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

Eco(bio)lencia, irenología y lucha por la paz en nuestro mundo único.

This is an analysis of violence within its characteristics, possible sources, definitions and classification, mainly from the point of view of Peace Research. The relationship between violence and environmental issues is highlighted as one of its main causes. Furthermore, the concept of violence against Nature is marked out; and pacifism, nonviolence and other similar proposals are presented as promising and advisable in the pursuit of ecopeace, which has proved its methods, experiences, capabilities and past achievements.Análisis de la violencia en sus características, posibles orígenes, definiciones y clasificación, principalmente desde las investigaciones para la paz; se destaca su relación con los problemas ambientales, en cuanto una de sus causas principales. Asimismo, se delimita la idea de violencia contra la Naturaleza y se presenta el pacifismo, la noviolencia y otras propuestas similares, como alternativas recomendables y promisorias en la búsqueda de una mayor ecopaz; esto último, debido a sus métodos, experiencias, capacidades y logros pasados

Educación vial: concepto e importancia global

Cruzar una luz roja, manejar a exceso de velocidad o bajo los efectos del alcohol, así como no dar mantenimiento a los vehículos son verdaderos actos de imprudencia, no accidentes, y las muertes por estas causas, pese a las campañas que se difunden en el mundo, siguen aumentando de forma alarmante entre los jóvenes. La educación vial, por tanto, resulta indispensable para que los transeúntes (peatones, ciclistas, pasajeros y conductores) tengan valores, habilidades y prácticas acordes con un ambiente sano y respetuoso

Cooperación y paz contra el virus social

La reciente crisis mundial ocasionada por el COVID-19 ha propiciado manifestaciones violentas inimaginables en contra del personal de salud, migrantes, ancianos y gente que continúa realizando labores esenciales; parece que la población no alcanza a comprender que la solidaridad y la paz son las únicas formas de enfrentar un problema que afecta a todos y no sólo a unos cuantos. El individualismo supera a la razón, por tanto, se propone revisar en qué consiste la violencia simbólica y contrarrestarla con la participación colectiva.&nbsp

Percepciones y valoraciones de los estudiantes acerca de la carrera de Ciencias de la Educación en el Instituto Nacional de Educación Superior (INAES) de Asunción, Paraguay

This study addresses on the students’ appraisal regarding the education they received at the National Institute of Higher Education (INAES) in Paraguay at the grade level. The main objective of this article is to analyse the students' perceptions about their degree on Educational Sciences, and about their institution. Using a quantitative approach, descriptive design and cross-sectional: 95.6% of the students have been surveyed. The respondents are distributed in the three courses/groups of which it is the only career of the night shift. The results show the main strengths and weaknesses detected or valued by the students, in which the positive and compliance responses prevailed for the management and administrative areas, as well as for the curricular plan of the career, the infrastructure, the Librarian service and the interest in participating in research and outreach activities. However, the students want better internet access, food services, some aspects of teacher performance, guidance on the teaching internship and, mainly, the treatment of the transversal axes in the career curriculum. In conclusion, it is stated that the students highly value their career and the institution, but they also want the improvement in some aspects and areas that they consider important.Este estudio aborda la apreciación de los estudiantes acerca de la educación recibida en el turno de la noche del Instituto Nacional de Educación Superior (INAES) de Paraguay, en el nivel de grado. El objetivo principal de este artículo es evaluar la percepción de los estudiantes de Ciencias de la Educación sobre su propia licenciatura e institución. La investigación se realizó a través de un enfoque cuantitativo, diseño descriptivo y corte transversal, para la cual han sido encuestados 95,6 % de los estudiantes distribuidos en los tres cursos/grupos de la única carrera del turno noche. Los resultados muestran las principales fortalezas y debilidades detectadas o valoradas por los estudiantes en los que predominan las respuestas positivas y de conformidad para las gestiones directivas y administrativas, así como para el plan curricular de la carrera, la infraestructura, el servicio bibliotecario y la predisposición para participar en actividades de investigación y de extensión. Los estudiantes también desean mejoras en la conectividad a Internet, los servicios de alimentación, algunos aspectos del desempeño docente, las orientaciones sobre la práctica profesional y, sobre todo, en el tratamiento de los ejes transversales del currículum de la carrera. Como conclusión se afirma que los estudiantes tienen una alta valoración hacia su carrera y la institución, pero que también se precisan transformaciones en algunos aspectos y áreas que consideran importantes

Drug resistance phenotypes and genotypes in Mexico in representative gram-negative species: Results from the infivar network.

AimThis report presents phenotypic and genetic data on the prevalence and characteristics of extended-spectrum β-lactamases (ESBLs) and representative carbapenemases-producing Gram-negative species in Mexico.Material and methodsA total of 52 centers participated, 43 hospital-based laboratories and 9 external laboratories. The distribution of antimicrobial resistance data for Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, Acinetobacter baumannii complex, and Pseudomonas aeruginosa in selected clinical specimens from January 1 to March 31, 2020 was analyzed using the WHONET 5.6 platform. The following clinical isolates recovered from selected specimens were included: carbapenem-resistant Enterobacteriaceae, ESBL or carbapenem-resistant E. coli, and K. pneumoniae, carbapenem-resistant A. baumannii complex, and P. aeruginosa. Strains were genotyped to detect ESBL and/or carbapenemase-encoding genes.ResultsAmong blood isolates, A. baumannii complex showed more than 68% resistance for all antibiotics tested, and among Enterobacteria, E. cloacae complex showed higher resistance to carbapenems. A. baumannii complex showed a higher resistance pattern for respiratory specimens, with only amikacin having a resistance lower than 70%. Among K. pneumoniae isolates, blaTEM, blaSHV, and blaCTX were detected in 68.79%, 72.3%, and 91.9% of isolates, respectively. Among E. coli isolates, blaTEM, blaSHV, and blaCTX were detected in 20.8%, 4.53%, and 85.7% isolates, respectively. For both species, the most frequent genotype was blaCTX-M-15. Among Enterobacteriaceae, the most frequently detected carbapenemase-encoding gene was blaNDM-1 (81.5%), followed by blaOXA-232 (14.8%) and blaoxa-181(7.4%), in A. baumannii was blaOXA-24 (76%) and in P. aeruginosa, was blaIMP (25.3%), followed by blaGES and blaVIM (13.1% each).ConclusionOur study reports that NDM-1 is the most frequent carbapenemase-encoding gene in Mexico in Enterobacteriaceae with the circulation of the oxacillinase genes 181 and 232. KPC, in contrast to other countries in Latin America and the USA, is a rare occurrence. Additionally, a high circulation of ESBL blaCTX-M-15 exists in both E. coli and K. pneumoniae