This article highlights the importance of historical knowledge in current medical training and practice, particularly in specialties such as Traumatology and Orthopedic Surgery. It criticizes the increasing technologization of medicine and its growing disconnection from the humanities. The study argues that the historical study of diseases -especially so-called "crippling" diseases, like poliomyelitis and musculoskeletal tuberculosis- provides a deeper understanding of current clinical processes, enhances medical empathy, and promotes a more comprehensive and critical education. A historiographic study was conducted on 138 medical records from the San Juan de Dios Sanatorium in Seville, spanning the years 1943 to 1950. Thirty-two cases related to poliomyelitis and musculoskeletal tuberculosis were analyzed in depth, 9 of which underwent surgical intervention. Two cases involving subtalar arthrorisis were highlighted as examples to reinterpret past treatments using current orthopedic knowledge. Patients with poliomyelitis treated in the past underwent aggressive surgical procedures that, although well-intentioned, often resulted in severe deforming sequelae. Many of these patients now present with osteoarthritis, chronic pain, or deformities. Techniques such as rib arch grafting (Grice's technique) were precursors to modern methods like the calcaneal stop screw. While some procedures had long-term functional success (over 90% positive outcomes), many failed to consider the emotional and psychosocial impact on the patient. This study demonstrates that understanding the historical context of disease is essential for providing more humane, effective, and empathetic care. It advocates for the integration of the History of Medicine into the curricula of medical specialties, to avoid simplistic judgments of past practices and to recognize that medical treatments are also cultural products of their time. Historical training allows physicians to develop critical, humanistic thinking and a respectful approach to the patient's experience.
This article explores the uses of historical cartography in the territorial dispute between the states of Piauí and Ceará in a civil suit (1.831/2011) filed in Brazil's Supreme Court. We base our analysis on historical maps from the seventeenth to the nineteenth centuries in order to understand continuities and transformations in how this region is represented. This analysis is then contrasted with documentation from the Overseas Historical Archive and the Brazilian Army's Technical Report on the dispute in order to relate the active role played by the environment, political influences with representations of the zones involved in the dispute, showing how cartography still serves to "reflect the world." Este artigo explora os usos da cartografia histórica na disputa territorial entre Piauí e Ceará, ajuizada em ação cível originária n.1.831/2011 no Supremo Tribunal Federal. Propomos um exercício analítico a partir de mapas históricos dos séculos XVII a XIX, no intento de perceber as continuidades e transformações nos modos de representar a região. Contrastamos esse exercício com documentação do Arquivo Histórico Ultramarino e com o Relatório Técnico do Exército Brasileiro sobre a disputa. Com isso, buscamos relacionar a agência do ambiente, influências políticas e representações das zonas litigantes, demonstrando como a cartografia permanece utilizada como “espelho do mundo”.
Many species are restricted to a marginal or suboptimal fraction of their historical range due to anthropogenic impacts, making it hard to interpret their ecological preferences from modern-day data alone. However, inferring past ecological states is limited by the availability of robust data and biases in historical archives, posing a challenge for policy makers . To highlight how historical records can be used to understand the ecological requirements of threatened species and inform conservation, we investigated sperm whale (Physeter macrocephalus) distribution in the Western Indian Ocean. We assessed differences in information content and habitat suitability predictions based on whale occurrence data from Yankee whaling logs (1792-1912) and from modern cetacean surveys (1995-2020). We built maximum entropy habitat suitability models containing static (bathymetry-derived) variables to compare models comprising historical-only and modern-only data. Using both historical and modern habitat suitability predictions  we assessed marine protected area (MPA) placement by contrasting suitability in- and outside MPAs. The historical model predicted high habitat suitability in shelf and coastal regions near continents and islands, whereas the modern model predicted a less coastal distribution with high habitat suitability more restricted to areas of steep topography. The proportion of high habitat suitability inside versus outside MPAs was higher when applying the historical predictions than the modern predictions, suggesting that different marine spatial planning optimums can be reached from either data sources. Moreover, differences in relative habitat suitability predictions between eras were consistent with the historical depletion of sperm whales from coastal regions, which were easily accessed and targeted by whalers, resulting in a modern distribution limited more to steep continental margins and remote oceanic ridges. The use of historical data can provide important new insights and, through cautious interpretation, inform conservation planning and policy, for example, by identifying refugee species and regions of anticipated population recovery. Contrastes del contenido de información ecológica entre los archivos de la caza de ballenas y los censos actuales de cetáceos para la planeación de la conservación y la identificación de cambios en la distribución histórica Resumen Muchas especies están restringidas a una fracción marginal o subóptima de su área de distribución histórica debido a impactos antropogénicos. Esto dificulta interpretar sus preferencias ecológicas con sólo usar los datos actuales. Sin