Visiones transversales de Puerto Rico y el Caribe

Con autorización de la editorial para este libro. La edición del libro estuvo a cargo de Beatriz Cruz Sotomayor y Félix R. Huertas González.Visiones transversales de Puerto Rico y el Caribe es producto de un proyecto internacional de investigación en el que han venido participando, por los pasados años, un grupo de historiadores y especialistas de diversas disciplinas en el área de los estudios caribeños. Como lo sugiere su título, el libro apuesta a la transversalidad como enfoque que permite explorar, desde múltiples perspectivas, la diversidad que ya de por sí implica la región caribeña y, en particular, la isla de Puerto Rico. Este persigue innovar en su metodología, marcos teóricos, perspectivas críticas y en una rica variedad de campos de estudio sobre Puerto Rico en el contexto del Caribe. Desde una diversidad de análisis, los ensayos transitan también un amplio espectro temático: esclavitud, urbanismo, ambiente, identidad, cultura, diáspora, economía, arte, literatura y política, entre otros.Connected Worlds: The Caribbean, Origin of the Modern World. Este proyecto ha recibido fondos del programa de investigación e innovación Horizon 2020 de la Unión Europea en virtud del acuerdo de subvención Marie Sklodowska-Curie Nº 823846. El proyecto está dirigido por la profesora Consuelo Naranjo Orovio del Instituto de Historia-CSIC.Peer reviewe

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

La horizontalidad en El palo ensebado de René Depestre: Metáfora colectiva/literaria haitiana

The decade of the seventies links four writers of great significance in the American continent - Gabriel García Márquez, Alejo Carpentier, Augusto Roa Bastos and René Depestre - under a common plot: the Latin American dictator. This essay analyzes several valuable elements of the little-known novel, El palo ensebado, by Depestre, as an ideological novel. The public square, a space of carnival festivities, gravitates as the organizing center for the events of the novel, the chronotope configurator of the narrative and polyphonic nucleus where the various voices that dismantle the official discourse converge. The elements of satire, polyphony, chronotope from Mikail Bakhtin, besides those of power and religiosity are discussed in order to deconstruct the metaphor of the author's greasy stick as if it were a slippery vertical machine that, through carnival and absurdity, becomes the horizontality of an invincible collective being.La década del setenta vincula a cuatro escritores de gran significación en el continente americano -Gabriel García Márquez, Alejo Carpentier, Augusto Roa Bastos y René Depestre- bajo una trama común: el dictador latinoamericano. Este ensayo analiza varios elementos valiosos de la novela poco conocida, El palo ensebado, de Depestre, como novela ideológica. La plaza pública, espacio de festividades carnavalescas, gravita como centro organizador de los acontecimientos de la novela, el cronotopo configurador de la narración y núcleo polifónico donde convergen las diversas voces que desmantelan el discurso oficial. Se discuten los elementos de la sátira, la polifonía, el cronotopo de Mijtail Bajtín, además de los del poder y la religiosidad a fin de deconstruir la metáfora del autor del palo ensebado como si fuera una máquina vertical resbalosa que, por medio del carnaval y el absurdo, se transforma en la horizontalidad de un ser colectivo invencible

El Caribe: Origen del mundo moderno

[EN] This book is a result of the European project titled Connected Worlds: The Caribbean, Origin of the Modern World. This project is directed by Consuelo Naranjo-Orovio from Institute of History (CSIC). The book is presented so that the educational community has the latest and necessary scientific knowledge, in a clear and accessible way, for its transmission to new generations, and contributes -through education and historical knowledge- to combat the discrimination against non-white populations in Europe, the Caribbean and Latin America. Through studies we try to promote, rescue and protect our historical memory and cultural expressions of different peoples, as well as enhance dialogue, debate and international cooperation.With this volume we want to contribute, in short, to the knowledge of the past and present of Caribbean countries and their connection with the rest of Latin America, Europe and Africa. The various themes emphasize topical issues that cannot be missing in the higher education of our societies, whose classrooms, a true reflection of society, are marked by integration, multiculturalism and coexistence between different cultures. Education therefore must contribute to the integration of human diversity and the banishment of concepts of one upmanship between populations, based on the misconception regarding the existence of races in the human species.In this book, teachers and students will find multimedia resources that expand the gathered information and various interviews with Caribbean history specialists, designed and conducted by Consuelo Naranjo Orovio and edited by Luis Centurión, from Ediciones Doce Calles publishing house team, who is also a project member: http://youtube.com/c/ConnecCaribbeanProyecto[ES] Este libro es el resultado del proyecto europeo titulado Connected Worlds: The Caribbean, Origin of the Modern World. Este proyecto está dirigido por Consuelo Naranjo-Orovio del Instituto de Historia (CSIC). El libro se presenta para que la comunidad educativa tenga el conocimiento científico más reciente y necesario, de manera clara y accesible, para su transmisión a las nuevas generaciones, y contribuye, a través de la educación y el conocimiento histórico, a combatir la discriminación contra las poblaciones no blancas en Europa, el Caribe y América Latina. A través de los estudios tratamos de promover, rescatar y proteger nuestra memoria histórica y expresiones culturales de diferentes pueblos, así como mejorar el diálogo, el debate y la cooperación internacional. Con este volumen queremos contribuir, en resumen, al conocimiento del pasado y el presente de los países del Caribe y su conexión con el resto de América Latina, Europa y África. Los diversos temas enfatizan temas de actualidad que no pueden faltar en la educación superior de nuestras sociedades, cuyas aulas, un verdadero reflejo de la sociedad, están marcadas por la integración, el multiculturalismo y la convivencia entre diferentes culturas. La educación, por lo tanto, debe contribuir a la integración de la diversidad humana y al destierro de los conceptos de un solo dominio entre las poblaciones, basado en el concepto erróneo sobre la existencia de razas en la especie humana. En este libro, maestros y estudiantes encontrarán recursos multimedia que amplían la información recopilada y varias entrevistas con especialistas en historia del Caribe, diseñadas y dirigidas por Consuelo Naranjo Orovio y editadas por Luis Centurión, del equipo de la editorial Ediciones Doce Calles, que también es miembro del proyecto: http://youtube.com/c/ConnecCaribbeanProyectoPeer reviewe

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60&nbsp;years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death.&nbsp;The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings