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PURPOSE: To provide an analysis of pediatric neurosurgery educational opportunities in Latin America in order to characterize and evaluate the strengths, weaknesses, and limitations to assume a career in pediatric neurosurgery. METHODS: An online survey was distributed to pediatric neurosurgeons in Latin America to assess aspects of pediatric neurosurgical education, working conditions, and training opportunities. The survey was open to neurosurgeons that treat pediatric patients, whether or not they had completed fellowship training in pediatrics. A descriptive analysis was done with a subgroup analysis stratified the results among certified pediatric neurosurgeons and non-certified pediatric neurosurgeons. RESULTS: In total, 106 pediatric neurosurgeons completed the survey, of whose the vast majority completed their training in a Latin American pediatric neurosurgery program. A total of 19 accredited academic programs in pediatric neurosurgery were found in Latin America distributed in 6 different countries. On average, the pediatric neurosurgical training in America Latina has a duration of 278 years, ranging from 1 to > 6 years. CONCLUSIONS: This study is the first of its kind to review pediatric neurosurgical training in Latin America, in which both pediatric and general neurosurgeons provide neurosurgical care to children in the continent; however, we found that in the majority of the cases, children are treated by certified pediatric neurosurgeons, of whose the vast majority were trained in Latin American programs. On the other hand, we found areas of improvement in the specialty in the continent, including regulation of training opportunities, increased support for funding, and more opportunities for education among all countries.

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Background: Acute coronary syndromes (ACS) include ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). The leading cause of mortality in Guatemala is acute myocardial infarction (AMI) and there is no established national policy nor current standard of care. Objective: Describe the factors that influence ACS outcome, evaluating the national healthcare system's quality of care based on the Donabedian health model. Methods: The ACS-Gt study is an observational, multicentre, and prospective national registry. A total of 109 ACS adult patients admitted at six hospitals from Guatemala's National Healthcare System were included. These represent six out of the country's eight geographic regions. Data enrolment took place from February 2020 to January 2021. Data was assessed using chi-square test, Student's t-test, or Mann-Whitney U test, whichever applied. A p-value < 0.05 was considered statistically significant. Results: One hundred and nine patients met inclusion criteria (80.7% STEMI, 19.3% NSTEMI/UA). The population was predominantly male, (68%) hypertensive (49.5%), and diabetic (45.9%). Fifty-nine percent of STEMI patients received fibrinolysis (alteplase 65.4%) and none for primary Percutaneous Coronary Intervention (pPCI). Reperfusion success rate was 65%, and none were taken to PCI afterwards in the recommended time period (2-24 hours). Prognostic delays in STEMI were significantly prolonged in comparison with European guidelines goals. Optimal in-hospital medical therapy was 8.3%, and in-hospital mortality was 20.4%. Conclusions: There is poor access to ACS pharmacological treatment, low reperfusion rate, and no primary, urgent, or rescue PCI available. No patient fulfilled the recommended time period between successful fibrinolysis and PCI. Resources are limited and inefficiently used.

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INTRODUCTION: Placenta accreta spectrum (PAS) causes severe morbidity and can result in maternal death. It must be managed in specialized centers with interdisciplinary groups, but few publications have described the usual management within a specific geographic region. We intend to describe the usual approach for PAS in reference centers in Latin America. METHODOLOGY: This was an observational, multicenter, cross-sectional study conducted in Latin American PAS reference centers. A standardized survey was implemented and applied to obstetric service coordinators and leaders of interdisciplinary groups with experience in PAS between September and November 2020. RESULTS: One hundred fifty-four hospitals were included. Most of them (64.3%) handle approximately one case of PAS every two months, and almost all centers (89.6%) believe that their performance could be improved. CONCLUSIONS: Most of the reference centers for PAS in Latin America attend to a small number of cases each year, and almost all of these hospitals identify opportunities to improve the management or approach for PAS in women.

