Acute adrenal insufficiency caused by antiphospholipid syndrome / 世界急诊医学杂志（英文）

@#Antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are frequently discussed together and considered two closely related diseases. APS involves multiple organ systems but APS-related endocrine manifestations are rare.[1] Among them adrenal insufficiency (AI) is the first endocrine manifestation of APS. The prompt diagnosis of AI is critical as this disorder has high morbidity and mortality if left untreated. Here we report a rare case of acute AI caused by APS secondary to SLE.

Most patients with non-hypertensive diseases at a critical care resuscitation unit require arterial pressure monitoring: a prospective observational study / 世界急诊医学杂志（英文）

@#BACKGROUND: Blood pressure (BP) monitoring is essential for patient care. Invasive arterial BP (IABP) is more accurate than non-invasive BP (NIBP), although the clinical significance of this difference is unknown. We hypothesized that IABP would result in a change of management (COM) among patients with non-hypertensive diseases in the acute phase of resuscitation. METHODS: This prospective study included adults admitted to the Critical Care Resuscitation Unit (CCRU) with non-hypertensive disease from February 1, 2019, to May 31, 2021. Management plans to maintain a mean arterial pressure >65 mmHg (1 mmHg=0.133 kPa) were recorded in real time for both NIBP and IABP measurements. A COM was defined as a discrepancy between IABP and NIBP that resulted in an increase/decrease or addition/discontinuation of a medication/infusion. Classification and regression tree analysis identified significant variables associated with a COM and assigned relative variable importance (RVI) values. RESULTS: Among the 206 patients analyzed, a COM occurred in 94 (45.6% [94/206]) patients. The most common COM was an increase in current infusion dosages (40 patients, 19.4%). Patients receiving norepinephrine at arterial cannulation were more likely to have a COM compared with those without (45 [47.9%] vs. 32 [28.6%], P=0.004). Receiving norepinephrine (relative variable importance [RVI] 100%) was the most significant factor associated with a COM. No complications were identified with IABP use. CONCLUSION: A COM occurred in 94 (45.6%) non-hypertensive patients in the CCRU. Receiving vasopressors was the greatest factor associated with COM. Clinicians should consider IABP monitoring more often in non-hypertensive patients requiring norepinephrine in the acute resuscitation phase. Further studies are necessary to confirm the risk-to-benefit ratios of IABP among these high-risk patients.

Uma visão dos trópicos de Heinrich Gerber, 1850-1860: ciência e pensamento econômico de um engenheiro politécnico alemão no Império do Brasil / Heinrich Gerber's vision of the tropics, 1850-1860: the scientific and economic thinking of a German polytechnic engineer in the Empire of Brazil

Resumo Analisa o pensamento científico do engenheiro politécnico Heinrich August Anton Gerber, contratado pelo governo da província de Minas Gerais de 1858 a 1867. O artigo explora o significado cultural e intelectual das atividades do engenheiro, especialmente a ideia de criação de empresa privada no setor da infraestrutura viária, bem como a mediação para importação de instrumentos científicos e livros. Os resultados também indicam que Gerber participa do envio de brasileiros para estudar engenharia em Paris. Este texto investiga as trocas culturais entre Brasil e Europa, a aplicação do conhecimento científico e o encontro com problemas práticos de ordem econômica e social pelo engenheiro no interior do Império do Brasil.

Abstract This article analyzes the scientific thinking of the German polytechnic engineer Heinrich August Anton Gerber, who was employed by Minas Gerais province from 1858 to 1867. We explore the cultural and intellectual significance of his activities, particularly the idea of creating a private company within the roadway infrastructure sector and his mediating role in the importation of scientific instruments and books. Gerber also appears to have been part of efforts to send Brazilians to study engineering in Paris. Cultural exchanges between Brazil and Europe are investigated, along with the application of scientific knowledge and his encounters with practical economic and social challenges in the interior of the Empire of Brazil.

A sociologia latino-americana na Guerra Fria Cultural: Florestan Fernandes, Aldo Solari e o Ilari / Latin American sociology in the Cultural Cold War: Florestan Fernandes, Aldo Solari, and ILARI

Resumo O que a colaboração entre Florestan Fernandes, Aldo Solari e o Instituto Latino-americano de Relações Internacionais, órgão do Congresso pela Liberdade da Cultura, explica sobre as ideias do sociólogo entre 1969 e 1972? A análise de documentos oficiais do instituto e correspondências e textos de Florestan e Solari sugere que esse episódio revela um sociólogo preocupado com a manutenção de espaços científicos num continente marcado pelo autoritarismo, o que permite matizar a periodização entre fases "acadêmico-reformista" e "político-revolucionária". Argumenta-se que, do ponto de vista do instituto, a parceria com Florestan era crucial para produzir legitimidade intelectual para suas ações.

Abstract What does the collaboration between the sociologist Florestan Fernandes, Aldo Solari, and the Latin American Institute of International Relations (ILARI), an organ of the Congress for Cultural Freedom, tell us about Fernandes's thinking between 1969 and 1972? The analysis of official ILARI documents and correspondence and texts by Fernandes and Solari suggests that this episode reveals Fernandes's concern with defending space for science on a continent marked by authoritarianism, thereby enabling a more nuanced understanding of his trajectory than one marked by two distinct phases, "reformist-academic" and "revolutionary-political." From ILARI's perspective, the partnership with Fernandes is revealed as critical in lending its actions intellectual legitimacy.

Influenciadores da desinformação nas pandemias de gripe espanhola e Covid-19: um estudo documental / Disinformation influencers in the spanish flu and covid-19 pandemics: a documentary study

Resumo: Introdução: Tão rápidas e destrutivas quanto a doença pandêmica,a propagação de inverdades em cenários de pandemias tem levado a muitas mortes. Para tanto, intervenções contrainfodêmicas são hoje um dos maiores desafios para o setor de saúde Objetivo: Este estudo teve como objetivo compreender as confluências da desinformação na gripe espanhola e na Covid-19 e como atuam os influenciadores de notícias falsas no campo da saúde brasileira. Método: Trata-se de estudo documental com abordagem qualitativa feita por meio da triangulação de dados em diferentes fontes e nos períodos da gripe espanhola (de 1918 a 1920) e da Covid-19 (de 2020 a 2021). Resultado: Observou-se que as pandemias foram e continuam cenários férteis para a produção e propagação dos influenciadores da desinformação e que se faz necessário problematizar os desafios da formação do trabalhador em tempos de modernidade líquida e em contextos de infodemias, já que os discursos profissionais têm sido fragilizados diante da desinformação. Conclusão: O estudo possibilitou compreender as confluências da desinformação entre a gripe espanhola e a Covid-19, e o papel da formação em saúde no enfrentamento da disseminação em massa de notícias falsas na saúde brasileira.

Abstract: Introduction: As fast and destructive as the pandemic disease is the spread of untruths in pandemic scenarios, which led to many deaths. Therefore, counter-infodemic interventions are currently one of the biggest challenges for the health sector. Objective: To understand the convergence of disinformation on the Spanish Flu and COVID-19 and how fake news influencers act in the Brazilian health field. Method: this is a documentary study with a qualitative approach, carried out through the triangulation of data from different sources and in the periods of the Spanish Influenza (1918 to 1920) and COVID-19 (2020 to 2021). Result: It was observed that the pandemics were and continue to be fertile scenarios for the production and dissemination of disinformation influencers and that it is necessary to problematize the challenges of worker training in times of liquid modernity and in contexts of infodemics, since the professional discourses have been weakened bydisinformation. Conclusion: the study allowed us to understand the convergence of disinformation between the Spanish Flu and COVID-19 and the role of health education when facing the mass dissemination of fake news in the Brazilian health field.

Small balloon strategy associated with low pacemaker implantation rate after self-expanding transcatheter valve implantation / 世界急诊医学杂志（英文）

@#BACKGROUND: This study aims to investigate whether small balloon aortic valvuloplasty (BAV) reduces the need for permanent pacemaker implantation (PPMI) after transcatheter aortic valve implantation (TAVI). METHODS: This was a retrospective analysis using data from our local TAVI database. Small BAV was defined as a small balloon size (=18 mm) pre-dilatation. Normal BAV was defined as a balloon size >18 mm. The primary endpoint was the incidence of new PPMI. RESULTS: Of 99 consecutive TAVI patients, five patients were excluded due to pre-existing permanent pacemaker. Patients in the small BAV group (n=57) had a significantly lower PPMI rate compared with the normal BAV group (n=37) (3.5% vs. 18.9%, P=0.026). Moderate or severe aortic valve regurgitation post-procedure was similar between the small BAV and normal BAV groups (5.3% vs. 8.1%, P=0.480); likewise, the mean aortic gradient post-procedure did not differ significantly (11.5±5.2 mmHg vs. 12.2±7.3 mmHg, 1 mmHg=0.133 kPa, P=0.580) between the groups. Device success rates were also similar (94.7% vs. 91.8%, P=0.680). In multivariable analysis, small BAV (P=0.027), the ratio of prosthesis diameter to annulus diameter (P=0.048), and mean aortic gradient by echo in the basement (P=0.021) were independent predictors of PPMI. CONCLUSIONS: The small BAV strategy is associated with a low rate of permanent pacemaker implantation after transcatheter self-expanding valve implantation in this single-center observational study.

Identifying critically ill patients at risk of death from coronavirus disease / 世界急诊医学杂志（英文）

@#BACKGROUND: A pandemic of coronavirus disease (COVID-19) has been declared by the World Health Organization (WHO) and caring for critically ill patients is expected to be at the core of battling this disease. However, little is known regarding an early detection of patients at high risk of fatality. METHODS: This retrospective cohort study recruited consecutive adult patients admitted between February 8 and February 29, 2020, to the three intensive care units (ICUs) in a designated hospital for treating COVID-19 in Wuhan. The detailed clinical information and laboratory results for each patient were obtained. The primary outcome was in-hospital mortality. Potential predictors were analyzed for possible association with outcomes, and the predictive performance of indicators was assessed from the receiver operating characteristic (ROC) curve. RESULTS: A total of 121 critically ill patients were included in the study, and 28.9% (35/121) of them died in the hospital. The non-survivors were older and more likely to develop acute organ dysfunction, and had higher Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) scores. Among the laboratory variables on admission, we identified 12 useful biomarkers for the prediction of in-hospital mortality, as suggested by area under the curve (AUC) above 0.80. The AUCs for three markers neutrophil-to-lymphocyte ratio (NLR), thyroid hormones free triiodothyronine (FT3), and ferritin were 0.857, 0.863, and 0.827, respectively. The combination of two easily accessed variables NLR and ferritin had comparable AUC with SOFA score for the prediction of in-hospital mortality (0.901 vs. 0.955, P=0.085). CONCLUSIONS: Acute organ dysfunction combined with older age is associated with fatal outcomes in COVID-19 patients. Circulating biomarkers could be used as powerful predictors for the in-hospital mortality.

A psicanálise e as transformações na concepção da infância nas crônicas e colunas de Clarice Lispector, 1952-1973 / Psychoanalysis and the transformations of childhood in the articles and columns written by Clarice Lispector, 1952-1973

Resumo O artigo estuda o papel da psicologia na transformação dos modos de conceber a infância nas décadas de 1950 a 1970, tendo como foco as colunas e crônicas publicadas em revistas e jornais de ampla circulação por Clarice Lispector entre 1952 e 1973. Delas emerge um novo paradigma que considera os filhos mistérios psicológicos no interior do âmbito doméstico, objeto de investigação por parte da mãe, e que entende a infância como núcleo do psiquismo adulto. Trata-se de um modelo biopsicológico, que combina a preocupação higiênica pela saúde física com uma atenção psicológica à subjetividade infantil, no qual a criança das classes médias emerge como índice do questionamento dos papéis de autoridade familiar e da nova centralidade do indivíduo.

