El Hospital de las Cinco Llagas : historia y documentos

El trabajo, de acuerdo con su propio título, está estructurado en dos partes diferenciadas, que se presentan en dos volúmenes. El primero de ellos está dedicado a la HISTORIA del Hospital, en nueve capítulos, y el segundo, con otros tres capítulos adicionales, se refiere a los DOCUMENTOS que reunió la institución a lo largo de sus casi cinco siglos de vida prestando servicios de atención a los enfermos y a los más necesitados de la sociedad. Dentro de la primera parte histórica, presentamos en el primer capítulo la etapa fundacional, que transcurre entre 1500 y 1539. Se trata de la gestación del Hospital, intramuros de la ciudad de Sevilla, por parte de las dos personas que podemos considerar fundadores de la obra pía, doña Catalina de Ribera y su hijo Fadrique Enríquez. Pero también nos fijamos aquí en los antecedentes familiares que posibilitaron la dotación del inmueble, en sus bulas y privilegios fundacionales. Se descubre además el primer emplazamiento que tuvo en la ciudad el Hospital de las Cinco Llagas, localizándolo en planimetría. Se trata también sobre su cúpula espiritual y gestora, sus iniciales Constituciones y los recursos humanos con los que contaba en esta primera fase. Concluye la etapa fundacional planteando la necesidad que tiene el establecimiento de un cambio en su sede, ya en tiempos del Marqués de Tarifa don Fadrique, y con la dotación económica que éste le lega para hacerlo posible. El segundo capítulo sigue la trayectoria histórica de la institución a partir de 1540, fase claramente marcada por la preparación y construcción del nuevo y gran Hospital de las Cinco Llagas en las afueras de la ciudad, al pie de la muralla almohade, frente a la puerta de La Macarena. El tercer capítulo trata de desentrañar todos los entresijos del gobierno del Hospital, hablando de su patronato rector, de las relaciones que mantuvieron estos patronos con los descendientes de los fundadores en diversos momentos, caracterizados por el enfrentamiento, y de la jurisdicción especial del territorio del Hospital que afecta a todos los que pisen su suelo. Tratamiento especial han tenido las Constituciones que regularon la vida del Hospital hasta el siglo XIX, a lo que dedicamos el cuarto capítulo, pues según los tiempos y el desenvolvimiento del Hospital, fueron evolucionando hasta que el establecimiento quedara bajo custodia de la Beneficencia del Estado, a cargo del Municipio y la Diputación. El quinto capítulo trata sobre la administración y el servicio del Hospital, desarrollando aquí todos y cada uno de los puestos y cargos que se desempeñan en Las Cinco Llagas, así como los salarios y raciones que este personal recibe por sus servicios. Otro aspecto que se contempla es el régimen de visitas a la institución. El sexto capítulo trata de acercamos a la economía del Hospital, aproximándonos a lo que debieron ser sus cimientos económicos, en gran parte aumentados con varios legados importantes de diversos benefactores, que crearon varias fundaciones anexas al propia Hospital como el patronato de Convalecientes de Diego de Yanguas. En él comentamos sus principales propiedades y rentas, tratando además -aunque más a nivel teórico que contable- sobre los aportes de indulgencias, limosnas, diezmos, juros, censos y obvenciones. Del funcionamiento de la institución se trata en el capítulo séptimo, donde abordamos los cuidados espirituales (cura animarum) y médicos (cura corporum) que reciben los enfermos en el Hospital. El capítulo octavo versa sobre dos aspectos plenamente encuadrables en el siglo XVIII, como fueron el reglamento de cirujanos que se le aplicó por real orden de Carlos III de 1764 y del “campo del Hospital” y las relaciones de la institución con el vecindario. Y ya en el capítulo noveno, tratamos sobre las grandes transformaciones que se dan en el Hospital durante los siglos XIX y XX, para finalizar con su degradación progresiva que obligó a su cierre en 1972 y al posterior y necesario proceso de restauración y reconversión que recibió hasta convertirse en lo que hoy es, el Parlamento de Andalucía. Ya dentro de la segunda parte, referida a los documentos se incluyen normas ISASD (G), Cuadro de Clasificación, Inventario, Catálogo General y Apéndice documental.The work, in accordance with his own title, is divided into two distinct parts, which are presented in two volumes. The first one is dedicated to the history of the Hospital, in nine chapters, and the second, with other three additional chapters, refers to documents that brought the institution throughout its nearly five centuries of life providing care to patients and to the most needy in society. The first historical part, we are in the first chapter the founding stage, between 1500 and 1539. It is the gestation of the Hospital, within the walls of the city of Seville, by two people who can be considered founders of the pious work, Doña Catalina de Ribera and his son Fadrique Enriquez. But also we look here at the family history that made possible the provision of the property, in their bulls and foundational privilege. Discover also the first site that was in the city, the Hospital de las Cinco Llagas, locating it in planimetry. It is also about their spiritual dome and Manager, their initial constitutions and human resources which had in this first phase. Concludes the foundational stage considering the need that has the establishment of a change at its headquarters, in the time of the Marqués de Tarifa don Fadrique, and with the funding that it bequeathed him to make it possible. The second chapter follows the historical trajectory of the institution from 1540, phase clearly marked by the preparation and construction of the new and large Hospital de las Cinco Llagas on the outskirts of the city, at the foot of the almohade wall, opposite the door of La Macarena. The third chapter deals unravel all the ins and outs of the Government of the Hospital, speaking of its Governing Board, relations between these employers with the descendants of the founders at various times, characterized by confrontation, and the special jurisdiction of the territory of the Hospital that affects all those who walked on its soil. Special treatment have had constitutions which regulated the life of the Hospital until the 19th century, to which we dedicate the fourth chapter, because according to the times and the development of the Hospital, they were evolving until the establishment remain in custody of the beneficence of the State, in charge of the municipality and the County Council. The fifth chapter deals with the Administration and the Hospital service, developing here each and every posts and positions that work in Las Cinco Llagas, as well as wages and rations that this staff receives for his services. Another aspect referred to is the regime of visits to the institution. The sixth chapter is closer to the economy's Hospital, approaching to what must have been its economic foundations, largely augmented with several important legacies of various benefactors, who created several foundations attached to the own Hospital as the patronato de Yanguas Diego Convalecientes. In it we discuss their main properties and incomes, trying to also - although more at theoretical level as accounting - on contributions of indulgence, alms, tithe, juros, censuses and perquisites. The functioning of the institution is in the seventh chapter, where we boarded the spiritual care (cura animarum) and doctors (cure corporum) that the patients are in the Hospital. The eighth chapter is about two aspects fully encuadrables in the 18th century, as they were the regulation of surgeons which was applied by Royal order of Carlos III of 1764 and the "field Hospital" and the relations of the institution with the neighborhood. And already in the ninth chapter, we treat about the major changes that occur in the Hospital during the 19th and 20th centuries, ending with its progressive degradation which forced closure in 1972 and the subsequent and necessary process of restoration and conversion that was to become what today is, the Parliament of Andalusia. In the second part, referred to documents include IS ASD (G), box classification, inventory, General catalogue and documentary Appendix standards

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 17

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 17 de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada, de acceso abierto a todas las áreas del conocimiento, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico. Con esta colección, se aspira contribuir con el cultivo, la comprensión, la recopilación y la apropiación social del conocimiento en cuanto a patrimonio intangible de la humanidad, con el propósito de hacer aportes con la transformación de las relaciones socioculturales que sustentan la construcción social de los saberes y su reconocimiento como bien público

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures