El paludismo en Córdoba desde la segunda mitad del siglo XIX hasta la primera mitad del XX. The paludism in Córdoba from the second half of XIXth century to the first half of XXth century.

A pesar de que en los últimos años los estudios sobre historia y sociología de la Salud y la Enfermedad han experimentado un salto cualitativo, se ha soslayado sistemáticamente el análisis del paludismo y los complejos entramados de poder que subyacen a su presencia en los Departamentos del Noroeste y -en menor medida- en los del Oeste de la provincia de Córdoba. Nos referimos específicamente a la presencia de la endemia en los departamentos de Cruz del Eje, San Javier, San Alberto, Minas y Pocho. Con el propósito de redimensionar un comportamiento endemoepidémico que en esas localidades de Córdoba se remontó -según exploraciones provisionales- a mediados del siglo XIX, se construyen problemáticas que cobran sentido al ingresar en el terreno de los proyectos político-estatales nacionales, provinciales y de las mismas localidades afectadas, y, en lo que refiere a la articulación de las respuestas sanitarias frente a una enfermedad de profundas connotaciones ligadas al desarrollo socioeconómico y político de las regiones en estudio. En ese sentido en una primera instancia se articulará un análisis demográfico de la presencia y distribucion de la enfermedad a partir del trabajo con datos de corte estadistíco, elaborando mapas, cuadros y gráficos de morbimortalidad. Convergentemente se realizará un análisis hermenéutico de fuentes históricas del período en estudio. A grandes rasgos se considera que en relación al impacto del paludismo en bastas zonas del interior de la provincia de Córdoba y en cuanto a la acción sanitaria de los aparatos de poder estatal, desde mediados del siglo XIX, hasta la importante reducción de casos nuevos de paludismo a mediados del XX, pueden determinarse dos etapas sucesivas: Una primera se podría datar desde mediados del siglo XIX hasta mediados de la década de 1930, en la que actúa un Estado Nacional liberal que se desentendía de los problemas sanitarios de la regiones dejando esa función en manos de las provincias afectadas. Un segundo momento, aunque delimitado provisionalmente entre mediados de la década del 30' y mediados de la década del 50', se halla complejizado en su definición al combinarse en él procesos políticos particulares de la esfera nacional y de la provincial. Por un lado, en el plano nacional se ha observado desde la historiografía del período que, a partir de la década del 40' comienza a manifestarse una acción estatal nacional progresivamente centralizada y dispuesta a combatir la enfermedad con instituciones que podían llegar a todos los sectores sociales y a todas las regiones geográficas, aunque en menor medida a las zonas extra-pampeanas.Paralelamente, al considerar esos años en la esfera provincial se debe analizar el impacto de las formulaciones e intervenciones del radicalismo sabattinista como matriz política contraria al gobierno conservador nacional y promotor de un nuevo modelo de Estado en el que ocuparían un lugar privilegiado las políticas orientadas a la "cuestión social" y a la Salud en particular. Por otro lado, cobra significación una cuestión poco reconocida en los estudios en materia de politica sanitaria: los planes del peronismo combinaron una política centralizada en materia de dirección con una descentralización en el área de la ejecución.Finalmente dentro de este complejo marco político sanitario, se debe atender a lo largo de las dos etapas delimitadas, al universo de las iniciativas articuladas desde las autoridades de las localidades afectadas por el paludismo, así como, a las iniciativas civiles ya sea de vecinos, Sociedades de Beneficencia y asociadas a la Iglesia Católica.De acuerdo a la perspectiva asumida se propone recuperar una significativa problemática de marginalidad socioeconómica de las regiones, procurando reconstruir el impacto sociodemográfico del paludismo en el Noroeste y Oeste de la provincia de Córdoba ingresando al analisis histórico de las construcciones del poder público y privado en ese contexto local.

Emma Darwin, a century of family letters, 1792-1896, ed. by her daughter Henrietta Litchfield ...

2

Emma Darwin, a century of family letters, 1792-1896, ed. by her daughter Henrietta Litchfield ...

1

A history of the first half-century of the National Academy of Sciences, 1863-1913.

1863-1913

A history of the first half-century of the National Academy of Sciences, 1863-1913.

1863-1913

Applicability of Two International Risk Scores in Cardiac Surgery in a Reference Center in Brazil

Background:The applicability of international risk scores in heart surgery (HS) is not well defined in centers outside of North America and Europe.Objective:To evaluate the capacity of the Parsonnet Bernstein 2000 (BP) and EuroSCORE (ES) in predicting in-hospital mortality (IHM) in patients undergoing HS at a reference hospital in Brazil and to identify risk predictors (RP).Methods:Retrospective cohort study of 1,065 patients, with 60.3% patients underwent coronary artery bypass grafting (CABG), 32.7%, valve surgery and 7.0%, CABG combined with valve surgery. Additive and logistic scores models, the area under the ROC (Receiver Operating Characteristic) curve (AUC) and the standardized mortality ratio (SMR) were calculated. Multivariate logistic regression was performed to identify the RP.Results:Overall mortality was 7.8%. The baseline characteristics of the patients were significantly different in relation to BP and ES. AUCs of the logistic and additive BP were 0.72 (95% CI, from 0.66 to 0.78 p = 0.74), and of ES they were 0.73 (95% CI; 0.67 to 0.79 p = 0.80). The calculation of the SMR in BP was 1.59 (95% CI; 1.27 to 1.99) and in ES, 1.43 (95% CI; 1.14 to 1.79). Seven RP of IHM were identified: age, serum creatinine > 2.26 mg/dL, active endocarditis, systolic pulmonary arterial pressure > 60 mmHg, one or more previous HS, CABG combined with valve surgery and diabetes mellitus.Conclusion:Local scores, based on the real situation of local populations, must be developed for better assessment of risk in cardiac surgery.

Comparison of ACUITY and CRUSADE Scores in Predicting Major Bleeding during Acute Coronary Syndrome

Background:The ACUITY and CRUSADE scores are validated models for prediction of major bleeding events in acute coronary syndrome (ACS). However, the comparative performances of these scores are not known.Objective:To compare the accuracy of ACUITY and CRUSADE in predicting major bleeding events during ACS.Methods:This study included 519 patients consecutively admitted for unstable angina, non-ST-elevation or ST-elevation myocardial infarction. The scores were calculated based on admission data. We considered major bleeding events during hospitalization and not related to cardiac surgery, according to the Bleeding Academic Research Consortium (BARC) criteria (type 3 or 5: hemodynamic instability, need for transfusion, drop in hemoglobin ≥ 3 g, and intracranial, intraocular or fatal bleeding).Results:Major bleeding was observed in 31 patients (23 caused by femoral puncture, 5 digestive, 3 in other sites), an incidence of 6%. While both scores were associated with bleeding, ACUITY demonstrated better C-statistics (0.73, 95% CI = 0.63 - 0.82) as compared with CRUSADE (0.62, 95% CI = 0.53 - 0.71; p = 0.04). The best performance of ACUITY was also reflected by a net reclassification improvement of + 0.19 (p = 0.02) over CRUSADE’s definition of low or high risk. Exploratory analysis suggested that the presence of the variables ‘age’ and ‘type of ACS’ in ACUITY was the main reason for its superiority.Conclusion:The ACUITY Score is a better predictor of major bleeding when compared with the CRUSADE Score in patients hospitalized for ACS.

Performance of Surgical Risk Scores to Predict Mortality after Transcatheter Aortic Valve Implantation

AbstractBackground:Predicting mortality in patients undergoing transcatheter aortic valve implantation (TAVI) remains a challenge.Objectives:To evaluate the performance of 5 risk scores for cardiac surgery in predicting the 30-day mortality among patients of the Brazilian Registry of TAVI.Methods:The Brazilian Multicenter Registry prospectively enrolled 418 patients undergoing TAVI in 18 centers between 2008 and 2013. The 30-day mortality risk was calculated using the following surgical scores: the logistic EuroSCORE I (ESI), EuroSCORE II (ESII), Society of Thoracic Surgeons (STS) score, Ambler score (AS) and Guaragna score (GS). The performance of the risk scores was evaluated in terms of their calibration (Hosmer–Lemeshow test) and discrimination [area under the receiver–operating characteristic curve (AUC)].Results:The mean age was 81.5 ± 7.7 years. The CoreValve (Medtronic) was used in 86.1% of the cohort, and the transfemoral approach was used in 96.2%. The observed 30-day mortality was 9.1%. The 30-day mortality predicted by the scores was as follows: ESI, 20.2 ± 13.8%; ESII, 6.5 ± 13.8%; STS score, 14.7 ± 4.4%; AS, 7.0 ± 3.8%; GS, 17.3 ± 10.8%. Using AUC, none of the tested scores could accurately predict the 30-day mortality. AUC for the scores was as follows: 0.58 [95% confidence interval (CI): 0.49 to 0.68, p = 0.09] for ESI; 0.54 (95% CI: 0.44 to 0.64, p = 0.42) for ESII; 0.57 (95% CI: 0.47 to 0.67, p = 0.16) for AS; 0.48 (95% IC: 0.38 to 0.57, p = 0.68) for STS score; and 0.52 (95% CI: 0.42 to 0.62, p = 0.64) for GS. The Hosmer–Lemeshow test indicated acceptable calibration for all scores (p > 0.05).Conclusions:In this real world Brazilian registry, the surgical risk scores were inaccurate in predicting mortality after TAVI. Risk models specifically developed for TAVI are required.

Science progress in the twentieth century : a quarterly journal of scientific work & thought.

v. 3 (1908-1909)

Science progress in the twentieth century : a quarterly journal of scientific work & thought.

v. 10 (1915-1916)

Science progress in the twentieth century : a quarterly journal of scientific work & thought.

v. 4 (1909-1910)

Science progress in the twentieth century : a quarterly journal of scientific work & thought.

v. 2 (1907-1908)

Science progress in the twentieth century : a quarterly journal of scientific work & thought.

v. 8 (1913-1914)

Science progress in the twentieth century : a quarterly journal of scientific work & thought.

v. 1 (1907)