Abstract The article examines the role of psychology in how childhood was understood during the period spanning 1950 to 1970, focusing on articles and columns Clarice Lispector published in broadly circulating magazines and newspapers from 1952 to 1973. From these writings emerges a new paradigm considering children as psychological mysteries within the domestic sphere, in which childhood is understood as the core of the adult psyche, as well as object of maternal exploration and care. This biopsychological model combines hygienic concerns related to physical health with psychological attention to childhood subjectivity. This way, the middle-class child reveals a transformation of family models and the new centrality of the individual.

La gripe de 1918 en Cuba / The 1918´s influenza epidemic in Cuba

Introducción: A finales de la segunda década del siglo XX, entre los años 1918 y 1919, a nivel mundial se propagó la pandemia de influenza que se conoce como gripe española. En Cuba causó una elevada morbilidad y mortalidad, lo que motivó una gran preocupación en la población y las autoridades sanitarias del país. Objetivos: Caracterizar la epidemia de gripe de 1918-1919 en Cuba a partir del análisis de los documentos que se conservan sobre su evolución y medidas preventivas. Método: Se realizó una investigación cualitativa a partir del análisis documental como procedimientos para la aplicación del método teórico histórico-lógico. Se revisaron estadísticas, artículos, directrices y planes de enfrentamiento a la epidemia, de la dirección de Sanidad, e informes sobre su control. Resultados: Entre 1918 y 1920, se reportó la mayor mortalidad en Cuba por gripe. La morbilidad se recoge desde 1942, con cifra mayor en 1957 (tasa de 1419.86 x 105 habitantes), 1951 (6.92 x 105 habitantes), 1947 (5.88 x 105 habitantes). La mortalidad más elevada correspondió a los años 1918- 1920 (193,92 x 105 habitantes; 50,11 y 47,46). Conclusiones: La epidemia de gripe de 1918, causó en Cuba una elevada morbilidad y mortalidad, se elaboraron planes adecuados de contingencia para frenarla, de acuerdo a su naturaleza y al desarrollo de los conocimientos científicos del momento(AU)

Introduction: At the end of the second decade of the 20th century, between the years 1918 and 1919, there was a global outbreak of influenza known as Spanish flu. In Cuba, it caused a high morbidity and mortality, which led to a great concern in the population and the health authorities of the country. Objective: To characterize the 1918-1919´s influenza epidemic in Cuba by analysing the documents preserved on its evolution and preventive measures. Methods: A qualitative research was carried out by performing a documentary analysis as a procedure for the implementation of the historical-logical theoretical method. There were reviewed statistics, articles, guidelines and plans of confrontation to the epidemic, and also reports on its control issued by the Health´s Directorate. Results: The epidemic was intense until early 1919; then it had some outbreaks with a relative frequency, but in a most benign form, until 1920. The morbidity data have records from 1942, with higher figures in 1957 (rate of 1419,86 x 105 inhabitants); 1951 (6.92 x 105 inhabitants); 1947 (5.88 x 105 inhabitants). The higher mortality rate corresponded to the years 1918-1920 (193.92 x 105 inhabitants; 50.11 and 47.46, respectively). Conclusions: The 1918´s Influenza Epidemic caused in Cuba a high morbidity and mortality. Adequate contingency plans were developed to halt it, according to its nature and the development of scientific knowledge at the time(AU)

