Gritos, grietas y siembras de nuestros territorios del sur: Catherine Walsh y el pensamiento crítico-decolonial en América Latina

Este libro es un trabajo colectivo, de homenaje y reconocimiento al trabajo investigativo, pedagógico y activista de Catherine Walsh. Sus trayectorias han privilegiado el proyecto político, ético y existencial de la interculturalidad crítica y la decolonialidad, cuyos ejes centrales entretejen la geopolítica del conocimiento, las luchas políticas y la praxis social de los pueblos afrodescendientes e indígenas, los pensamientos feministas, las pedagogías alternativas. Cathy es una incansable tejedora de espacios colectivos, que abren grietas y siembran semillas. Su tarea ha sido caminar con y acompañar a colectivos, líderes y lideresas que trabajan fuera de la academia. Y su compromiso ha sido ese: pensar “con”, nunca sobre o a propósito de otrxs. El activismo social, la in-disciplina, la desobediencia epistémica, el pensamiento crítico, enraizado en la lucha por la justicia social, contra la violencia y la deshumanización que viven hoy los pueblos y comunidades racializadas en América Latina, definen el caminar de Catherine Walsh. Aquí, quienes caminaron con ella, estudiantes, colegas, intelectuales y militantes latinoamericanos, relatan las dimensiones de la transformación impulsada por ella en los cuerpos, las comunidades y los territorios del pensar

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570