006 were studied in the Loreto region and in Iquitos, which is the most important town of the region and the principal fish marketplace of the Peruvian Amazon. Despite important inter-annual variations, the overall fish landings have significantly increased in the region during this period. The same three species dominated the catches during the whole period (Prochilodus nigricans, Potamorhina altamazonica and Psectrogaster amazonica), making up about 62% of the catches. However, the number of species exploited by commercial fisheries increased considerably during the 22 years of this study (from about 21 species in 1984 to over 65 in 2006), although part of the difference may be accounted for by a better identification of individual species nowadays. At the same time, the large high-valued species, such as Arapaima gigas, Colossoma macropomum and Brachyplatystoma rousseauxii, declined significantly and were replaced by smaller, short-lived and lower-valued species. Catches of the silver Arahuana (Osteoglossum bicirrhosum) also declined significantly during the studied period, strengthening recent warnings about the species' conservation status (Moreau and Coomes, Oryx 40:152-160, 2006). The relative proportions of the trophic groups (detritivores, omnivores and piscivores) remained relatively constant over the study period, but there were significant changes in the relative abundances of the species groups. The proportion of the dominant group, the Characiformes, which averaged about 81% of the catches, increased between 1984 and 2006, whereas the proportion of the Siluriformes and Perciformes remained constant. On the other hand, the proportion of Osteoglossiformes, represented only by two well known species (Arapaima gigas and Osteoglossum bicirrhosum), declined sharply during the same period. Important differences were observed between the landings of Iquitos and the landing of the whole Loreto region, indicating that conclusions drawn from the study of the Iquitos landings cannot be extrapolated to the whole landings of the Loreto region. The most important difference was the decreasing fish landings in Iquitos, whereas the total landings increased in the Loreto region at the same time. Potential causes of this phenomenon are discussed. Decreasing fish abundance around Iquitos (because of a higher fishing pressure) and a behavioural adaptation of fishermen to better law enforcement in Iquitos are likely explanations to be further investigated.

Objectives: The objectives were to evaluate the diagnostic accuracy for sepsis in an emergency department (ED) population of the cluster of differentiation-64 (CD64) glycoprotein expression on the surface of neutrophils (nCD64), serum levels of soluble triggering receptor expressed on myeloid cells-1 (s-TREM-1), and high-mobility group box-1 protein (HMGB-1).Methods: Patients with any of the following as admission diagnosis were enrolled: 1) suspected infection, 2) fever, 3) delirium, or 4) acute hypotension of unexplained origin within 24 hours of ED presentation. Levels of nCD64, HMGB-1, and s-TREM-1 were measured within the first 24 hours of the first ED evaluation. Baseline clinical data, Sepsis-related Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE II) score, daily clinical and microbiologic information, and 28-day mortality rate were collected. Because there is not a definitive criterion standard for sepsis, the authors used expert consensus based on clinical, microbiologic, laboratory, and radiologic data collected for each patient during the first 7 days of hospitalization. This expert consensus defined the primary outcome of sepsis, and the primary data analysis was based in the comparison of sepsis versus nonsepsis patients. The cut points to define sensitivity and specificity values, as well as positive and negative likelihood ratios (LRs) for the markers related to sepsis diagnosis, were determined using receiver operative characteristics (ROC) curves. The patients in this study were a prespecified nested subsample population of a larger study.Results: Of 631 patients included in the study, 66% (95% confidence interval [CI] = 62% to 67%, n = 416) had sepsis according with the expert consensus diagnosis. Among these sepsis patients, SOFA score defined 67% (95% CI = 62% to 71%, n = 277) in severe sepsis and 1% (95% CI = 0.3% to 3%, n = 6) in septic shock. The sensitivities for sepsis diagnosis were CD64, 65.8% (95% CI = 61.1% to 70.3%); HMGB-1, 57.5% (95% CI = 52.7% to 62.3%); and s-TREM-1, 60% (95% CI = 55.2% to 64.7%). The specificities were CD64, 64.6% (95% CI = 57.8% to 70.8%), HMGB-1, 57.8% (95% CI = 51.1% to 64.3%), and s-TREM-1, 59.2% (95% CI = 52.5% to 65.6%). The positive LR (LR+) for CD64 was 1.85 (95% CI = 1.52 to 2.26) and the negative LR (LR-) was 0.52 (95% CI = 0.44 to 0.62]; for HMGB-1 the LR+ was 1.36 (95% CI = 1.14 to 1.63) and LR-was 0.73 (95% CI = 0.62 to 0.86); and for s-TREM-1 the LR+ was 1.47 (95%

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Background: Recent data have suggested that 18 million of new sepsis cases occur each year worldwide, with a mortality rate of almost 30%. There is not consensus on the clinical definition of sepsis and, because of lack of training or simply unawareness, clinicians often miss or delay this diagnosis. This is especially worrying; since there is strong evidence supporting that early treatment is associated with greater clinical success. There are some difficulties for sepsis diagnosis such as the lack of an appropriate gold standard to identify this clinical condition. This situation has hampered the assessment of the accuracy of clinical signs and biomarkers to diagnose sepsis.

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