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Introducción: La segunda causa de muerte a nivel mundial corresponde a los ataques cerebrovasculares (ACV), de los cuales más de dos terceras partes son de origen isquémico. Causan discapacidad a largo plazo por lo que conocer la anatomía de la circulación cerebral y las posibles manifestaciones clínicas del ACV isquémico permite sospechar, diagnosticar y brindar un manejo oportuno y apropiado, reduciendo el impacto en la salud y la calidad de vida del paciente y sus cuidadores. Objetivo: relacionar los últimos hallazgos en la anatomía arterial cerebral, los mecanismos fisiopatológicos y las manifestaciones clínicas del ACV isquémico de la arteria cerebral media (ACM). Materiales y métodos: revisión de la literatura mediante la búsqueda con términos MeSH en la base de datos Medline, incluyendo estudios, ensayos y metaanálisis publicados entre 2000 y 2020 en inglés y español, además de otras referencias para complementar la información. Resultados: se seleccionaron 59 publicaciones, priorizando las de los últimos 5 años y las más relevantes del rango temporal consultado. Conclusiones: son escasos los estudios sobre la presentación clínica de los ACV, lo que sumado a la variabilidad interindividual de la irrigacióncerebral, dificulta la determinación clínica de la localización de la lesión dentro del lecho vascular. La reperfusión del área de penumbra isquémica como objetivo terapéutico se justifica por los mecanismos fisiopatológicos de la enfermedad.

Introduction: Cerebrovascular accidents (CVAs) are the second leading cause of death worldwide, of which more than two thirds are ischemic. They cause long-term disability, therefore, knowledge on the cerebral circulation anatomy and possible clinical manifestations of ischemic CVAs allows us to suspect, diagnose and provide timely and appropriate management, reducing the negative impact on the health and quality of life of patients and caregivers. Objective: to list the latest findings on cerebral arterial anatomy, pathophysiological mechanisms and clinical manifestations of ischemic middle cerebral artery (MCA) CVAs. Materials and methods: a literature review using a MeSH terms search in the Medline database, including studies, trials and meta-analyses published in English and Spanish between 2000 and 2020, using other complementary references. Results: 59 publications were selected prioritizing those published in the past 5 years and the most relevant in said period. Conclusions: there are few studies on the clinical presentation of CVAs, which, added to the interindividual variability of cerebral circulation anatomy, makes clinical identification of lesion location, within the vascular bed, difficult. Reperfusion of the ischemic penumbra region, as a therapeutic objective, is based on the pathophysiological mechanisms of the disease.

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RESUMEN La cirugía de la hernia umbilical ha sido considerada tradicionalmente como sencilla y de fácil ejecución. El cambio conceptual de la hernia umbilical y los avances en su tratamiento han modificado su abordaje, estableciéndose escenarios de complejidad variable (obesidad, embarazo, cirróticos, distasis de los rectos, etc.) que demandan un conocimiento más profundo del tema por parte de la comunidad médica. El impacto económico en el sistema de salud, debido a su alta prevalencia como patología quirúrgica, implica un uso racional de recursos, así como la necesidad de una nueva categorización dentro de la cirugía de la pared abdominal. Es necesario establecer modificaciones en los procesos diagnósticos y terapéuticos en una entidad que ha sido relegada a los niveles básicos del ejercicio quirúrgico habitual.

SUMMARY Umbilical hernia surgery has traditionally been considered simple and easy to perform. A conceptual change of the umbilical hernia and the advances in its treatment have modified its approach, establishing scenarios of variable complexity (Obesity, pregnancy, cirrhosis, diastasis of the rectus, etc.), which demand a deeper knowledge of the subject on the medical community. The economic impact on the health system, due to its high prevalence as a surgical pathology, implies a rational use of resources, as well as the need for a new categorization within the abdominal wall surgery. It is necessary to establish modifications in the diagnostic and therapeutic processes in an entity that has been relegated to the basic levels of the usual surgical practice.

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