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Analysis De Sangre Pdf Download [2021]

Living with Rodolfo and Cervantes's "La fuerza de la sangre" Elizabeth Rhodes "La fuerza de la sangre," the sixth of Cervantes's Novelas ejemplares, is widely recognized as a problematic text. In it, the nobly-born youth Rodolfo abducts, blindfolds, rapes, then completely forgets Leocadia, a lovely sixteen-year-old of the impoverished nobility. Dissimulating the family shame, Leocadia's supportive parents raise the child born of the rape as their nephew, and the narrator consistently represents the boy as a blessing. In the end, the perpetrator and his victim marry, further reproduce, and live happily ever after, to the delight of their four parents and the ongoing consternation of readers.

Analysis De Sangre Pdf Download

Indeed, if read literally, "La fuerza de la sangre" could be an apology for rape, evidence of what wondrous things happen to the victim in [End Page 201] its wake, for on the surface Leocadia's fortunes ultimately do nothing but rise as a consequence of Rodolfo's having violated her: her honor is restored, aristocrats legitimize her son, she and her family ascend from the poor nobility to the wealthy upper class, supported by in-laws who embrace the young wife and a husband who does as well. Along such lines, González Echevarría contends that the novella endorses "the positive power of evil, incarnated in sexual desire and the acts that it induces" (192).2 The narrator's repeated insistence that the heroine and her parents were thankful for the child born of the assault, and Leocadia's final proclamation that it was all worth it ("lo doy por bien empleado," 409), make the entire business very hard to swallow today.3

It bears mention that the fictional mode of the tale exacerbates readers' discomfort, for Cervantes wrote "La fuerza de la sangre" dripping with the features of romance, which is to say wish-fulfillment fiction. Those features include heavy doses of symbolism, such as the cross Leocadia takes from Rodolfo's bedroom, loud narrative echoes of the romance vita of St. Leocadia, insertion of the divinity at crucial moments in the plot, and perfect structural symmetry.6 He padded the [End Page 202] narrative with unusually dense epithets, pre-placed adjectives signaling high expectations, opening with "anciano hidalgo," "deshonesta desenvoltura," "malos gustos" and "crueles entrañas," to cite a few (387; 388; 388; 389). The lexicon droops with the weight of symbolic hyperbole: Rodolfo and his prowling cohorts are wolves, Leocadia's family the sheep; the former are headed down a dark incline whereas the latter are headed up; Rodolfo leaves Toledo three days after raping Leocadia and returns when their son is seven years old, for example. The heroine's exclamations immediately following the rape, stylized, very long, and highly self-conscious, can hardly be called verisimilar, and the happy ending, as robust as it is superficial, closes the case with the resonance of a judge's gavel.

A thorough electronic search of the relevant literature without language restrictions was carried out using PubMed (Medline), Cochrane Central Register of Controlled Trials, BioMed, Database of Abstracts of Reviews of Effects, and Cochrane Plus databases up to February 1, 2017. All descriptive studies reporting an assessment of CE treatment and published in a peer-reviewed journal with available full-text were considered for a qualitative analysis. Randomized controlled trials were included in a quantitative meta-analysis. We used the standard methodological procedures established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

We included 33 studies related to the pharmacological treatment of CE in humans. Of these, 22 studies with levels of evidence 2 to 4 were qualitatively analysed, and 11 randomized controlled trials were quantitatively analysed by meta-analysis.

All relevant studies that reported the assessment of one modality of treatment or a comparison of two or several therapeutic methods to treat CE in humans and were published in a peer-reviewed journal with full text available were considered for analysis and classified according to levels of evidence and grades of recommendation proposed by the Oxford Centre for Evidence-Based Medicine (OCEBM) [11]. Data from editorials, letters to editors, reports of expert committees, and opinions of respected authorities based on clinical experience were excluded from the analysis because these designs do not have the same value, impact or power to make decisions or make recommendations. The results from non-randomized controlled trials, cohort or case-control analytic studies, prospective or retrospective case series, and literature reviews were qualitatively analysed but excluded from our quantitative meta-analysis. We included in the meta-analysis only studies from randomized controlled trials [Level of Evidence 1, Grade of recommendation A].

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement [12] was used as a guide. Prespecified outcome-specific quality criteria were used to judge the admission of each qualitative and quantitative outcome into the appropriate analysis. Two investigators independently reviewed each eligible study and extracted the information and data necessary to carry out the qualitative analysis and the meta-analysis. Disagreements were resolved by consensus among all authors. The authors evaluated all randomized trials included in the meta-analysis to determine whether they were in accordance with the CONsolidated Standards Of Reporting Trials-CONSORT 2010 statement [12].

Thirty-three articles [6, 8,9,10, 13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41] related to medical treatment of CE in humans that met the inclusion criteria of CE treatment in humans were selected and classified by type of study design. Of them, 22 studies [6, 10, 13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32] non-randomized controlled trials, prospective or retrospective case series and literature reviews [Levels of Evidence 2 to 4] were qualitatively analysed, and 11 randomized controlled trials [8, 9, 33,34,35,36,37,38,39,40,41] [Level of Evidence 1] were quantitatively analysed by meta-analysis.

This analysis included 22 studies [6, 10, 13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32] with levels of evidence below 1 (2 to 4): non-randomized controlled trial, one paper [13]; cohort study, one paper [21]; prospective descriptive study, six papers [15, 17, 22, 24, 25, 29]; retrospective study, six papers [16, 18, 23, 26, 28, 32]; and case series, two papers [10, 30] (Table 1 summarizes the main data of these studies in alphabetical order).

The meta-analysis included 11 randomized controlled trials [8, 9, 33,34,35,36,37,38,39,40,41] [Level of Evidence 1, Grade of recommendation A]. The main methodological characteristics of these studies are presented in Table 3, and therapeutic findings are shown in Table 4. Chronologically, the oldest publication dates back to 1986 (Davis et al. [34]), while the most current was published in 2011 (Shams-UI-Bari et al. [41]). The geographic location varies, including Turkey [33], Spain [9, 37], Switzerland [34, 35], Italy [36], Iran [38, 39], India [40, 41] and Saudi Arabia [8].

Praziquantel, an isoquinolone derivative, has had limited use in the treatment of CE [47]. Praziquantel has shown efficacy in vitro and in animal models. Weekly dose of 50 mg/kg or dose every 2 weeks have displayed suitable pharmacokinetics in humans [47]. There are few clinical studies documenting praziquantel benefits in humans [8, 9, 30, 50]; however, combination of praziquantel with mebendazole [50] or albendazole [8, 9] seems to be more effective and possibly more rapid than benzimidazole monotherapy. The earliest report of a trial of combination praziquantel and albendazole in the treatment of human hydatid disease was made by Yasawy et al. [30]. Major disadvantages of these works are different praziquantel schemes: various treatment groups are too small for significant analysis and failure to use matching controls [8, 30]. Combination of praziquantel and albendazole may produce some benefit in pre- and post-intervention chemotherapy and might be helpful when spillage occurs during surgical procedure [8, 9]. Combined treatment reduces potentially the risk of disease recurrence and intraperitoneal seeding of infection that may develop via cyst rupture and spillage. Additionally, praziquantel may prevent the vesicular development of protoscoleces and inhibit the formation of secondary cysts. Combination therapy increases levels of albendazole sulphoxide (the active metabolite of albendazole) both in serum and in cyst fluid compared with levels in patients received only albendazole [14]. Praziquantel has been given at a dose of 40 mg/kg in different regimens for each patient (daily, weekly, fortnightly or monthly) with standard courses of albendazole for between 2 and 3 months. At present, there is scarce evidence supporting a recommendation for the routine use of praziquantel in prolonged chemotherapy for established CE where surgery is not indicated or in severe disseminated disease. This treatment and dosage regimen require evaluation. Further randomized controlled studies are required to determine whether there are significant advantages of combination therapy with albendazole and praziquantel to clarify treatment recommendations. Finally, there are few medical therapeutic options available for CE. As there is some evidence of usefulness of praziquantel in this disease, potential benefits should be explore.

One of the limitations of this study was the calculation of overall effects in the meta-analysis sections due to the scarcity of data. Some authors argue that, since clinical and methodological diversity always occurs in meta-analyses, a good statistical combination of studies is always difficult [51, 52]. Nevertheless, a qualitative review and a meta-analysis are better than a lack of information. The authors used forest plots to interpret the results of the meta-analyses, which is an accepted methodology. However, when there are few studies, these plots and their associated tests of significance are not very robust, and more studies are necessary to obtain conclusive evidence.


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