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Introduction: Congenital choledochal cyst (CCC) is a rare cystic dilatation of intrahepatic or extrahepatic biliary ducts. We present a case of a type IVb choledochal cyst presenting as recurrent acute pancreatitis in a young healthy female with initial negative screenings. Case Description/Methods: An 18-year-old-female with a history of COVID-19 presented to the emergency department with one month of persistent abdominal pain, nausea, and vomiting. She was hospitalized once prior for similar symptoms and was diagnosed with acute pancreatitis. This admission, blood work showed elevated lipase, elevated liver enzymes, mild bilirubinemia with a normal lipid panel and urine was significant for infection. She received fluids, antiemetics and was started on prophylactic antibiotics for ascending cholangitis. A right upper quadrant ultrasound ruled out cholelithiasis or acute cholecystitis, but showed dilation of the common bile duct. MRCP confirmed dilation with bulbous termination in the periampullary region diagnosed as type IVb choledochal cyst. Discussion(s): CCCs are rare in Western countries with an incidence between 1 in 100,000 to 150,000. 80% of these cysts are diagnosed in patients under the age of 10. They are difficult to diagnose due to variable clinical presentations. A study of 214 CCC patients demonstrated the most common symptom was abdominal pain, followed by jaundice and fever. When cysts are found in adults, symptoms resemble atypical acute biliary tract disease. Surgical cyst removal may be needed for patients with significant risk factors such as older age and age of symptom onset, due to increased risk of malignant transformation. Longer periods of observation have been documented to be associated with an increased chance of developing late complications, such as anastomotic stricture, biliary calculi and recurrent cholangitis. Type IVb CCCs, as seen in this case, consist of multiple extrahepatic cysts and hepaticojejunostomy is the treatment. This patient's young age and recurrent acute pancreatitis combined with her lab and imaging findings strongly suggest the diagnosis of CCC. The anatomical location of the CCC impeded flow of pancreatic enzymes through the ampulla of vater, leading to recurrent pancreatitis in an otherwise healthy young female. CCC, although very rare, should be considered in the differential of acute pancreatitis when other causes such as gallstones and heavy alcohol consumption cannot be identified, as prompt diagnosis and surgical removal is imperative.
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Nowadays, SPOCs (Small Private Online Courses) have been used as complementary methods to support classroom teaching. SPOCs are courses that apply the usage of MOOCs (Mas sive Open Online Courses), combining classroom with online education, making them an exciting alternative for contexts such as emergency remote teaching. Although SPOCs have been contin- uously proposed in the software engineering teaching area, it is crucial to assess their practical applicability via measuring the effectiveness of this resource in the teaching-learning process. In this context, this paper aims to present an experimental evaluation to investigate the applicability of a SPOC in a Verification, Validation, and Software Testing course taught during the period of emergency remote education during the COVID-19 pandemic in Brazil. Therefore, we conducted a controlled experiment comparing alternative teaching through the application of a SPOC with teach ing carried out via lectures. The comparison between the teaching methods is made by ana- lyzing the students' performance during the solving of practical activities and essay questions on the con tent covered. In addition, we used questionnaires to analyze students' motivation during the course. Study results indicate an improvement in both motivation and performance of students participating in SPOC, which corroborates its applicability to the software testing teaching area.
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Introduction: One of the main problems facing the university system is the high student dropout rate due to a number of variables, accentuated by the COVID-19 pandemic. This is a problem not only in Spanish universities but is prevalent worldwide. It is therefore important to understand and analyze the underlying reasons for dropout so that it can be addressed and mechanisms implemented to limit dropout in higher education to the greatest extent possible. Method: A systematic review was carried out summarizing the results of studies and reports on university dropout in Spain and specifically in the universities of the Autonomous Community of Andalusia. The review was conducted in accordance with the PRISMA statement by searching the scientific databases Scopus and Web of Science, limiting the search to articles published between 2010 and 2022. Results: The main publications in both Spain and the Autonomous Community of Andalusia were identified. The review included the main causes of university dropout indicated in each of the selected studies and the proposals to reduce it, including educational policies, the rise of distance education, academic failure in basic educational stages, and social, personal, psychological, and economic variables. Conclusion: There is a lack of research on university dropout, with only 25% of Spanish universities having carried out research on this subject in the last 12 years. The studies analyzed conclude that the most frequent causes of university dropout are associated with low academic performance, poor social support in the new academic environment, low socio-economic status, pessimism, and lack of motivation, together with other less significant factors such as poor relationships with teachers, lack of vocation, work incompatibility, and previous academic performance. Further research on the causes of university dropout and its prevention is needed both before university entrance, by providing meaningful information to secondary school students, and during the university stay, through institutional and teaching policies that improve family support and social roots, produce positive academic experiences, favor associationism, and encourage activities that improve planning and time management, together with cognitive learning strategies, motivational strategies and the use of advanced learning materials [such as Information and Communication Technology (ICT) tools]. Copyright © 2023 de la Cruz-Campos, Victoria-Maldonado, Martínez-Domingo and Campos-Soto.