embargo, la inferencia de estados ecológicos pasados está limitada a la disponibilidad de datos sólidos y a los sesgos de los archivos históricos, lo que plantea un reto para la conservación y los responsables de las políticas. Analizamos la distribución del cachalote (Physeter macrocephalus) en el Océano Índico occidental para resaltar cómo pueden utilizarse los registros históricos para comprender los requisitos ecológicos de las especies amenazadas y direccionar su conservación. Evaluamos las diferencias en el contenido de la información y las predicciones de idoneidad del hábitat basadas en los datos de presencia de ballenas de los registros balleneros Yanquis (1792-1912) y de los estudios actuales sobre cetáceos (1995-2020). Construimos modelos de idoneidad de hábitat con máxima entropía que incluían variables estáticas (derivadas de la batimetría) para comparar los modelos que abarcan datos históricos y actuales. Evaluamos la ubicación de las áreas marinas protegidas (AMP) contrastando las predicciones dentro y fuera de ellas con los modelos históricos y actuales de la idoneidad del hábitat. El modelo histórico predijo una alta idoneidad del hábitat en las regiones costeras y de la plataforma continental cercanas a los continentes e islas, mientras que el modelo moderno predijo una distribución menos costera con una alta idoneidad del hábitat más restringida a las zonas de topografía escarpada. La proporción de hábitats de alta idoneidad dentro y fuera de las AMP fue mayor con la aplicación de las predicciones históricas que con la de las modernas, lo que sugiere que se pueden alcanzar diferentes niveles óptimos de ordenación del espacio marino a partir de ambas fuentes de datos. Además, las diferencias entre los periodos en las predicciones relacionadas con la idoneidad del hábitat fueron coherentes con la reducción histórica de los cachalotes en las regiones costeras, las cuales eran fácilmente accesibles para los balleneros, lo que resultó en una distribución actual más limitada a los márgenes continentales escarpados y a las crestas oceánicas remotas. El uso de datos históricos puede aportar nuevos e importantes conocimientos e informar, mediante una interpretación prudente, a la planificación y la política de conservación; por ejemplo, con la identificación de especies refugiadas y regiones de recuperación poblacional. 由于人类活动的影响, 许多物种的分布区只局限于其历史分布区的边缘或次优区域, 因此, 仅用现代数据很难解释其生态偏好。然而, 推断过去的生态状态受制于历史档案中稳健数据的可用性和偏倚, 这对决策者和保护工作构成了挑战。为了强调如何利用历史记录来了解受威胁物种的生态需求并为保护提供信息, 我们调查了抹香鲸(Physeter macrocephalus)在西印度洋的分布情况。我们评估了基于扬基捕鲸日志(1792-1912年)和现代鲸类调查(1995-2020年)中的鲸鱼出现数据的信息内容与栖息地适宜性预测之间的差异。我们建立了包含静态(来自海洋测深学)变量的最大熵栖息地适宜性模型, 从而对仅用历史数据和仅用现代数据的模型进行了比较。接下来, 通过利用历史和现代的栖息地适宜性模型, 我们比较了海洋保护区内外的预测结果, 以评估海洋保护区的选址情况。历史模型预测大陆和岛屿附近的陆架和沿海地区的栖息地适宜性较高, 而现代模型预测中栖息地适宜性高的地区在沿海地区分布较少, 而更多局限在地形陡峭的地区。用历史数据预测和用现代数据预测的结果相比较, 海洋保护区内部栖息地适宜性高于海洋保护区外部的比例更高, 这表明以这两种数据为来源制定的最优海洋空间规划有所不同。此外, 不同时代相对栖息地适宜性预测的差异与历史上抹香鲸在沿海地区的种群灭绝情况一致, 这些是捕鲸者容易进入并作为目标的区域, 以致于鲸类的现代分布更多地局限于陡峭的大陆边缘和远洋的海岭。使用历史数据可以提供重要的新见解, 加之谨慎的解读, 可以为保护规划和政策提供信息, 例如对避难物种和种群恢复区域的确定。【翻译:胡怡思;审校:聂永刚】.
Mixed symptoms, combining manic or hypomanic elements with depressive features, are a core and frequent dimension of mood disorders. From Kraepelin and Weygandt’s early descriptions to contemporary formulations, diagnostic definitions have shifted between highly restrictive and broader dimensional approaches. The DSM-5 “with mixed features” specifier represented progress, yet limitations remain, notably the exclusion of overlapping symptoms (irritability, distractibility, psychomotor agitation). Recent systematic reviews estimate prevalence at 18% of major depressive episodes, 33% of bipolar depressive episodes, and 35% of manic or hypomanic episodes. Mixed presentations are linked to higher suicide risk, greater illness burden, and poorer treatment response. In recent years, the most robust pharmacological evidence comes from trials with second-generation antipsychotics, particularly lumateperone (with prespecified data across MDD and BD-I/II), lurasidone, ziprasidone, cariprazine, and olanzapine/fluoxetine. In contrast, lithium, valproate, and lamotrigine lack specific studies in depressive episodes with mixed features, and antidepressant monotherapy remains insufficiently supported. This review integrates historical foundations, epidemiological data, and updated therapeutic evidence, highlighting the need for more sensitive diagnostic consensus and longer-term controlled trials to guide clinical practice. Los síntomas mixtos, que combinan elementos maníacos e hipomaníacos con características depresivas, constituyen una dimensión central y frecuente de los trastornos del ánimo. Desde las primeras descripciones de Kraepelin y Weygandt hasta las formulaciones actuales, las definiciones diagnósticas han oscilado entre criterios muy restrictivos y aproximaciones dimensionales más amplias. La introducción del especificador "con síntomas mixtos" en el DSM-5 representó un avance, aunque persisten limitaciones notables, como la exclusión de síntomas solapados (irritabilidad, distracción, agitación psicomotora). Revisiones sistemáticas recientes estiman que la prevalencia de características mixtas alcanza al 18 % de los episodios depresivos mayores, al 33 % de los episodios depresivos bipolares y al 35 % de los episodios maníacos o hipomaníacos. Estos cuadros se asocian con mayor riesgo suicida, evolución más grave y menor respuesta terapéutica. En los últimos años, la evidencia farmacológica más robusta proviene de ensayos con antipsicóticos de segunda generación, destacándose lumateperona, lurasidona, ziprasidona, cariprazina y olanzapina/fluoxetina. En contraste, litio, valproato y lamotrigina carecen de estudios específicos en episodios depresivos con características mixtas, y la monoterapia antidepresiva sigue sin respaldo suficiente. Esta revisión integra los antecedentes históricos, los hallazgos epidemiológicos y la evidencia terapéutica más reciente, subrayando la necesidad de consensos diagnósticos más sensibles y de ensayos controlados a largo plazo que orienten la práctica clínica.
