615 research outputs found
Regional integration in Central Asia: A firm-centered view
No full textRegional integration remains among the main topics of international discourse in Central Asia, though the progress of international cooperation is very limited. Our aim is to understand the connection between the organization of economic institutions in Central Asia and the regional integration. The existing literature has explored the state level of integration in great detail: varying from rational choice explanations of security dilemma to the studies of social construction of the region in Central Asia. This paper, however, provides a firm-centered perspective on the regional integration. Thus, it first considers how varieties of political economies of Central Asian countries influence the regionalization process in the region through economic networks established by private actors, and how institutions are shaped by regionalization. Second, it considers how political institutions determine the impact of informal networks on formal regional integration initiatives, and looks at the potential effect of formal regionalism on regionalization process in Central Asia.Regionalization, informal integration, transition
Economic role of public administration in Central Asia: Decentralization and hybrid political regime
No full textThe aim of the paper is to understand how the organization of public administration in Central Asia shapes the results of economic development in the region. It discusses the main factors of bad quality of public administration in the region, paying particular attention to the link between political regimes and public administration. Moreover, it provides an overview of decentralization and devolution of power in Central Asian countries as one of the main channels of transformation of administration. The paper covers both formal decentralization and informal distribution of power between levels of government.Public administration, hybrid regimes, decentralization
Un caso de endocarditis de Libman Sacks
No full textLibman y Sacks en 1924 evidenciaron lesiones en las válvulas cardiacas de pacientes con Lupus Eritematoso Sistémico, siendo las más afectadas la válvula mitral y la aórtica. Se trata de vegetaciones estériles, cuya prevalencia es del 53 al 74% y guarda relación con actividad lúpica y síndrome de anticuerpos antifosfolipídicos. El ecocardiograma es el estudio de elección para el diagnóstico y seguimiento de la enfermedad. La regurgitación es la afectación más frecuente, las lesiones valvulares pocas veces son severas, el tratamiento incluye profilaxis para endocarditis, manejo antiagregante y en algunos casos anticoagulante. El uso de corticoesteroides no previene la presentación de la enfermedad pero facilita la recuperación. En aquellos pacientes con disfunción valvular y repercusión hemodinámica se puede optar por manejo conservador. En casos seleccionados de afectación valvular severa se debe considerar el reemplazo valvular, así como individualizar el uso de válvula mecánica versus bioprotésica. En la actualidad la reparación valvular es una alternativa al reemplazo con mejores tasas de mortalidad y supervivencia
Libman-Sacks endocarditis in systemic lupus erythematosus: Prevalence, associations, and evolution
No full textPURPOSE: We evaluated the prevalence and progression of Libman-Sacks endocarditis in patients with systemic lupus erythematosus and any association between this valvulopathy and their clinical and laboratory characteristics. METHODS: Doppler echocardiography was performed in 342 consecutive patients with systemic lupus erythematosus (297 females and 45 males). The clinical and laboratory data were recorded. Patients were reevaluated after a follow-up period of 4 years. RESULTS: Libman-Sacks endocarditis was found in 38 patients (11%). In 24 of 38 patients, mitral valve involvement was found, resulting in regurgitation in all ( mild in 18, moderate in 4, and severe in 2), whereas stenosis co-occurred with regurgitation in 9 patients (mild in 6 and moderate in 3). Thirteen (34%) of 38 patients had aortic valve involvement; 11 had regurgitation (mild) and 8 had stenosis (mild), coexistent with regurgitation in 6 of them. One patient had mild tricuspid regurgitation. A significant association was found between Libman-Sacks endocarditis and disease duration and activity, thromboses, stroke, thrombocytopenia, anticardiolipin antibodies, and antiphospholipid syndrome. During the follow-up period, 252 of 342 patients were reevaluated