Digital technologies as support for everyday life for university students

El presente artículo tiene como propósito contribuir a la comprensión de los modos en que los jóvenes universitarios se sostienen frente al mundo. Para ello, desde una metodología cualitativa, con una técnica de entrevistas a los estudiantes de Ciencias de la Administración de la Universidad Politécnica Salesiana (UPS) de Ecuador, se indagó sobre los usos y apropiaciones de las Tecnologías de la información y las comunicaciones digitales (TICD) que están ocurriendo en el ámbito educativo universitario. Los resultados indican que la incorporación de dispositivos electrónicos como teléfonos inteligentes, computadores de escritorio y personales, en conjunto con el uso de las redes sociales digitales más comunes como Facebook, WhatsApp, Twitter e Instagram, se convierten masivamente en herramientas comunicacionales y de entretenimiento, facilitando, por un lado, el proceso de formación universitaria y por otro como soporte imprescindible en la vida cotidiana.The purpose of this article is to contribute to an understanding of the ways in which young university students hold up to the world. For this, from a qualitative methodology, with a technique of interviews to the Administration Sciences students of the Universidad Politecnica Salesiana (UPS) of Ecuador, it was inquired about the uses and appropriations of the Information Technologies and the digital communications (TICD) that are happening in the university education field. The results indicate that the incorporation of electronic devices such as smartphones, desktops and personal computers, together with the use of the most common digital social networks such as Facebook, WhatsApp, Twitter and Instagram, become massively communication and entertainment tools, facilitating, on the one hand, the process of university education and, on the other hand, as an essential support in daily life.Facultad de Periodismo y Comunicación Socia

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

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

Duplicaciones del tracto gastrointestinal en niños, presentación de dos casos. Hospital Infantil Doctor Robert Reid Cabral (HIRRC), República Dominicana

Introduction: Gastrointestinal duplication is a relatively rare anomaly that can occur at any level from the oral cavity to the rectum, cases of gastric duplication are even more rare, and most of them have been reported in children. Material and method: In the following work two cases are exposed: number 1 female patient of 2 years of life, with clinical presentation of vomiting of food content that later became bilious in number of 3-4 occasions per day of 2 days of evolution, diffuse abdominal pain of 2 days of evolution, abdominal mass located in the right hemiabdomen. Case number 2 male patient of 4 days of life, to whom obstetric ultrasound is performed at 34 weeks of gestation where abdominal cystic image is evidenced. Both cases are performed exploratory laparotomy evidencing in case number 1 gastric duplication to which total exeresis and gastric raffia is performed and case number 2 evidences intestinal malrotation with volvulus of the middle intestine plus intestinal duplication (ileal) to which procedure is performed From Ladd plus resection and ileoileal terminal term anastomosis, both patients evolve satisfactorily. Conclusion: The purpose is to describe the presentation of both cases in childhood, the importance of diagnostic methods and surgical correction by different techniques according to the location of the cyst in the gastrointestinal tract.Introducción: la duplicación gastrointestinal es una ano-malía relativamente rara que puede ocurrir en cualquier nivel desde la cavidad bucal hasta el recto, los casos de duplicación gástrica son aún más raros, y la mayoría de ellos se han reportado en niños. Material y método: en el siguiente trabajo se expone dos casos; número 1: paciente de sexo femenino de 2 años de edad, con presentación clínica de vómitos de contenido alimentario que luego se tornaron biliosos en número de 3-4 ocasiones por día, de 2 días de evolución, dolor abdo-minal difuso de 2 días de evolución, masa abdominal localizada en hemiabdomen derecho. Caso número 2: paciente masculino de 4 días de vida, a quien se realiza ultrasonido obstétrico a las 34 semanas de gestación, donde se evidencia imagen quística nivel abdominal. A ambos casos se le realiza laparotomía exploratoria eviden-ciando en caso número 1: duplicación gástrica al que se le realiza exéresis total y rafia gástrica, y el caso número 2: malrotación intestinal con vólvulo de intestino medio más duplicación intestinal (ileal), al que se le aplica proce-dimiento de Ladd más resección y anastomosis termino terminal ileoileal, ambos pacientes evolucionan de manera satisfactoria. Conclusión: el propósito consiste en describir la presen-tación de ambos casos en la infancia, lo importante de los métodos diagnósticos y de la corrección quirúrgica por diferentes técnicas según la localización del quiste en el tracto gastrointestinal

Labial Mucocutaneous Leishmaniasis in an 18-year-old female patient. Case report

La leishmaniasis es una enfermedad parasitaria generalizada transmitida por vectores causada por varias especies de protozoos intracelulares obligados del género Leishmania y transmitida por picaduras de moscas infectadas. Aproximadamente 23 especies de leishmaniasis causan una de las tres formas clínicas de la enfermedad: leishmaniasis cutánea, mucosa y visceral. La enfermedad es endémica en 98 países con aproximadamente 2 millones de casos nuevos por año lo que pone en riesgo a más de 350 millones de personas. Es una enfermedad importante con una amplia gama de manifestaciones clínicas y un problema de salud pública en muchas partes del mundo. Se presenta en diferentes formas clínicas dependiendo de la especie de Leishmania involucrada y de factores relacionados con el huésped. Los tipos clínicos habituales no provocan dificultades diagnósticas. La presentación anormal a veces conduce a dificultades de diagnóstico y retrasos en el tratamiento. Además de las manifestaciones clínicas clásicas, en los últimos años se han descrito algunos signos raros y atípicos de la enfermedad. Se reporta una paciente femenina de 28 años con lesión ulcerosa costrosa localizada en labio superior, con evolución de aproximadamente 1 mes.Leishmaniasis is a widespread vector-borne parasitic disease caused by several species of obligate intracellular protozoa of the genus Leishmania and transmitted by the bites of infected flies. Approximately 23 species of leishmaniasis cause one of three clinical forms of the disease: cutaneous, mucosal, and visceral leishmaniasis. The disease is endemic in 98 countries with approximately 2 million new cases per year, putting more than 350 million people at risk. It is an important disease with a wide range of clinical manifestations and a public health problem in many parts of the world. It presents in different clinical forms depending on the Leishmania species involved and factors related to the host. The usual clinical types do not cause diagnostic difficulties. Abnormal presentation sometimes leads to diagnostic difficulties and delays in treatment. In addition to the classic clinical manifestations, in recent years some rare and atypical signs of the disease have been described. A 28-year-old female patient is reported with a crusty ulcerative lesion located on the upper lip, with an evolution of approximately 1 month