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Latin America suffered more than 41 billion attempted cyberattacks in 2020, as the COVID-19 pandemic generated remote working, setting conditions for cybercriminals to exploit vulnerabilities in corporate computer networks. The general objective of this research was to implement sandbox technology to protect against ransomware attacks in a local network of a financial institution. The implementation of Sandbox technology was developed with opensource software. To this end, a server with sandbox technology was implemented and configured to manage all operations performed by customers. A test lab was implemented with five machines in a virtualized environment. Five types of ransomware were collected and downloaded from the tutorialjinni page, executed in the test lab and analyzed by Cuckoo Sandbox, the latter reported that of the five ransomware injected, 100% were detected and successfully isolated, using on average 0.89 Gb of ram memory and with an average time of 123.6 s, which demonstrated that Cuckoo Sandbox is effective and optimal in utilizing hardware resources, thus contributing to the perimeter security of the computer network. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Latin America suffered more than 41 billion attempted cyberattacks in 2020, as the COVID-19 pandemic generated remote working, setting conditions for cybercriminals to exploit vulnerabilities in corporate computer networks. The general objective of this research was to implement sandbox technology to protect against ransomware attacks in a local network of a financial institution. The implementation of Sandbox technology was developed with opensource software. To this end, a server with sandbox technology was implemented and configured to manage all operations performed by customers. A test lab was implemented with five machines in a virtualized environment. Five types of ransomware were collected and downloaded from the tutorialjinni page, executed in the test lab and analyzed by Cuckoo Sandbox, the latter reported that of the five ransomware injected, 100% were detected and successfully isolated, using on average 0.89 Gb of ram memory and with an average time of 123.6 s, which demonstrated that Cuckoo Sandbox is effective and optimal in utilizing hardware resources, thus contributing to the perimeter security of the computer network. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Animal specimens in natural history collections are invaluable resources in examining the historical context of pathogen dynamics in wildlife and spillovers to humans. For example, natural history specimens may reveal new associations between bat species and coronaviruses. However, RNA viruses are difficult to study in historical specimens because protocols for extracting RNA from these specimens have not been optimized. Advances have been made in our ability to recover nucleic acids from formalin-fixed paraffin-embedded samples (FFPE) commonly used in human clinical studies, yet other types of formalin preserved samples have received less attention. Here, we optimize the recovery of RNA from formalin-fixed ethanol-preserved museum specimens in order to improve the usability of these specimens in surveys for zoonotic diseases. We provide RNA quality and quantity measures for replicate tissues subsamples of 22 bat specimens from five bat genera (Rhinolophus, Hipposideros, Megareops, Cynopterus, and Nyctalus) collected in China and Myanmar from 1886 to 2003. As tissues from a single bat specimen were preserved in a variety of ways, including formalin-fixed (8 bats), ethanol-preserved and frozen (13 bats), and flash frozen (2 bats), we were able to compare RNA quality and yield across different preservation methods. RNA extracted from historical museum specimens is highly fragmented, but usable for short-read sequencing and targeted amplification. Incubation of formalin-fixed samples with Proteinase-K following thorough homogenization improves RNA yield. This optimized protocol extends the types of data that can be derived from existing museum specimens and facilitates future examinations of host and pathogen RNA from specimens.
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Background: Due to COVID pandemic, there have been increased needs for ECMO circuits to support patients with respiratory failure1. Unfortunately, due to pharmacokinetics alteration of commonly used sedative and psychotropic medications by the ECMO circuits2,new sedation approaches to manage delirium and agitation is required. We present a case of COVID pneumonia patient on ECMO support, whose delirium symptoms were managed with a novel psychopharmacotherapy protocol. Case: Mr. M is a 57-year-old male patient with past medical history of obesity, hypertension, admitted to Stanford Hospital due to COVID pneumonia, complicated by respiratory failure, required to be on Veno-Venous ECMO support with bridge to transplant. He had significant hyperactive delirium with Richmond Agitation-Sedation Scale (RASS) score of +3 and ICDSC score of 7 for most of the days, despite heavy conventional pharmacological sedation. We observe the same problems with most patients placed on the ECMO system, leading to an investigation and development of a new protocol. Discussion: Patient on ECMO support requires adequate sedation to prevent clinical deterioration that can result from hyperactive delirium (ie., chugging, blood clots or decannulation)2. Nevertheless, ECMO circuit’s significant alterations of drug pharmacokinetics, such as increased volume of distribution and sequestration of lipophilic and protein bound medications, with no clear guidelines on managing sedation/delirium in patients with ECMO support at this time2, we conducted an extensive literature search and developed a novel protocol. This new sedation approach includes alpha-2 agonists, opioids, barbiturates and calcium channel modulators with the lowest lipophilicity and protein binding potential of each medication in its class4,5,thus overcoming the challenges introduced by ECMO circuits. The new protocol allowed the patient to participate in lung transplant work-up, physical therapy, and eventually facilitated receiving bilateral lung transplantation. Conclusion/Implications: ECMO is a life saving device that can help patient with cardiac-respiratory failure, and its use has been increasing in clinical practice. However, there needs to be an improvement in successful sedation/delirium management to minimize adverse events, and optimize the success of this lifesaving technologies. References: 1. Cho HJ, et al. ECMO use in COVID-19: lessons from past respiratory virus outbreaks-a narrative review. Crit Care. 2020 Jun 6;24(1):301 2. deBacker J, et al. Sedation Practice in Extracorporeal Membrane Oxygenation-Treated Patients with Acute Respiratory Distress Syndrome: A Retrospective Study. ASAIO J. 2018 Jul/Aug;64(4):544-551 3. Lemaitre F, et al. Propofol, midazolam, vancomycin and cyclosporine therapeutic drug monitoring in extracorporeal membrane oxygenation circuits primed with whole human blood. Crit Care. 2015;19(1):40 4. Hansch C, et al. Hydrophobicity and central nervous system agents: on the principle of minimal hydrophobicity in drug design. J Pharm Sci. 1987 Sep;76(9):663-87 5. Bockbrader HN, et al. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clin Pharmacokinet. 2010 Oct;49(10):661-9
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The incidence of acute kidney injury (AKI) in hospitalized patients with COVID-19 is variable, being as- sociated with worse outcomes. The objectives of the study were to evaluate the incidence, risk factors (considering demographic characteristics, comorbidities, initial clinical presentation and associated complications) and impact of AKI in subjects hospitalized for COVID-19 in two third-level hospitals in C..rdoba, Argentina. A retrospective cohort study was conducted. We included 448 adults who were consecutively hospitalized for COVID-19 between March 3 and October 31, 2020 and were followed throughout the hospitalization. The incidence of AKI was 19% (n = 85;stage I = 43, stage II = 17, and stage III = 25, 18 required renal replacement therapy). In the multivariate analysis, the variables that were independently associated with AKI were: age (for every 10 years, adjusted odd ratio [95%CI] = 1.30 [1.04-1.63], p = 0.022), history of chronic kidney disease -CKD- (9.92 [4.52-21.77], p < 0.001), blood neutrophil count at admission -BNCA- (for every increase of 1000 BNCA, 1.09 [1.01-1.18], p = 0.037) and requirement for mechanical ventilation -MV- (6.69 [2.24-19.90], p = 0.001). AKI was associated with longer hospitalization, higher admission (63.5 vs. 29.7%;p < 0.001) and longer stay in the intensive care unit, a positive association with respiratory bacterial superinfection, sepsis, respiratory distress syndrome, MV requirement and mortality (mortality without AK I = 12.4% vs with AKI = 47.1%;stage I = 26%, stage II = 41% and stage III = 88%;p < 0.001). AKI was independently associated with higher mortality (3.32 [1.6-6.9], p = 0.001). In conclusion, the incidence of AKI in adults hospitalized for COVID-19 was 19% and had a clear impact on morbidity and mortality. The independent risk factors for AKI were: Age, CKD, BNCA and MV.