echocardiographically. Among the 38 patients with Libman-Sacks vegetations, 5 with mild mitral regurgitation at the beginning developed moderate (n = 4) and severe mitral regurgitation (n = 1), 2 patients with mitral stenosis (mild in 1 and moderate in 1) developed severe mitral regurgitation, and 2 patients with mild aortic regurgitation developed moderate and severe mitral regurgitation, whereas a significant deterioration of aortic stenosis was found. Two patients who were candidates for surgery died. Among the 213 patients without vegetations at the beginning, 8 developed new Libman-Sacks lesions. CONCLUSIONS: Libman-Sacks vegetations can be found in approximately 1 of 10 patients with systemic lupus erythematosus, and they are associated with lupus duration, disease activity, anticardiolipin antibodies, and antiphospholipid syndrome manifestations. A progression of valve lesions may occur during long-term follow-up. (c) 2007 Elsevier Inc. All rights reserved
Libman-Sacks Endocarditis and Embolic Cerebrovascular Disease
No full textObjectivesThe aim of this study was to determine whether Libman-Sacks endocarditis is a pathogenic factor for cerebrovascular disease (CVD) in systemic lupus erythematosus (SLE).BackgroundA cardioembolic pathogenesis of SLE CVD manifested as: 1) neuropsychiatric systemic lupus erythematosus (NPSLE), including stroke and transient ischemic attacks (TIA); 2) neurocognitive dysfunction; and 3) magnetic resonance imaging of focal brain lesions has not been established.MethodsA 6-year study of 30 patients with acute NPSLE (27 women, 38 ± 12 years of age), 46 age- and sex-matched SLE controls without NPSLE (42 women, 36 ± 12 years of age), and 26 age- and sex-matched healthy controls (22 women, 34 ± 11 years of age) who underwent clinical and laboratory evaluations, transesophageal echocardiography, carotid duplex ultrasound, transcranial Doppler ultrasound, neurocognitive testing, and brain magnetic resonance imaging/magnetic resonance angiography. Patients with NPSLE were re-evaluated after 4.5 months of therapy. All patients were followed clinically for a median of 52 months.ResultsLibman-Sacks vegetations (87%), cerebromicroembolism (27% with 2.5 times more events per hour), neurocognitive dysfunction (60%), and cerebral infarcts (47%) were more common in NPSLE than in SLE (28%, 20%, 33%, and 0%) and healthy controls (8%, 0%, 4%, and 0%, respectively) (all p ≤ 0.009). Patients with vegetations had 3 times more cerebromicroemboli per hour, lower cerebral blood flow, more strokes/TIA and overall NPSLE events, neurocognitive dysfunction, cerebral infarcts, and brain lesion load than those without (all p ≤ 0.01). Libman-Sacks vegetations were independent risk factors of NPSLE (odds ratio [OR]: 13.4; p < 0.001), neurocognitive dysfunction (OR: 8.0; p = 0.01), brain lesions (OR: 5.6; p = 0.004), and all 3 outcomes combined (OR: 7.5; p < 0.001). Follow-up re-evaluations in 18 of 23 (78%) surviving patients with NPSLE demonstrated improvement of vegetations, microembolism, brain perfusion, neurocognitive dysfunction, and lesion load (all p ≤ 0.04). Finally, patients with vegetations had reduced event-free survival time to stroke/TIA, cognitive disability, or death (p = 0.007).ConclusionsThe presence of Libman-Sacks endocarditis in patients with SLE was associated with a higher risk for embolic CVD. This suggests that Libman-Sacks endocarditis may be a source of cerebral emboli
Libman–Sachs endocarditis: regression after immunosuppressive therapy in a patient with systemic lupus erythematosus
No full textLibman–Sachs endocarditis (nonbacterial thrombotic endocarditis, NBTE) may be one of the cardiac manifestations of systemic lupus erythematosus (SLE). It is characterized by the presence of sterile platelet thrombi on previously normal heart valves. The diagnosis of NBTE is difficult as it is often asymptomatic until complications such as systemic emboli or valvular dysfunction occur. Patients with Libman–Sachs endocarditis and SLE are treated with immunosuppressive and anticoagulant therapy and, if it is ineffective, surgical treatment.A clinical case of SLE and Libman–Sachs endocarditis is presented. The clinical manifestations, diagnostic methods and treatment of NBTE in SLE are discussed. The difficulties in differential diagnosis and selection of optimal treatment tactics faced by physicians are highlighted
Libman-Sacks Endocarditis with Unusual Large Size Vegetation Involving the Mitral Valve