The Virtual Health Library on Homeopathy (BVS Homeopatia Brasil) represents a pioneering initiative in the organization, digitization, and dissemination of homeopathic knowledge in Latin America. This article presents a narrative review of its trajectory, from the informational invisibility of homeopathy during the 1970s and 1980s to its consolidation as the main specialized digital repository in the field. Key milestones are analyzed: the creation of the HOMEOINDEX database, the development of the HP category in the DeCS thesaurus, the leadership of Dr. Matheus Marim in the digital transition, and the institutionalization of the BVS through agreements with BIREME, Pan American Health Organization (PAHO), World Health Organization (WHO), and the Brazilian Ministry of Health. The article also describes its current features, recent technological updates, and the incorporation of artificial intelligence as an emerging challenge. The review identifies BVS Homeopatia as a successful model for democratizing access to scientific knowledge, sustained by interinstitutional cooperation and active community engagement. It concludes that its sustainability will depend on continued use by professionals and the general public, as well as on its capacity to adapt to the technological and epistemological transformations of the 21st century. La Biblioteca Virtual en Salud (BVS) Homeopatía Brasil representa una experiencia pionera en la organización, digitalización y difusión del conocimiento homeopático en América Latina. Este artículo ofrece una revisión narrativa sobre su trayectoria, desde la invisibilidad informacional de la homeopatía en las décadas de 1970 y 1980 hasta su consolidación como el principal repositorio digital especializado en el área. Se analizan los hitos fundamentales: la creación de la base HOMEOINDEX, el desarrollo de la categoría HP del DeCS, el liderazgo del Dr. Matheus Marim en la transición al entorno digital, y la institucionalización de la BVS mediante convenios con BIREME, la Organización Panamericana de la Salud (OPS), la Organización Mundial de la Salud (OMS) y el Ministerio de Salud de Brasil. Asimismo, se describen sus principales funcionalidades, el proceso reciente de actualización tecnológica y la incorporación de inteligencia artificial como reto emergente. La revisión identifica a la BVS Homeopatía como un modelo exitoso de democratización del acceso al conocimiento, sostenido por una red de cooperación interinstitucional y la participación de la comunidad. Se concluye que su sostenibilidad dependerá del uso continuo por parte de profesionales y del público general, así como de su capacidad para adaptarse a las transformaciones tecnológicas y epistemológicas del siglo XXI.
Data on morbidity and mortality after subtotal or total gastrectomy are scarce in developing countries, especially considering the epidemiological shift in gastric cancer (decrease in distal and increase in proximal tumors). To identify factors associated with morbidity and mortality in patients with gastric cancer undergoing curative-intent surgery at a cancer center in Ecuador. Historical cohort study conducted at the National Oncology Institute "Dr. Juan Tanca Marengo" in Guayaquil (2019 - 2021). Only adenocarcinomas treated with curative intent were included. Outcomes were postoperative complications and mortality at 30, 90 days, and overall. Logistic regression was used to estimate factors associated with higher risk. A total of 111 patients were included (87 subtotal, 24 total gastrectomy). At least one complication occurred in 15.4% (subtotal) and 17.9% (total). Thirty-day, 90-day, and overall mortality after subtotal gastrectomy were 1.1%, 2.3%, and 34.5%; after total gastrectomy, 0%, 4.2%, and 54.2%, respectively. Postoperative complications were significantly associated with Bormann III/IV tumors (OR 9.6; 95% CI 1.8 - 79.7; p = 0.0175) and longer hospital stay (OR 2.3; 95% CI 1.4 - 5.1; p <0.001). Mortality was associated with Bormann III/IV tumors (p = 0.0038) and gastro-duodenal leak (p = 0.0383). Ninety-day morbidity and mortality rates were lower than previously reported. Bormann III/IV tumors and postoperative gastro-duodenal leakage were associated with increased mortality. La información sobre morbimortalidad tras una gastrectomía subtotal o total es limitada en países en vías de desarrollo, especialmente ante el cambio epidemiológico del cáncer gástrico. Identificar factores asociados a morbimortalidad en pacientes con cáncer gástrico operados con intención curativa en un centro oncológico de Ecuador. Estudio de cohorte histórica realizado en el Instituto Oncológico Nacional “Dr. Juan Tanca Marengo” (Guayaquil, 2019-2021). Se incluyeron adenocarcinomas gástricos operados con intención curativa. Se evaluaron eventos adversos y mortalidad (30, 90 días y global). Se estimaron factores asociados mediante regresión logística. Se incluyeron 111 pacientes (87 gastrectomía subtotal, 24 total). Hubo ≥ 1 evento adverso en 15,4% (subtotal) y 17,9% (total). La mortalidad a 30, 90 días y global tras la gastrectomía subtotal fue, respectivamente, del 1,1%, 2,3% y 34,5%; tras la total fue de 0%, 4,2% y 54,2%, respectivamente. La presencia de eventos adversos se asoció con tumor Bormann III/IV (OR 9.6; IC95% 1,8 - 79,7; p = 0,0175) y una mayor estancia hospitalaria (OR 2,3; IC95% 1,4 - 5.1; p < 0,001). La mortalidad se asoció con Bormann III/IV (p = 0,0038) y dehiscencia gastro-duodenal (p = 0,0383). Las tasas de morbimortalidad a 90 días fueron menores a lo reportado en otras series. Bormann III/IV y dehiscencia gastroduodenal fueron factores asociados a mayor mortalidad.
The aging of the population is raising the need to make structural changes in the National Health System. First, the need to increase geriatric services in all hospitals. Second, implement and integrate intermediate care (IC), and Third and last, guarantee medical care in long-term care. IC is characterized by a wide range of resources located between acute hospital care and primary care, which include hospitalization devices, both with and without admission or confinement, home and outpatient care, which help to provide continuity and time-limited transition of care. The main objective of IC is an integral (multidimensional) and integrated (interdisciplinary and coordinated between different care levels) care of the older adults, based on the specialized geriatric care. The integration of the IC in the current health system is based on the establishment of two coordinated work dynamics with primary care and acute hospital care, AI becoming key, inside several devices, to prevent hospital admissions (prevent entry -Step Up- focus to give access to primary care to avoid unnecessary hospital admissions) and to facilitate early discharge in acute hospitals (Step Down- focus to promote the best autonomy and functional recovery after a complex acute care). With these objectives in mind, as members of the Intermediate Care Group of the Spanish Society of Geriatrics and Gerontology, the authors propose the following work aiming to revise the current status of available IC resources in Spain, to analyze the context, historical background and its conceptual framework. All these will allow to highlight the undeniable value of IC to healthcare professionals and managers.
The pioneering experience of Health Agents (HA) has significantly reduced infant mortality and became a national reference, leading to the creation of the Community Health Workers Program (PACS) across the country and, subsequently, serving as the foundation for establishing the Family Health Program (PSF), currently known as the Family Health Strategy (ESF), consolidated as the main Primary Health Care model within the Unified Health System (SUS). Carlile Lavor, a Public Health physician who served as Secretary of Health of the State of Ceará in 1987, was responsible for establishing Health Agents and came to be popularly and affectionately known as the "father of the ACS". In an interview granted to researcher Anya Vieira-Meyer, Lavor reflects on the historical trajectory and contemporary challenges of Community Health Workers (ACS) in Brazil. A experiência pioneira dos Agentes de Saúde (AS) teve impacto expressivo na redução da mortalidade infantil e tornou-se referência nacional, dando origem ao Programa de Agentes Comunitários de Saúde (PACS) em todo o país e, posteriormente, servindo de base para a criação do Programa de Saúde da Família (PSF), atualmente denominado Estratégia Saúde da Família (ESF), consolidada como o modelo principal de atenção primária no âmbito do Sistema Único de Saúde (SUS). Carlile Lavor, médico sanitarista e Secretário de Saúde do Ceará em 1987, foi responsável pela criação dos Agentes de Saúde, sendo popularmente e carinhosamente conhecido como “pai dos ACS”. Em entrevista concedida à pesquisadora Anya Vieira-Meyer, Carlile compartilha reflexões sobre a trajetória histórica e os desafios contemporâneos dos Agentes Comunitários de Saúde (ACS) no Brasil. La experiencia pionera de los Agentes de Salud (AS) tuvo un impacto significativo en la reducción de la mortalidad infantil y se convirtió en una referencia nacional, dando origen al Programa de Agentes Comunitarios de Salud (PACS) en todo el país y, posteriormente, sirviendo de base para la creación del Programa de Salud de la Familia (PSF), actualmente denominado Estrategia de Salud de la Familia (ESF), consolidada como el principal modelo de atención primaria en el marco del Sistema Único de Salud (SUS). Carlile Lavor, médico sanitarista y Secretario de Salud de Ceará en 1987, fue responsable de la creación de los Agentes de Salud, siendo popular y cariñosamente reconocido como el “padre de los ACS”. En una entrevista concedida a la investigadora Anya Vieira-Meyer, Carlile comparte reflexiones sobre la trayectoria histórica y los desafíos contemporáneos de los Agentes Comunitarios de Salud (ACS) en Brasil.
Acute lymphoblastic leukemia (ALL) is the most common malignant neoplasm in childhood, with the highest incidence occurring between 10 and 14 years of age in the Mexican population. ALL results from the abnormal proliferation of a malignant clone of leukocytes. The Mexican pediatric population exhibits idiosyncratic characteristics that are associated with a less favorable prognosis compared to the Caucasian population. In 1847, Rudolph Virchow first coined the term leukemia. In 1976, the French-American-British classification was introduced, which described the morphological characteristics of leukemic cells as L1, L2, and L3, providing greater diagnostic accuracy and distinguishing between myeloid and lymphoid leukemia. At that time, the disease-free survival rate was 20%. In 2008, the World Health Organization (WHO) introduced an immunological classification based on the immunophenotype of leukemias, marking a new era in the prognosis and clinical management of the disease. This classification reduced interobserver morphological diagnostic errors by identifying antigens that classify the cell lineage and maturation stage. The expression and combination of cellular antigens, as well as molecular rearrangements, are directly associated with the prognosis of ALL. Treatment has evolved alongside diagnostic advances in recent years, with strategies aimed at limiting treatment-related toxicity through safer chemotherapy regimens. La leucemia linfoblástica aguda (LLA) es la neoplasia maligna más frecuente en la infancia, presentándose con mayor incidencia entre los 10 y 14 años en la población mexicana. La LLA resulta de la proliferación anormal de una clona maligna de leucocitos. La población pediátrica mexicana presenta características idiosincráticas que se asocian a una evolución menos favorable, en comparación con la población caucásica. En 1847, Rudolph Virchow acuñó por primera vez el término leucemia. En 1976 surgió la clasificación Franco-Británico-Americana, la cual describió las características morfológicas de las células leucémicas como L1, L2 y L3, brindando mayor certeza diagnóstica y diferenciando entre leucemia mieloide y linfoide. En esa década, la sobrevida libre de enfermedad era del 20%. En 2008, la Organización Mundial de la Salud (OMS) introdujo la clasificación inmunológica basada en el inmunofenotipo de las leucemias, marcando una nueva era en el pronóstico y la evolución de la enfermedad. Esta clasificación permitió reducir los errores de diagnóstico morfológico interobservador mediante la identificación de antígenos que clasifican la estirpe celular y el estadio de maduración. La expresión y combinación de antígenos celulares, así como los reordenamientos moleculares, se relacionan directamente con el pronóstico de la LLA. El tratamiento ha evolucionado en paralelo con los avances diagnósticos en los últimos años, con estrategias dirigidas a limitar la toxicidad del tratamiento mediante ciclos de quimioterapia más seguros.
Although, in principle, the Lancet article Commission on Medicine, Nazism, and the Holocaust, aims to provide medical students with a moral compass to guide the future of medical practice as a social retaining wall against anti-Semitism, it deals with the Holocaust not from a philosophical point of view, but from a pedagogical one, resorting to didactic strategies from a historiographical approach. What seemed to be a plea against the behaviour of the Nazi doctors' experiments becomes a justification of the positive law of the liberal democracies in use. However, what it ignores is of the utmost importance: that the majority of the regime's doctors were tried and sentenced for their iniquitous actions, and yet, in contemporary Western society, an even greater danger is very much present: techno-science, which, as it stands, can once again compromise the identity, dignity and very life of the human person. Going deeper into the causes, the target of our study, and preventing their repetition means rethinking human nature from the perspective of aristotelian-thomistic thought, which is the basis of the moral laws that derive from the natural law. This moral rearmament supposes assuming, from philosophical realism, the ontological order of being, the anthropological order of being-with, insofar as reason knows as the order of ought to be, which is transmuted into an ethical order thanks to the exercise of the freedom of the human person.
Understanding which species will be extirpated in the aftermath of large-scale human disturbance is critical to mitigating biodiversity loss, particularly in hyperdiverse tropical biomes. Deforestation is the strongest driver of contemporary local extinctions in tropical forests but may occur at different tempos. The 2 most extensive tropical forest biomes in South America-the Atlantic Forest and the Amazon-have experienced historically divergent pathways of habitat loss and biodiversity decay, providing a unique case study to investigate rates of local species persistence on a single continent. We quantified medium- to large-bodied mammal species persistence across these biomes to elucidate how landscape configuration affects their persistence and associated ecological functions. We collected occurrence data for 617 assemblages of medium- to large-bodied mammal species (>1 kg) in the Atlantic Forest and the Amazon. Analyzing natural habitat cover based on satellite data (1985-2022), we employed descriptive statistics and generalized linear models (GLMs) to investigate ecospecies occurrence patterns in relation to habitat cover across the landscapes. The subregional erosion of Amazonian mammal assemblage diversity since the 1970s mirrors that observed since the colonial conquest of the Atlantic Forest, given that 52.8% of all Amazonian mammals are now on a similar trajectory. Four out of 5 large mammals in the Atlantic Forest were prone to extirpation, whereas 53% of Amazonian mammals were vulnerable to extirpation. Greater natural habitat cover increased the persistence likelihood of ecospecies in both biomes. These trends reflected a median local species loss 63.9% higher in the Atlantic Forest than in the Amazon, which appears to be moving toward a turning point of forest habitat loss and degradation. The contrasting trajectories of species persistence in the Amazon and Atlantic Forest domains underscore the importance of considering historical habitat loss pathways and regional biodiversity erosion in conservation strategies. By focusing on landscape configuration and identifying essential ecological functions associated with large vertebrate species, conservation planning and management practices can be better informed. Uso de la pérdida histórica de hábitat para predecir la desaparición de mamíferos contemporáneos en los bosques neotropicales Resumen Tener conocimiento de cuáles especies desaparecerán después de una perturbación humana es de suma importancia para mitigar la pérdida de la biodiversidad, particularmente en los biomas híper diversos. La deforestación es la principal causante de las extinciones locales contemporáneas en los bosques tropicales, aunque puede ocurrir en diferentes tiempos. Los dos bosques tropicales más extensos de América del Sur — el Bosque Atlántico y la Amazonia — han experimentado formas históricamente divergentes de pérdida de hábitat y decadencia de biodiversidad, lo que proporciona un caso único de estudio para investigar las tasas de persistencia de las especies locales en un solo continente. Cuantificamos la persistencia de las especies de mamíferos de talla mediana a grande en estos dos bosques para aclarar cómo la configuración del paisaje afecta su persistencia y las funciones ecológicas asociadas. Recolectamos datos de presencia de 617 ensambles de especies de mamíferos de talla mediana a grande (>1 kg) en el Bosque Atlántico y en la Amazonia. Analizamos la cobertura natural del hábitat con base en datos satelitales (1985‐2022) y empleamos estadística descriptiva y modelos lineales generalizados (MLG) para investigar los patrones de presencia de las eco especies en relación con la cobertura del hábitat en los distintos paisajes. La erosión subregional de la diversidad de ensambles de mamíferos en la Amazonia desde los 70s es igual a la observada en el Bosque Atlántico desde la conquista colonial, dado que 52.8% de todos los mamíferos amazónicos se encuentran en una trayectoria similar. Cuatro de los cinco grandes mamíferos en el Bosque Atlántico estaban propensos a desaparecer, mientras que el 53% de los mamíferos amazónicos estaban vulnerables a desaparecer. Una mayor cobertura natural del hábitat incrementó la probabilidad de persistencia de las eco especies en ambos bosques. Estas tendencias reflejaron una pérdida mediana de especies locales 63.9% mayor en el Bosque Atlántico que en la Amazonia, lo cual parece dirigirse hacia un momento decisivo para la degradación y pérdida del hábitat del bosque. Las trayectorias contrastantes de la persistencia de especies en el Bosque Atlántico y la Amazonia destacan la importancia de considerar dentro de las estrategias de conservación las maneras en las que se ha perdido históricamente el hábitat y la erosión de la biodiversidad regional. Si nos enfocamos en la configuración del paisaje y en la identificación de las funciones ecológicas esenciales asociadas con las especies grandes de vertebrados, podemos informar de mejor manera a la planeación de la conservación y las prácticas de manejo. 了解哪些物种会在大规模人类干扰之后发生灭绝对于减缓生物多样性丧失至关重要, 尤其是对高生物多样性的热带生物群落而言。森林砍伐是当下热带森林局部物种灭绝最主要的驱动因素, 但可能发生的速度不一致。南美洲最广阔的两个热带森林生物群落——大西洋森林和亚马逊流域——历史上经历了不同的栖息地丧失和生物多样性衰减过程, 为研究单一大陆上局部物种续存提供了独特的案例。本研究量化分析了这些生物群落中的中大型哺乳动物的物种续存情况, 以阐明景观格局对其续存及相关生态功能的影响。我们收集了大西洋森林和亚马逊流域617种中大型哺乳动物(体重大于1千克)的出现数据, 并根据卫星数据(1985–2022年)分析了自然栖息地的覆盖情况, 采用描述性统计和广义线性模型分析了生态物种的出现模式与景观中栖息地覆盖情况的关系。结果显示, 自20世纪70年代以来, 亚马逊流域哺乳动物群落多样性的亚区域侵蚀与自殖民者征服大西洋森林以来所观察到的情况一致, 表现为52.8%的亚马逊流域哺乳动物都处于类似的轨迹之中。大西洋森林中五种大型哺乳动物中有四种容易灭绝, 而亚马逊流域哺乳动物中有53%容易灭绝。在这两个生物群落中, 自然栖息地覆盖率的提高可以增加生态物种续存的可能性。这些趋势反映出大西洋森林局部灭绝物种数量的中位数比亚马逊流域高出63.9%, 而亚马逊流域似乎正走向森林栖息地丧失和退化的转折点。亚马逊流域和大西洋森林物种续存相反的轨迹强调了在保护战略中考虑历史栖息地丧失过程和区域生物多样性侵蚀的重要性。关注景观格局并识别与大型脊椎动物相关的基本生态功能, 可以更好地指导保护规划与管理实践。【翻译:胡怡思;审校:聂永刚】.
The aim of this study is to evaluate the effect of erector spinae plane block (ESPB) as a rescue therapy in the recovery room. This single-center historical cohort study included patients who received either ESPB or intravenous meperidine for pain management in the recovery room. Patients' numeric rating scale (NRS) scores and opoid consumptions were evaluated. One hundred and eight patients were included in the statistical analysis. Sixty-two (57%) patients received ESPB postoperatively (pESPB) and 46 (43%) patients were managed with IV meperidine boluses only (IV). The cumulative meperidine doses administered were 0 (0-40) and 30 (10-80) mg for the pESPB and IV groups, respectively (p < 0.001). NRS scores of group pESPB were significantly lower than those of Group IV on T30 and T60. ESPB reduces the frequency of opioid administration and the amount of opioids administered in the early post-operative period. When post-operative rescue therapy is required, it should be considered before opioids. Evaluar el efecto del bloqueo del plano erector espinal (ESPB) como terapia de rescate en la sala de recuperación. Este estudio de cohortes histórico de un solo centro incluyó a pacientes que recibieron ESPB o meperidina intravenosa para el tratamiento del dolor en la sala de recuperación. Se evaluaron las puntuaciones de la escala de calificación numérica (NRS) de los pacientes y los consumos de opiáceos. En el análisis estadístico se incluyeron 108 pacientes. Recibieron ESPB 62 (57%) pacientes y los otros 46 (43%) fueron manejados solo con bolos de meperidina intravenosa. Las dosis acumuladas de meperidina administradas fueron 0 (0-40) y 30 (10-80) mg para los grupos de ESPB y de meperidina sola, respectivamente (p < 0.001). Las puntuaciones de dolor del grupo ESPB fueron significativamente más bajas que las del grupo de meperidina sola en T30 y T60. El ESPB reduce la frecuencia de administración de opiáceos y la cantidad de estos administrada en el posoperatorio temprano. Cuando se requiera terapia de rescate posoperatoria, se debe considerar antes que los opiáceos.
This study presents the most representative notions of the transhumanism concept in light of its temporal development, starting from the first time that there is a record of a similar conception, with the aim of drawing a common thread between all of them and elucidating the relationship that these may have. For this, the works of Dante, Julian Huxley, FM-2030, Max More, Nick Bostrom and Raymond Kurzweil will be reviewed. From this analysis it will be extracted that all these different conceptions of transhumanism are united by their search for transcendence in the human being and the longing for a future state of divinity; Likewise, they differ in the way these common elements are understood. Such common and divergent notions allow a deeper understanding of what transhumanism is and promote a new perspective to understand these cutting-edge ideas.
Autoimmune responses are characterized by the development of antibodies and the activation of T lymphocytes against self-antigens. This leads to an effector immune response against tissues expressing antigens, which are later recognized by the host immune system. Host antigens attacked by antibodies are called "autoantigens" and are of different kinds, including receptors, enzymes, and channel proteins. The autoimmune response is potentiated by cytokines that mediate the activation of Th1, Th2, or Th17 lymphocytes. The released cytokines can also be recognized as autoantigens, meaning they can be targets of the autoimmune response. The effects of autoimmunity on cytokines or their receptors are diverse, and the mechanisms of this type of autoimmune response are discussed in this review. Las reacciones autoinmunitarias se caracterizan por el desarrollo de anticuerpos y la activación de linfocitos T contra autoantígenos. Esto desata una respuesta inmunitaria efectora contra los tejidos que expresan antígenos reconocidos por la autoinmunidad. Los antígenos atacados por anticuerpos se denominan “autoantígenos” y son de diferentes tipos, como receptores, enzimas y proteínas de canal. La reacción autoinmunitaria es potenciada por citocinas que median la activación de los linfocitos Th1, Th2 o Th17. Las citocinas liberadas también pueden ser reconocidas como autoantígenos y, por lo tanto, pueden ser objetivos de la reacción autoinmunitaria. Los efectos de la autoinmunidad en las citocinas o sus receptores son diversos, razón por la cual los mecanismos de este tipo de reacción autoinmunitaria se discuten en esta revisión. Las reacciones autoinmunitarias se caracterizan por el desarrollo de anticuerpos y la activación de linfocitos T contra autoantígenos. Esto desata una respuesta inmunitaria efectora contra los tejidos que expresan antígenos reconocidos por la autoinmunidad. Los antígenos atacados por anticuerpos se denominan “autoantígenos” y son de diferentes tipos, como receptores, enzimas y proteínas de canal. La reacción autoinmunitaria es potenciada por citocinas que median la activación de los linfocitos Th1, Th2 o Th17. Las citocinas liberadas también pueden ser reconocidas como autoantígenos y, por lo tanto, pueden ser objetivos de la reacción autoinmunitaria. Los efectos de la autoinmunidad en las citocinas o sus receptores son diversos, razón por la cual los mecanismos de este tipo de reacción autoinmunitaria se discuten en esta revisión.
A perspective of epidemics and pandemics in Mexico is offered, focusing on three time periods, namely, end of the 18th century, the 20th century, and the 21st century, in order to analyze how they were approached by health and government authorities, as well as the challenges they have represented. Historical documentary sources were consulted and, in current cases, participation in them was analyzed. Epidemiological and social historical methodologies were combined. The presence of epidemics in Mexico is a constant on its evolution, which highlights the need for the epidemiological surveillance system to be updated, the importance of being prepared to face an epidemic and to develop a contingency plan. Se ofrece una perspectiva de las epidemias y pandemias en México en tres periodos: fines del siglo XVIII y siglos XX y XXI, con el fin de analizar cómo las autoridades sanitarias y gubernamentales abordaron estos problemas, así como los desafíos que han representado. Se consultaron fuentes históricas documentales y, en los casos actuales, la participación en ellos. Se combinó metodología epidemiológica e histórica social. La presencia de las epidemias en México es una constante, lo cual evidencia la necesidad de actualizar el sistema de vigilancia epidemiológica, de estar preparados para enfrentar una epidemia y de elaborar un plan de contingencia.
This was a 30-year retrospective cohort study that approximates closely to the natural history of cardiac tumors diagnosed in the fetus, since there was no case of pregnancy interruption. To assess morbidity and mortality in the perinatal period and at long term in fetuses diagnosed with cardiac tumor. Our secondary objective was to assess the evaluating factors of perinatal and postnatal results. This was a retrospective cohort study with 74 pregnant women with an echocardiographic diagnosis of fetal cardiac tumor at two referral centers between May 1991 and November 2021. A descriptive analysis was performed, and data were expressed as absolute (n) and relative (%) frequencies, median and interquartile range. Fisher's exact test was used to evaluate the association of echocardiographic characteristics and clinical manifestations with perinatal and postnatal results. Global survival was calculated using the Kaplan-Meier method and the curves were compared by the log-rank test. The time of follow-up, calculated in months, corresponded to the time elapsed from hospital discharge to current status (survived/ censoring or death). The level of significance was set at 5% (p<0.05). Rhabdomyoma is the most common type of cardiac tumor (85%), with a high morbidity (79.3%) and overall mortality of 17.4%. The presence of fetal hydrops was a predictor of death. The presence of fetal hydrops had an impact on mortality, and hence is an important factor in counselling and determining the prognosis. Most deaths occurred before hospital discharge. Seguimento de coorte retrospectiva de 30 anos que se aproxima da história natural dos tumores cardíacos diagnosticados no feto uma vez que nenhum caso foi submetido à interrupção da gestação. Avaliar a morbidade e mortalidade perinatal e em longo prazo em fetos com diagnóstico de tumor cardíaco. Como objetivo secundário avaliar os fatores que influenciaram os resultados perinatais e pós-natais. Estudo de coorte retrospectiva envolvendo 74 gestantes com diagnóstico ecocardiográfico fetal de tumor cardíaco acompanhadas em dois serviços de referência no período de maio de 1991 a novembro de 2021. Foi realizada análise descritiva dos dados por meio de frequências absolutas (n) e relativas (%), mediana e intervalos interquartis. Para avaliar a associação entre as características ecocardiográficas e as manifestações clínicas com os resultados perinatais e pós-natais, foi aplicado o teste exato de Fisher. O cálculo da sobrevida global foi realizado pelo método de Kaplan-Meier e a comparação de curvas pelo teste de log-rank. O tempo de seguimento, calculado em meses, foi definido a partir da data de alta do hospital à data do status atual (vivo/censura ou óbito). O nível de significância considerado foi de 5% (p<0,05). o rabdomioma é o tipo mais frequente (85%) de tumor cardíaco; apresenta alta morbidade (79,3%) e mortalidade geral de 17,4%; a presença de hidropisia fetal preditiva de óbito. A presença de hidropisia fetal teve impacto na mortalidade, sendo fator importante para aconselhamento e estabelecimento de prognóstico. A maioria dos óbitos ocorrem antes da alta hospitalar. This was a 30-year retrospective cohort study that approximates closely to the natural history of cardiac tumors diagnosed in the fetus, since there was no case of pregnancy interruption To assess morbidity and mortality in the perinatal period and at long term in fetuses diagnosed with cardiac tumor. Our secondary objective was to assess the evaluating factors of perinatal and postnatal results. This was a retrospective cohort study with 74 pregnant women with an echocardiographic diagnosis of fetal cardiac tumor at two referral centers between May 1991 and November 2021. A descriptive analysis was performed, and data were expressed as absolute (n) and relative (%) frequencies, median and interquartile range. Fisher's exact test was used to evaluate the association of echocardiographic characteristics and clinical manifestations with perinatal and postnatal results. Global survival was calculated using the Kaplan-Meier method and the curves were compared by the log-rank test. The time of follow-up, calculated in months, corresponded to the time elapsed from hospital discharge to current status (survived/ censoring or death). The level of significance was set at 5% (p<0.05). Rhabdomyoma is the most common type of cardiac tumor (85%), with a high morbidity (79.3%) and overall mortality of 17.4%. The presence of fetal hydrops was a predictor of death. The presence of fetal hydrops had an impact on mortality, and hence is an important factor in counselling and determining the prognosis. Most deaths occurred before hospital discharge.