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This article aims to analyze the use of Twitter as a communication channel by the president of El Salvador, Nayib Bukele (@nayibbukele), an outsider, who is also considered the 'millennial'president of that nation and who strongly employs this digital platform for the dissemination of its government policies. The present analysis is landed and justified in the context of COVID-19, characterized by the taking of restrictive confinement measures at the regional and local level, with a strong struggle between the executive and the Salvadoran legislative apparatus, as well as the impact of the virus on all corners of the globe. As a temporality, the April June quarter of 2020 is taken, for a total corpus of 766 messages. Through content analysis, the role of the political actor in a health crisis, the presence of struggles with the political class, the construction of the category of people applied to the Central American nationality, the polarization present in their agenda and others are analyzed. Elements of interest within the construction of the 'us-them'dichotomy in a digital environment. As the main finding, it is obtained that Bukele is framed within two characterizations;the first coupled with confronting political and social actors (mainly the legislative apparatus), an environment strongly marked by polarization;and the second, where he connects with citizens through charisma and the use of a close and positive language, in which cases polarization becomes an absent element and integration is called for.
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The purpose is to find out the public’s perception of the information transmitted by COVID-19 in Ecuador’s conventional social communication media between March and June 2020, since it is the first country in the region to be affected. The questions: Was there a lack of information?, What information would citizens like to receive? and What strategies should the media implement?” are answered through a qualitative methodological approach of a descriptive and relational type. The research techniques are survey, content analysis, interviews with experts and description of digital publications. The conclusion is that there was little transparency and little research. According to those surveyed, the media should not subordinate deontology to immediacy. The urgency of contrast, consistency, multiple sources and educational approaches is shown. Stories require a humane approach and build transmedia stories. What happened in Ecuador is a reference for other realities, for example in neighboring countries of the Andean área. © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Despite the fact that teaching methodologies have been constantly evolving, the pandemic COVID-19 is forcing a much faster growth of these methodologies, mainly through the use of technological advances. Although in the literature there are some studies on the development of new remote teaching resources, few of them are specific to undergraduate engineering courses. In this way, this paper proposes the use of acoustic modems implemented in mobile devices, so that they can be used as remote teaching resources of telecommunications engineering courses. This application allows to measure the performance in terms of Bit Error Rate of a communication system for different parameters configured by users. The results obtained show a fairly acceptable performance. © 2020 IEEE.
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Background: Describe characteristics of self-medication of the population, in the context of the COVID 19 pandemic. Material and Methods: We carried out a cross-sectional survey with students in a major public Peruvian university. We measured perception of self-medication of the population, as well as characteristics, consequences, and associated factors. Results: A total of 274 students of Pharmacy and biochemistry filled in the questionnaire, 80.3% of which reported to know someone that self-medicated during the COVID-19 pandemic. 98.9 % of surveyed participants considered that the current pandemic increased self-medication practices in the population and that it occurred more frequently when people have symptoms associated with COVID-19 (65.4%). The medicines most frequently used were ivermectin (79.2%), azithromycin (71.2%) and hydroxychloroquine (38.7%). Conclusion: According to the surveyed participants, self-medication has increased in the general population during the COVID-19 pandemic. Strategies to prevent these practices are needed, as they could delay adequate medical care. © The Author(s), 2021.
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During a pandemic, economic, technological, and health systems' vulnerability become even more evident. A key challenge in Brazil is to control the trade deficit and difficulty in access to medicines and health products, even their development. Brazil's heavy external dependency on health inputs and products is one of the negative factors in confronting the global health emergency caused by SARS-CoV-2. The article aimed to discuss the vulnerabilities of the domestic chemical and biotechnological subsystem in the face of the current pandemic, with a focus on the pharmaceutical and biotech industry and the linkage between the fields of health and political economics. A qualitative study was performed with a literature review and analysis of secondary data as the methodological procedures. The results revealed low investment in public health, low innovation capacity, the pharmaceutical industry's profile, external dependency, currency exchange policy, patents, and other factors, demonstrating the major vulnerability in innovation and technology in the domestic pharmaceutical and biotech industry and the essential nature of linkage between various fields, especially health and the economy, for the incorporation of a systemic vision that creates the conditions to reduce vulnerabilities in the response to the pandemic and promote a development project for the country.