No full textAntiphospholipid syndrome (APS) is an autoimmune hypercoagulable disorder characterized by thrombophilia, vascular thrombosis, and recurrent abortions associated with persistent antiphospholipid antibodies. APS may exist in its primary form, or more commonly is found to be associated with variety of rheumatic disorders, such as systemic lupus erythematosus. Cardiac involvement is not an uncommon complication in primary antiphospholipid patients. Libman-Sacks lesions are typically small, sessile, and wart-like, varying in size from 1-4 mm. Here we present an unusual case of a 37 year-old pregnant woman who suffered from heart failure associated with primary antiphospholipid syndrome and Libman-Sacks endocarditis, with large vegetations involving the mitral valve. The patient underwent mitral valve replacement with a mechanical prosthesis.</jats:p
Government-Business Relations and Catching Up Reforms in the CIS
No full textThe paper addresses the problem of similarities and divergence of transition paths at the later stage of transition in the countries of the Commonwealth of Independent States. The main aim is to clarify the influence of specifics of government-business relations on economic reforms carried out at the later stage of transition in countries, which have been relatively less successful during the earlier transition. The paper discusses potential channels of influence of institutional organization of government-business relations on economic reforms and compares government-business relation models and paths of transition in Russia, Kazakhstan and UkrainePost-Soviet economies, catching up reforms, institutional trap, government-business relations
Institutional competition in the post-Soviet space
No full textInstitutional competition is often discussed as an instrument of market creation and preservation in transition and development economies. The post-Soviet space offers an interesting case study for the analysis of this problem: increasing international investment flows and absent policy coordination establish an environment for intensification of institutional competition among jurisdictions. Nevertheless, in the post-Soviet world the quality of institutions seems to remain low. This paper deals with potential effects of interjurisdictional competition on institutional quality in the post-Soviet space while addressing two levels of analysis: rational choice factors (economic inequality and learning effects) and interplay of formal and informal institutions (perception of free markets, trust to the public authority and interaction of deep and shallow institutional levels).Institutional competition, demand for bad institutions, formal and informal institutions
Active NET formation in Libman–Sacks endocarditis without antiphospholipid antibodies : A dramatic onset of systemic lupus erythematosus
No full textAlthough neutrophil extracellular traps (NETs) have been highlighted in several systemic inflammatory diseases, their clinical correlates and potential pathological role remain obscure. Herein, we describe a dramatic onset of systemic lupus erythematosus (SLE) with clear-cut pathogenic implications for neutrophils and NET formation in a young woman with cardiac (Libman–Sacks endocarditis) and central nervous system (psychosis and seizures) involvement. Despite extensive search, circulating antiphospholipid autoantibodies, a hallmark of Libman–Sacks endocarditis, could not be detected. Instead, we observed active NET formation in the tissue of the mitral valve, as well as in the circulation. Levels of NET remnants were significantly higher in serially obtained sera from the patient compared with sex-matched blood donors (p =.0011), and showed a non-significant but substantial correlation with blood neutrophil counts (r = 0.65, p =.16). The specific neutrophil elastase activity measured in serum seemed to be modulated by the provided immunosuppressive treatment. In addition, we found anti-Ro60/SSA antibodies in the cerebrospinal fluid of the patient but not NET remnants or increased elastase activity. This case illustrates that different disease mechanisms mediated via autoantibodies can occur simultaneously in SLE. NET formation with release of cytotoxic NET remnants is a candidate player in the pathogenesis of this non-canonical form of Libman–Sacks endocarditis occurring in the absence of traditional antiphospholipid autoantibodies. The case description includes longitudinal results with clinical follow-up data and a discussion of the potential roles of NETs in SLE
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