Degeneración y mejoramiento de la raza: ¿higiene social o eugenesia? Colombia, 1920-1930 / Degeneration and improvement of the race: social higiene or eugenics? Colombia, 1920-1930

Resumen Este artículo pretende discutir de qué manera ciertos saberes y prácticas orientados al "mejoramiento de la raza" colombiana entre 1920 y 1930 son similares o pueden localizarse en el marco de lo que ha sido definido por la historiografía como "movimiento eugenésico latinoamericano". El término de "higiene social" aparece en algunos textos médicos colombianos durante ese período para hablar del mejoramiento de una fracción de la población que se definía como "degenerada". Se trata de contribuir a la reflexión sobre la necesidad de repensar las estrategias del "mejoramiento de la raza" como problemas locales, heterogéneos y diversos.

Abstract This article discusses the similarities between certain knowledges and practices focused on "improving the race" in Colombia from 1920-1930, showing how they can be located within a framework defined by historiography as the "Latin American eugenic movement." The term "social hygiene" appears in some Colombian medical texts during this period to describe the improvement of a fraction of the population defined as "degenerate." This study contributes to discussion of the need to rethink "racial improvement" strategies as local, heterogeneous, diverse problems.

Esporte e gênero na Alemanha durante a década de 1920: Body by Weimar, de Erik N. Jensen / Sport and Gender in Germany during the twenties: Body By Weimar, by Erik N. Jensen / Deporte y género en Alemania durante la década de 1920: Body by Weimar, por Erik N. Jensen

Analisamos o livro Body by Weimar, de Erik N. Jensen. Ao estudar questões de gênero na história do esporte na Alemanha após a primeira guerra mundial, endossamos os procedimentos metodológicos adotados pelo autor no desenvolvimento da obra. Eles podem estimular novos caminhos à pesquisa histórica no campo da Educação Física.

We have analyzed the book Body by Weimar, Erik N. Jensen. By studying gender issues in sports history in Germany after the first world war, we endorse the adopted methodological procedures. They can stimulate new ways of historical research in the field of Physical Education. Therefore, we affirm the importance of the work.

Hemos analizado el libro Body by Weimar, de Erik N. Jensen. Mediante el estudio de las cuestiones de género en la historia del deporte en Alemania después de la primera guerra mundial, estamos de acuerdo con los procedimientos metodológicos adoptados. Pueden estimular nuevas formas de investigación histórica en el campo de la educación física. Por lo tanto, afirmamos la importancia de la obra.

War is hazardous for your health: photographs and testimonies about death, wounds, disease and medical care during the Mexican Revolution / Guerra é prejudicial à sua saúde: fotografias e testemunhos sobre morte, ferimentos, doenças e cuidados médicos durante a Revolução Mexicana

Revolutionary wars have devastating and far-reaching effects on the health of the populations caught up in them. However, the deaths and injuries produced by weaponry are only part of the story, because diseases resulting from malnutrition and contaminated drinking water account for the majority of medical problems. This essay uses photographs and testimonies of participants to explore health issues during the Mexican Revolution (1910-1920), as well as incorporating secondary literature on this question. Furthermore, photographic images are not presented as simple (indexical) windows onto the world. Rather, the author attempts to identify the imagemakers and provide explanations that help in imagining the reasons behind the making of the photographs.

Revoluções armadas têm efeitos devastadores e de longo alcance sobre a saúde das populações envolvidas. No entanto, mortes e ferimentos produzidos por armas são apenas parte da história, pois doenças resultantes de má nutrição e contaminação da água potável são responsáveis pela maior parte dos problemas médicos. O artigo utiliza fotografias e testemunhos de participantes para investigar questões de saúde durante a Revolução Mexicana (1910-1920), incorporando também literatura secundária sobre a questão. As imagens fotográficas não são apresentadas simplesmente como janelas (indexadores) para o mundo. Tenta-se identificar os autores das imagens e construir explanações que ajudem a imaginar as razões por que cada fotografia foi tirada.