In The Prince, Machiavelli often associates power with force and the ability to compel obedience. In the Discourses on Livy and Florentine Histories, however, he emphasizes the role that moral ...authority has played in the construction of princely power, especially in republics like ancient Rome and modern Florence. This article explores the alternative style of princely virtù that Machiavelli associates with these princes and contrasts it with cruder forms of fraud, like moral hypocrisy, playing the hero, and ideological innovation. Finally, it shows how Machiavelli’s analysis of power and princely virtù constitutes a revival of the historiographic tradition epitomized by Thucydides, Sallust, and Tacitus, in which irony is used to critique the social grammars that princes have used to underwrite their domination.
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Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Who is Lucrezia, the mysterious woman at the center of Machiavelli’s comic play Mandragola? And why is she deemed “fit to govern a kingdom”? This article revisits these questions with attention to ...Mandragola’s sophisticated, and often irreverent, allusions to Roman source materials. While scholars have long recognized that Mandragola draws on Roman history and drama, its sustained engagement with Lucretian and Ovidian poetry has gone largely unnoticed. In what follows, I trace these allusions and show how Machiavelli uses them to bring into view the fertility of erotic desire. Mandragola is replete with Lucretian phrases and imagery, but a close examination of these references indicates they are made playfully, and even satirically, in the style of Ovid’s Ars amatoria, a didactic elegy on the art of seduction that develops a mixed assessment of Epicurean teachings. Like Ovid, Machiavelli embraces the hedonism that motivates Epicureanism—but without accepting that happiness requires distancing ourselves from illusion. This departure allows both Ovid and Machiavelli to reassess the status of erotic desire. For Lucretius, erotic desire must be handled with extreme caution lest it entangle the mind in ruinous false beliefs and destroy the possibility of theoretical wisdom. Machiavelli, following Ovid, recommends a different course, in which happiness is achieved through the deliberate manipulation of erotic fantasy. For Machiavelli, staging erotic fantasies is an essential part of statecraft.
Introduction
Patients undergoing laparotomy for emergency general surgery (EGS) conditions, constitute a high-risk group with poor outcomes. These patients have a high prevalence of comorbidities. ...This study aims to identify patient factors, physiological and time-related factors, which place patients into a group at increased risk of mortality.
Methodology
In a retrospective analysis of all patients undergoing an emergency laparotomy at Greys Hospital from December 2012 to 2018, we used decision tree discrimination to identify high-risk groups.
Results
Our cohort included 1461 patients undergoing a laparotomy for an EGS condition. The mortality rate was 12.4% (181). Nine hundred and ten patients (62.3%) had at least one known comorbidity on admission. There was a higher rate of comorbidities among those that died (154; 85.1%). Patient factors found to be associated with mortality were the age of 46 years or greater (
p
< 0.001), current tuberculosis (
p
< 0.001), hypertension (
p
= 0.014), at least one comorbidity (0.006), and malignancy (0.033). Significant physiological risk factors for mortality were base excess less than −6.8 mmol/L (
p
< 0.001), serum urea greater than 7.0 mmol/L (
p
< 0.001) and waiting time from admission to operation (
p
= 0.014). In patients with an enteric breach, those younger than 46 years and a Shock Index of more than 1.0 were high-risk. Patients without an enteric breach were high-risk if operative duration exceeded 90 min (
p
= 0.004) and serum urea exceeding 7 mmol/dl (
p
= 0.016).
Conclusion
In EGS patients, patient factors as well as physiological factors place patients into a high-risk group. Identifying a high-risk group should prompt consideration for an adjusted approach that ameliorates outcomes.
Background
Despite the human immunodeficiency virus (HIV) being the most common comorbidity in South African surgical patients, its impact on appendicitis has not been well-described. We aimed to ...determine HIV status’ influence on patients’ presentation, assessment, management and outcomes with acute appendicitis.
Methods
The retrospective chart review included all patients aged 12 years and older who were HIV-positive or HIV-negative and presented with acute appendicitis between 1 January 2013 and 31 December 2019. The primary outcome measure was survival to discharge. Secondary outcomes included analysis of the presentation (vital signs), assessment (biochemical, inflammatory markers) and management (intraoperative anatomical severity grading, length of hospital stay).
Results
Of the 1096 patients with appendicitis, 196 (17.9%) were HIV-positive, and CD4 counts were available for 159. The median age was 23 years, with the HIV-positive patients being older and HIV-negative group having more males (58.7%). While the HIV-positive patients had a longer median length of hospital stay, there was no statistically significant difference in the two groups’ incidence of high-grade appendicitis (
p
= 0.670). The HIV-positive patients had a higher median shock index (OR 7.65; 95% CI 2.042–28.64) than their HIV-negative counterparts. HIV-positivity had a significant association with mortality (OR 9.56; 95% CI 1.68–179.39), and of the seven HIV-positive patients who died, 66.7% (
n
= 4) had a CD4 < 200 cells/mm
3
(OR 8.6; 95% CI 1.6–63.9).
Conclusion
HIV-positive patients, those with CD4 < 200 cells/mm
3
or not on ART, have increased mortality risk and may benefit from increased perioperative surveillance. Patients with an unknown HIV status in a high-prevalence population should be offered HIV testing to risk stratify more accurately.
Introduction
The open abdomen (OA) is a necessary component of damage control surgery and closure is often challenging. Our aim was to review our ten-year experience with OA in trauma patients and to ...compare the success of a dual closure technique termed vacuum-assisted, mesh-mediated fascial traction (VAMMFT) to an exclusively Bogota Bag (BB) approach.
Methods
A retrospective analysis was performed using the HEMR database from 2012 to 2022, comparing demographics, mechanism of injury, admission vitals and biochemistry between patients with BB and VAMMFT applications. Rate of secondary abdominal closure and complications were assessed in both groups. Logistic regression was used to find predictors of closure.
Results
OA was required by 348 patients at index laparotomy. Of these, 133 (38.2%) were managed with VAMMFT and 215 (61.8%) exclusively with a BB. There were no statistical differences between the BB and VAMMFT groups in terms of demographics, injuries, admission vitals and biochemistry. The VAMMFT group achieved a closure rate of 73% compared to 54.9% in the BB group (OR of 2.2 1.4–3.7). There was no significant difference in fistulation rate between the two groups (
p
= 0.103). Length of hospital stay was 30 versus 17 days in the VAMMFT and BB groups, respectively (OR 1.41 1.30–1.54). There were no independent predictors of closure identified in the VAMMFT group. Older patients were less likely to achieve closure when BB was used (OR 0.97 0.95–0.99). VAMMFT failure was commonly due to lack of stock (39%) and protocol violations (33%).
Conclusion
The VAMMFT approach to the OA is efficacious and safe. VAMMFT achieves a much higher rate of secondary closure than BB alone with a low rate of enteric fistula formation.
Introduction
This project aims to define the common comorbidities associated with patients undergoing emergency laparotomy in South Africa, to review the impact of these comorbidities on outcome and ...to attempt to model these various factors.
Method
A retrospective review of all patients undergoing emergency laparotomy for an emergency general surgical condition was performed from the prospectively entered Hybrid Electronic Medical Registry (HEMR). Univariate and multiple logistic regression analysis was performed to establish associations and independent risk factors for developing an adverse event.
Results
Over a six-year time period, a total of 1464 patients underwent emergency laparotomy. The median age was 34 years. Males constituted 58.8% (861) of the patients and 754 patients (51.5%) experienced at least one adverse event. The mortality rate was 12 percent. Comorbidities and social factors were documented in 912 patients (62.3%). The rate of adverse events among patients with comorbidities was 59% (538). Patients without comorbidities or significant social factors had an adverse event rate of 39.1% (216). This difference was statistically significant (p < 0.001). The most frequent comorbidity in our sample was HIV, followed by hypertension, underlying malignancy, diabetes mellitus, active TB and cardiovascular disease.
Conclusion
Emergency laparotomy in South Africa is associated with significant morbidity and mortality. The patients are younger than in high-income countries. Diabetes mellitus, hypertension, HIV and active TB are associated with the development of an AE.
Thank you to Yves Winter for his very thoughtful and fair evaluation of my book. As Winter says, Machiavelli’s Florentine Republicis a book about Machiavelli’s effort to take the measure of ...Florentine republicanism in theFlorentine Histories. Winter is persuaded by the foundational argument of the book, which is that Machiavelli wrote theHistoriesto provide his readers with a corrected account of what Florentine republicanism actuallywas—a more faithful rendering of its defining principles and achievements, intended to supplant the faulty and tendentious storytelling of humanist historiographers like Leonardo Bruni. Moreover, Winter is convinced that with this account in hand, Machiavelli develops a subtle but uncompromising analysis of Medici power, dissipating the pseudo-republican fog that had once surrounded figures like Cosimo Medici and shielded their tyrannical designs against intelligible republican critique.
Nontraumatic surgical emergencies constitute a significant portion of total surgical workload and are associated with a significant mortality rate. The spectrum and outcome of surgical emergencies in ...a low-middle-income country may differ from that in high-income countries. This study aims to describe the spectrum and outcome of emergency laparotomy for nontrauma surgical emergencies at a single-tertiary center in South Africa.
A retrospective interrogation of a hybrid electronic record system of consecutive patients undergoing emergency laparotomy for nontraumatic surgical emergencies presenting to Greys Hospital from December 2012 to December 2018.
One thousand four hundred sixty four patients were included with a median age of 34 y (IQR 23-52) and male predominance (861; 59%). The mortality rate was 12.5% (183). The most common comorbidity was human immunodeficiency virus (353; 24.1%) which did not influence mortality. At least one comorbidity increased the odds of mortality by 4 times (95% CI 2.7-6.2). Mortality was associated with longer waiting times to operation (12.8 versus 8.4 h; P < 0.001) and longer operating times (105 min versus 80 min respectively; P < 0.001). Temporary abdominal closure was used in 245 (16.7%) patients. Planned repeat laparotomy was performed in 193 (13.2%) patients. Acute appendicitis (594, 40.6%) was the most common pathology of which 61.4% had the American Association for the Surgery of Trauma grade of 4 or more (high grade). This was followed by perforated peptic ulcer disease (10.5%). The adverse event rate was 51.5% (754). Postoperative pulmonary complications and acute kidney injury were the most common. The strongest predictors of mortality were abdominal compartment syndrome (OR 26.5, 95% CI 9.36-94.13) and postoperative hemodynamic instability 17.43 (OR 17.4, 95% CI 11.80-25.98).
Our spectrum of disease differs to that found in high-income countries. The morbidity and mortality rates are significant, and attention must be focused on attempts to reduce this. Various comorbidities and adverse events are associated with increased mortality.
BACKGROUND—Although adiposity is increasingly recognized as a risk factor for atrial fibrillation (AF), the importance of epicardial fat compared with other adipose tissue depots remains uncertain. ...We sought to characterize and compare the associations of AF with epicardial fat and measures of abdominal and overall adiposity.
METHODS AND RESULTS—We conducted a meta-analysis of 63 observational studies including 352 275 individuals, comparing AF risk for 1-SD increases in epicardial fat, waist circumference, waist/hip ratio, and body mass index. A 1-SD higher epicardial fat volume was associated with a 2.6-fold higher odds of AF (odds ratio, 2.61; 95% confidence interval CI, 1.89–3.60), 2.1-fold higher odds of paroxysmal AF (odds ratio, 2.14; 95% CI, 1.45–3.16) and, 5.4-fold higher odds of persistent AF (odds ratio, 5.43; 95% CI, 3.24–9.12) compared with sinus rhythm. Likewise, a 1-SD higher epicardial fat volume was associated with 2.2-fold higher odds of persistent compared with paroxysmal AF (odds ratio, 2.19; 95% CI, 1.66–2.88). Similar associations existed for postablation, postoperative, and postcardioversion AF. In contrast, associations of abdominal and overall adiposity with AF were less extreme, with relative risks per 1-SD higher values of 1.32 (95% CI, 1.25–1.41) for waist circumference, 1.11 (95% CI, 1.08–1.14) for waist/hip ratio, and 1.22 (95% CI, 1.17–1.27) for body mass index.
CONCLUSIONS—Strong and graded associations were observed between increasing epicardial fat and AF. Moreover, the strength of associations of AF with epicardial fat is greater than for measures of abdominal or overall adiposity. Further studies are needed to assess the mechanisms and clinical relevance of epicardial fat.
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