The differential diagnosis between autism and schizophrenia in childhood has been the subject of numerous controversies. Because verbal hallucinations could be one of the main clinical phenomena when establishing a differential diagnosis, the objective was to investigate the presence or absence of verbal hallucinations in autism. For this, a selective and unsystematic review of the current scientific evidence was carried out. Added to this, the phenomenon of hallucination, and mainly verbal hallucination, was conceptualized from a historical perspective; the relevance given to hallucinations in the delimitation of the mentioned nosographic constructs was broached; and verbal hallucinations in autism were analyzed comparing different paradigms, including contributions from psychoanalysis. We observe that from the side of scientific evidence it is not possible to state strong conclusions regarding the presence or absence of verbal hallucinations in autism. In turn, the historical review of the concept of verbal hallucination from classical psychiatry together with contributions from psychoanalysis, invite us to think that one of the differential characteristics between autism and psychosis is the absence of verbal hallucinations in the first diagnosis, and that if there were hallucinations in autism, these would present different qualities from those of psychosis. We consider it highly relevant to be able to establish this differentiation in the hallucinatory phenomenon in autism, not only in order to establish a differential diagnosis between the two conditions, but also because of the implications that this could have in pharmacotherapy. El diagnóstico diferencial entre el autismo y la esquizofrenia en la infancia ha sido motivo de numerosas controversias. Debido a que las alucinaciones verbales podrían ser uno de los fenómenos clínicos principales al momento de establecer un diagnóstico diferencial, se propuso como objetivo indagar sobre la presencia o ausencia de alucinaciones verbales en el autismo. Para ello se realizó una revisión selectiva y asistemática de la evidencia científica actual. Sumado a esto se conceptualizó el fenómeno de la alucinación, y principalmente la alucinación verbal, desde una perspectiva histórica; se abordó la relevancia otorgada a las alucinaciones en la delimitación de los constructos nosográficos mencionados; y se analizó las alucinaciones verbales en el autismo comparando distintos paradigmas, incluyendo aportes del psicoanálisis. Observamos que desde el lado de la evidencia científica no es posible afirmar conclusiones contundentes respecto de la presencia o ausencia de alucinaciones verbales en el autismo. A su vez, la revisión histórica del concepto de alucinación verbal desde la psiquiatría clásica junto con aportes del psicoanálisis, nos invitan a pensar que una de las características diferenciales entre el autismo y la psicosis es la ausencia de alucinaciones verbales en el primer cuadro, y que de haber alucinaciones en el autismo, estas presentarían cualidades diferentes a las de la psicosis. Consideramos sumamente relevante poder establecer esta diferenciación en el fenómeno alucinatorio en el autismo, no sólo para poder establecer un diagnóstico diferencial entre ambos cuadros, sino también por las implicancias que esto podría suscitar en el tratamiento farmacológico.
In this paper, the first 20 years of publication of the scientific journal AMHA - Acta medico-historica Adriatica (2002-2022) are presented and analysed. This journal has undoubtedly become and remained the central activity of the Croatian Scientific Society for the History of Health Culture, which has rapidly evolved into a globally esteemed journal in the history of medicine. The beginning and the context of publishing the journal with reference to the scientific conference "Rijeka and Its Citizens in Medical History" are presented, as well as the journal's profiling into a distinguished international scientific journal, co-publishing with the Faculty of Medicine (University of Rijeka) and its fast development in the later years. The analysis shows the growth of the journal's visibility through indexation in different international journal databases, the number and ratio of scientific articles and the variety of published material. Finally, a review of the potential future directions of development and the significance of this journal within the national, regional and international context is given.
Since its foundation, the Faculty of Medical Sciences (FCM, UNC, Argentina) and its members in the design and implementation of eugenic public policies aimed at preventing depopulation and reducing infant mortality. This study describes these policies since the foundation of this institution until the outbreak of the university reform process. A bibliographical analysis of online databases and library catalogs was performed in order to identify texts referring to child care and public health policies promoted by the FCM from 1877 to 1918. Results: 11 bibliographical references were obtained: three books, two scientific journal articles and six Thesis for the title of Doctor in Medicine and Surgery from the FCM. A great interest in the characterization of infant mortality in Córdoba and the promotion of exclusive breastfeeding is evident in the texts analyzed. This is associated with the creation and administration of childcare health institutions, including the Children's Protective Clinic. The FCM, associated to political groups in Córdoba, actively participated in the dissemination of childcare concepts (whose recipients were mainly women-mothers of low socioeconomic strata) and in the implementation of actions aimed at the population growth and the inculcation of moral values accepted by its academics. Desde su fundación, la Facultad de Ciencias Médicas (FCM, UNC, Argentina) y sus miembros participaron en el diseño y la aplicación de políticas públicas eugénicas destinadas a evitar la despoblación y disminuir la mortalidad infantil. El presente trabajo describe dichas políticas desde la fundación de dicha institución hasta el inicio del proceso de Reforma Universitaria. Se realizó un análisis bibliográfico de bases de datos online y catálogos de bibliotecas para identificar textos referidos a políticas de puericultura y salud pública promovidas por la FCM en el período 1877 - 1918. Se obtuvieron un total de 11 referencias bibliográficas: tres libros, dos artículos publicados en revistas científicas y seis Tesis para optar al título de Doctor en Medicina y Cirugía de la FCM. Discusión: Se evidencia en los textos analizados un gran interés en la caracterización de la mortalidad infantil en Córdoba y la promoción de la lactancia materna exclusiva. A ello se asocia la creación y administración de instituciones de salud de puericultura entre los que se destaca el Consultorio Protector de la Infancia. La FCM, ligada a grupos políticos cordobeses, participó activamente en la difusión de los conceptos de puericultura (cuyas destinatarias eran principalmente las mujeres-madres de estratos socioeconómicos carenciados) y en la implementación de acciones tendientes al crecimiento poblacional y la inculcación de valores morales aceptados por sus académicos.
Geoffroea decorticans is a drought-tolerant native tree to the Atacama Desert, one of the most extreme hyper-arid environments on Earth. Despite its ecological and socioeconomic value, little is known about its genetic status across a fragmented distribution. This study aimed to characterize the genetic diversity and population structure, and to assess evidence of genetic bottlenecks to propose conservation strategies for long-term persistence. We genotyped 194 individuals from eight natural populations spanning the species' range in northern Chile using nine nuclear microsatellite loci. We analyzed genetic diversity, differentiation, and structure. In addition, bottleneck signatures were evaluated through heterozygosity excess, allele frequency distribution, and M-ratio tests, and the effective population size (Ne) was estimated for each population. Null-allele frequencies were low across the studied loci. Most populations exhibited moderate to high levels of genetic diversity (Ar = 3.86, H O = 0.73, H E = 0.625) and significant heterozygote excess (F IS = -0.192). Pairwise linkage disequilibrium patterns across loci varied among populations, and we detected significant genetic structure and differentiation. Multiple populations showed evidence of recent and/or historical bottleneck events, with low effective population sizes (NE-LD < 20). We documented genetic variation, population structure, and bottleneck signals in G. decorticans populations across the Atacama Desert and emphasize the urgency of genetic monitoring. Conservation plans should prioritize populations based on genetic information including those with low diversity, strong bottleneck signals and high uniqueness; promote rigorous evaluation of source materials for future assisted gene flow programs, and protect habitat corridors to maintain adaptive potential under increasing aridification.