“Alternativa neodesarrollista” y política social. Tendencias en la Argentina reciente / ‘Neo-developmental alternative’ and social politics. Trends in recent Argentina

El artículo expone la discusión de las características actuales que adquiere el neodesarrollismo en Argentina, identificando rupturas y continuidades con el modelo neoliberal. Posteriormente, se analizan las implicanciasque dichas transformaciones tienen en el campo de las políticas sociales llevadas a cabo por el Ministerio de Desarrollo Social de la Nación, donde se buscan identificar las lógicas que atraviesan su configuración. Al respecto, se reconstruye la racionalidad que da sustento al desarrollo de la política social, donde ejes como comunidad, familia y trabajo se tornan centrales en la definición de las acciones sistemáticas de intervención estatal sobre las distintas expresiones de la “cuestión social”.   This article presents the discussion of current characteristics acquired by the neo-developmentalism in Argentina, identifying ruptures and continuities regarding neoliberal model. Subsequently, the implicationsof these transformations in the field of social policies carried out by the National Ministry of Social Development are analyzed, in order to identify the logics that go through its configuration. In this regard, the rationalitythat underpins the development of social politics rebuilt, in which axes such as community, family and work become central in the definition of systematic actions of state intervention on the different expressions of the‘social question’

Neutrophil/lymphocyte ratio predicts in‐hospital complications in Takotsubo syndrome. Results from a prospective multi‐center registry

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Prognostic role of neoplastic markers in Takotsubo syndrome

Takotsubo syndrome (TTS) is an acute heart failure syndrome with significant rates of in and out-of-hospital mayor cardiac adverse events (MACE). To evaluate the possible role of neoplastic biomarkers [CA-15.3, CA-19.9 and Carcinoembryonic Antigen (CEA)] as prognostic marker at short- and long-term follow-up in subjects with TTS. Ninety consecutive subjects with TTS were enrolled and followed for a median of 3 years. Circulating levels of CA-15.3, CA-19.9 and CEA were evaluated at admission, after 72 h and at discharge. Incidence of MACE during hospitalization and follow-up were recorded. Forty-three (46%) patients experienced MACE during hospitalization. These patients had increased admission levels of CEA (4.3 ± 6.2 vs. 2.2 ± 1.5 ng/mL, p = 0.03). CEA levels were higher in subjects with in-hospital MACE. At long term follow-up, CEA and CA-19.9 levels were associated with increased risk of death (log rank p < 0.01, HR = 5.3, 95% CI 1.9-14.8, HR = 7.8 95% CI 2.4-25.1, respectively, p < 0.01). At multivariable analysis levels higher than median of CEA, CA-19.9 or both were independent predictors of death at long term (Log-Rank p < 0.01). Having both CEA and CA-19.9 levels above median (> 2 ng/mL, > 8 UI/mL respectively) was associated with an increased risk of mortality of 11.8 (95% CI 2.6-52.5, p = 0.001) at follow up. Increased CEA and CA-19.9 serum levels are associated with higher risk of death at long-term follow up in patients with TTS. CEA serum levels are correlated with in-hospital MACE

Impact of intra-aortic balloon counterpulsation on all-cause mortality among patients with Takotsubo syndrome complicated by cardiogenic shock: results from the German-Italian-Spanish (GEIST) registry

Aims: Takotsubo syndrome (TTS) is an acute and reversible left ventricular dysfunction and can be complicated by cardiogenic shock (CS). However, few data are available on optimal care in TTS complicated by CS. Aim of this study was to evaluate short- and long-term impact of intra-aortic balloon pumping (IABP) on mortality in this setting. Methods and results: In a multi-centre, international registry on TTS, 2248 consecutive patients were enrolled from 38 centres from Germany, Italy, and Spain. Of the 2248 patients, 212 (9.4%) experienced CS. Patients with CS had a higher prevalence of diabetes (27% vs. 19%), male sex (25% vs. 10%), and right ventricular involvement (10% vs. 5%) (P < 0.01 in all cases). Forty-three patients with CS (20% of 212) received IABP within 8 h (interquartile range 4-18) after admission. No differences in terms of age, gender, cardiovascular risk factors, and admission left ventricular ejection fraction were found among patients with and without IABP. There were no significant differences in terms of 30-day mortality (16% vs. 17%, P = 0.98), length of hospitalization (18.9 vs. 16.7 days, P = 0.51), and need of invasive ventilation (35% vs. 41%, P = 0.60) among two groups: 30-day survival was not significantly different even after propensity score adjustment (log-rank P = 0.73). At 42-month follow-up, overall mortality in patients with CS and TTS was 35%, not significantly different between patients receiving IABP and not (37% vs. 35%, P = 0.72). Conclusions: In a large multi-centre observational registry, the use of IABP was not associated with lower mortality rates at short- and long-term follow-up in patients with TTS and CS

‘Neo-developmental alternative’ and social policy. Trends in recent Argentina

El artículo expone la discusión de las características actuales que adquiere el neodesarrollismo en Argentina, identificando rupturas y continuidades con el modelo neoliberal. Posteriormente, se analizan las implicancias que dichas transformaciones tienen en el campo de las políticas sociales llevadas a cabo por el Ministerio de Desarrollo Social de la Nación, donde se buscan identificar las lógicas que atraviesan su configuración. Al respecto, se reconstruye la racionalidad que da sustento al desarrollo de la política social, donde ejes como comunidad, familia y trabajo se tornan centrales en la definición de las acciones sistemáticas de intervención estatal sobre las distintas expresiones de la “cuestión social”.This article presents the discussion of current characteristics acquired by the neo-developmentalism in Argentina, identifying ruptures and continuities regarding neoliberal model. Subsequently, the implications of these transformations in the field of social policies carried out by the National Ministry of Social Development are analyzed, in order to identify the logics that go through its configuration. In this regard, the rationality that underpins the development of social policyis rebuilt, in which axes such as community, family and work become central in the definition of systematic actions of state intervention on the different expressions of the ‘social question’Fil: Mallardi, Manuel Waldemar. Centro Interdisciplinario para el Estudio de Políticas Públicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rossi, Adriana Elisabet. Universidad Nacional del Centro de la Provincia de Buenos Aires; Argentina. Facultad Latinoamericana de Ciencias Sociales; Argentin

Procesos de vinculación entre el Estado y la Sociedad Civil en la gestión de servicios sociales: Tendencias en ciudades medias del interior de la provincia de Buenos Aires

This work intends to socialize elaborated reflections towards current relations between State¿s different levels and Civil Society Organizations which produce social services, considering those cities classified as Intermediate Size Cities (ISC's) due its population ranges between 50.000 and 200.000 inhabitants. ISC's situation's relevance is based on its high growth in recent years, mainly associated to economical crisis periods. This growing, understood under a social regressivity context, doesn't necessarily mean life quality improvements for most of the population, quite the contrary, it translates on social problematic proliferation formerly associated with big size cities (Roccatagliata, 2001). In this context, state social security scheme alterations implies that responses given by State to social question manifestations, seems affected as well by focalization as by responsibility transferences towards two orbits quite different from State of Right¿s logic: Market and Civil Society, contributing to re-commodification and re-philanthropization (Montaño, 2003). The intervention of Civil Society Organizations tends to be argued than its main identity feature is given by its "alternative" and "original" condition in relation to Public Policies. However, provisional research results allows us to appreciate that, based on the different grades of economical dependence, this innovative strategies can be coopted by State interventions, and finally keep on reproducing that which they critiqued on its genesis.El presente trabajo pretende socializar reflexiones elaboradas en torno a las actuales relaciones entre el Estado, en sus distintos niveles, con Organizaciones de la Sociedad Civil productoras de servicios sociales, en ciudades clasificadas como Aglomeraciones de Tamaño Intermedio (ATIs), por tener una población que oscila entre los 50.000 y 200.000 habitantes. La relevancia de analizar la situación de las ATIs radica en su fuerte crecimiento en los últimos años, principalmente asociado a períodos de crisis económicas. Este crecimiento, en un marco de regresividad social, no significa necesariamente mejoras en la calidad de vida de la población, por el contrario, significan la proliferación de problemáticas sociales que antes eran fenómenos típicos de las grandes ciudades (Roccatagliata, 2001). En este contexto, las alteraciones en el esquema de seguridad social estatal implica que las respuestas dadas desde el Estado a las manifestaciones de la cuestión social se ven afectadas tanto por la focalización como con relación a la transferencia de responsabilidades a dos orbitas o sectores con lógicas totalmente distintas a las del Estado de derecho: el mercado y la sociedad civil, dando lugar a procesos de re- mercantilización y re-filantropización (Montaño, 2003). La intervención desarrollada por las Organizaciones de la Sociedad Civil en la retórica suelen esgrimir como principal rasgo de identidad su condición de "alternativas" y "novedosas" en relación a las políticas públicas estatales. Sin embargo, resultados provisorios de la investigación llevada a cabo, permiten apreciar que a partir de los grados de dependencia económica que dichas organizaciones presentan con los distintos niveles estatales, sus estrategias innovadoras pueden verse cooptadas por las intervenciones estatales, reproduciendo aquello mismo que han establecido como crítica en su génesis

Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 2—Treatment and Prognosis

Takotsubo syndrome (TTS) represents a form of acute heart failure featured by reversible left ventricular systolic dysfunction. The management during the acute phase is mainly performed with supportive pharmacological (diuretics, ACE-inhibitors/angiotensin-receptor blockers (ARBs), anticoagulants, antiarrhythmics, non-catecholamine inotropics (levosimendan), and non-pharmacological (mechanical circulatory and respiratory support) therapy, due to the wide clinical presentation and course of the disease. However, there is a gap in evidence and there are no randomized and adequately powered studies on clinical effectiveness of therapeutic approaches. Some evidence supports the use ACE-inhibitors/ARBs at long-term. A tailored approach based on cardiovascular and non-cardiovascular risk factors is strongly suggested for long-term management. The urgent need for evidence-based treatment approaches is also reflected by the prognosis following TTS. The acute phase of the disease can be accompanied by various cardiovascular complications. In addition, long term outcome of TTS patients is also related to non-cardiovascular comorbidities. Physical triggers such as hypoxia and acute neurological disorders in TTS are associated with a poor outcome

Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 2—Treatment and Prognosis

Takotsubo syndrome (TTS) represents a form of acute heart failure featured by reversible left ventricular systolic dysfunction. The management during the acute phase is mainly performed with supportive pharmacological (diuretics, ACE-inhibitors/angiotensin-receptor blockers (ARBs), anticoagulants, antiarrhythmics, non-catecholamine inotropics (levosimendan), and non-pharmacological (mechanical circulatory and respiratory support) therapy, due to the wide clinical presentation and course of the disease. However, there is a gap in evidence and there are no randomized and adequately powered studies on clinical effectiveness of therapeutic approaches. Some evidence supports the use ACE-inhibitors/ARBs at long-term. A tailored approach based on cardiovascular and non-cardiovascular risk factors is strongly suggested for long-term management. The urgent need for evidence-based treatment approaches is also reflected by the prognosis following TTS. The acute phase of the disease can be accompanied by various cardiovascular complications. In addition, long term outcome of TTS patients is also related to non-cardiovascular comorbidities. Physical triggers such as hypoxia and acute neurological disorders in TTS are associated with a poor outcome

Genetic variation in transmembrane 6 superfamily member 2 and the risk of nonalcoholic fatty liver disease and histological disease severity

We explored the role of transmembrane 6 superfamily member 2 (TM6SF2) rs58542926 C/T nonsynonymous (p.Glu167Lys) variant in genetic susceptibility to nonalcoholic fatty liver disease (NAFLD) and disease severity. A total of 361 individuals (135 control subjects and 226 patients with histologically proven NAFLD) were included in a sample with 97% power for the additive genetic model. A discrete trait analysis of NAFLD showed that rs58542926 was associated with a modest risk of fatty liver (P = 0.038; odds ratio [OR]: 1.37; 95% confidence interval [CI]: 1.02-1.84); nevertheless, conditioning on patatin-like phospholipase domain-containing 3 (PNPLA3)-rs738409 abolished this effect. We did not observe an interaction between rs738409 and rs58542926 variants on the risk of NAFLD. We observed a significant association of rs58542926 and disease severity (P = 0.027), but not lobular inflammation or fibrosis; rs58542926 was not associated with levels of liver enzymes. An allelic test showed that the T (Lys167) allele was significantly associated with disease progression (P = 0.021; OR, 1.66; 95% CI: 1.08-2.55). A significant association was found with the histological degree of liver steatosis (β, 0.15; standard error: 0.06; P = 0.0299) that was independent of rs738409. Homozygous carriers of the C (Glu167) allele showed increased risk for cardiovascular disease. TM6SF2 protein expression was decreased markedly in liver of NAFLD patients, compared to controls. In addition, TM6SF2 immunoreactivity was reduced in subjects carrying at least one copy of the T allele, consistent with a difference in liver allele-specific transcript abundance. Conclusion: rs58542926 is a low-frequency variant with a modest effect on NAFLD, suggesting that carriers of the T allele are slightly more likely to accumulate fat in the liver and develop nonalcoholic steatohepatitis than those without. TM6SF2 appears to play a significant role in disease biology.Fil: Sookoian, Silvia Cristina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Castaño, Gustavo Osvaldo. Gobierno de la Ciudad de Buenos Aires. Hospital "Dr. Abel Zubizarreta"; ArgentinaFil: Scian, Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Mallardi, Pablo. Hospital Diego Thompson; ArgentinaFil: Fernandez Gianotti, Tomas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Burgueño, Adriana Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: San Martino, Julio. Hospital Diego Thompson; ArgentinaFil: Pirola, Carlos José. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Médicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; Argentin

Liver disease and heart failure: an uptodate

Physicians can often treat heart diseases (chronic or acute heart failure) affecting the liver and liver diseases affecting the heart. Systemic diseases can also affect both heart and liver. This review aimed to summarize principal finding on fatty liver as risk marker for heart failure or liver fibrosis as score to predict outcome in heart failure and, above all, rare systemic diseases affecting heart and liver. Principal evidence from human and animal models is reported, in order to better understand the extremely complex relationship between heart and liver