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

Design and Characterization of Ocular Inserts Loaded with Dexamethasone for the Treatment of Inflammatory Ophthalmic Disease

The short precorneal residence time of ophthalmic drops is associated with their low absorption; therefore, the development of ocular inserts capable of prolonging and controlling the ophthalmic release of drugs is an interesting option in the design and development of these drugs. A surface response design was developed, specifically the Central Composite Design (CCD), to produce ophthalmic films loaded with Dexamethasone (DEX) by the solvent evaporation method having experimental levels of different concentrations of previously selected polymers (PVP K-30 and Eudragit RS100.). Once optimization of the formulation was obtained, the in vivo test was continued. The optimal formulation obtained a thickness of 0.265 ± 0.095 mm, pH of 7.11 ± 0.04, tensile strength of 15.50 ± 3.94 gF, humidity (%) of 22.54 ± 1.7, mucoadhesion strength of 16.89 ± 3.46 gF, chemical content (%) of 98.19 ± 1.124, release of (%) 13,510.71, and swelling of 0.0403 ± 0.023 g; furthermore, in the in vivo testing the number and residence time of PMN cells were lower compared to the Ophthalmic Drops. The present study confirms the potential use of polymeric systems using PVPK30 and ERS100 as a new strategy of controlled release of ophthalmic drugs by controlling and prolonging the release of DEX at the affected site by decreasing the systemic effects of the drug

Clínica Integral 2 - OD537 - 202102

El curso de Clínica Integral 2 es un curso teórico-práctico de modalidad Blended que pertenece a la línea de Educación Clínica Profesional de la carrera de Odontología, dirigido a estudiantes del sexto ciclo. Este curso permitirá a los estudiantes integrar los conocimientos teóricos y habilidades que les permita desarrollar competencias clínicas para el diagnóstico y ejecución de diversos tratamientos con el fin de prevenir y/o reestablecer la salud oral de manera interdisciplinaria. Propósito: El curso Clínica Integral 2 ha sido diseñado con el propósito de desarrollar las competencias generales de Comunicación Oral, Comunicación Escrita, Pensamiento Crítico y Manejo de la Información en su nivel 2 y las competencias específicas de Práctica Clínica y Profesionalismo en su nivel 2.

Clínica Integral 2 - OD537 - 202101

El curso de Clínica Integral 2 es un curso teórico-práctico de modalidad blended que pertenece a la línea de Educación Clínica y Profesional de la carrera de Odontología, dirigido a estudiantes del sexto ciclo. Presenta como requisito el curso OD536 Clínica Integral I. Este curso permitirá a los estudiantes integrar los conocimientos teóricos y habilidades que les permita desarrollar competencias clínicas para el diagnóstico y ejecución de diversos tratamientos con el fin de prevenir y/o restablecer la salud oral de manera interdisciplinaria. Propósito: 1 El curso Clínica Integral 2 ha sido diseñado con el propósito de desarrollar las competencias generales de Comunicación Oral, Pensamiento Crítico y Ciudadanía en su nivel 2 y las competencias específicas de Práctica Clínica-Diagnóstico en su nivel 3, Práctica Clínica-Tratamiento en su nivel 2, Práctica Clínica-Prevención en su nivel 1, Profesionalismo-Sentido Ético y Legal y Responsabilidad Profesional en su nivel 2 y Profesionalismo- Aprendizaje Autónomo y Desarrollo Profesional en su nivel 2

Internado Clínico - OD540 - 202101

Descripción: Internado Clínico es un curso Blended que cuenta con 12 horas de taller presencial dedicadas al trabajo clínico dentro del Centro Universitario de Salud y 2 horas de taller virtual sincrónicas donde desarrollarán habilidades interprofesionales; teniendo como requisito el curso OD539 Clínica Integral 4 y se dicta en simultáneo con el curso OD326 Seminario Integrador I. 1El presente curso permite a los estudiantes demostrar las competencias clínicas propias de un odontólogo profesional, con sentido ético y responsabilidad, para realizar el correcto diagnóstico de los pacientes, identificando los determinantes de riesgos de enfermedad del individuo y asociarlos a un contexto clínico y familiar. De esta forma, el estudiante podrá plantear estrategias terapéuticas y preventivas consensuadas con los pacientes gracias a una comunicación oral efectiva y empática. Propósito: El curso ha sido diseñado de tal forma que el estudiante pueda demostrar no solo habilidades clínicas a través de requisitos procedimentales, sino también, su capacidad para trabajar en equipo interprofesional que le permitan satisfacer las demandas cada vez más complejas del entorno actual de atención en salud. El curso contribuye directamente al desarrollo de las competencias generales de Comunicación Oral en el nivel 3 y las competencias específicas de: Práctica Clínica- Diagnóstico , Práctica Clínica-Tratamiento , Práctica Clínica-Prevención y Profesionalismo-Sentido Ético y Legal y Responsabilidad Profesional en su nivel 3

Juventudes, género y salud sexual reproductiva. Realidades, expectativas y retos

El resultado de la reflexión de este trabajo pone énfasis en la construcción de estas identidades juveniles, donde la perspectiva de género, las coyunturas laborales y educativas y el acceso y conocimiento de la salud sexual y reproductiva juegan un papel fundamental. Estas tres dimensiones analíticas unen los trece capítulos que integran el documento, donde se visibilizan las distintas formas de ser y vivir la juventud.Juventudes, género y salud sexual reproductiva. Realidades, expectativas y retos es una obra que reconoce a la población joven también en su diversidad y complejidad. Desde distintos abordajes teóricos, con diversos instrumentales metodológicos, las y los autores convergen en reconocer la precariedad, la inestabilidad y la incertidumbre como tristes realidades que signan las características de nuestras poblaciones jóvenes contemporáneas.Proyecto de investigación institucional financiado por el Programa de Fortalecimiento de la Calidad Educativa de la Secretaría de Educación Pública. P/PFCE-2016-15MSU001

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN