RESUMO

Studies are lacking on long-term effects among retinoblastoma patients in low- and middle-income countries. Therefore, we examined cause-specific mortality in a retrospective cohort of retinoblastoma patients treated at Antonio Candido de Camargo Cancer Center (ACCCC), São Paulo, Brazil from 1986 to 2003 and followed up through December 31, 2018. Vital status and cause of death were ascertained from medical records and multiple national databases. We estimated overall and cause-specific survival using the Kaplan-Meier survival method, and estimated standardized mortality ratios (SMRs) and absolute excess risk (AER) of death. This cohort study included 465 retinoblastoma patients (42% hereditary, 58% nonhereditary), with most (77%) patients diagnosed at advanced stages (IV or V). Over an 11-year average follow-up, 80 deaths occurred: 70% due to retinoblastoma, 22% due to subsequent malignant neoplasms (SMNs) and 5% to non-cancer causes. The overall 5-year survival rate was 88% consistent across hereditary and nonhereditary patients (p = .67). Hereditary retinoblastoma patients faced an 86-fold higher risk of SMN-related death compared to the general population (N = 16, SMR = 86.1, 95% CI 52.7-140.5), corresponding to 42.4 excess deaths per 10,000 person-years. This risk remained consistent for those treated with radiotherapy and chemotherapy (N = 10, SMR = 90.3, 95% CI 48.6-167.8) and chemotherapy alone (N = 6, SMR = 80.0, 95% CI 35.9-177.9). Nonhereditary patients had only two SMN-related deaths (SMR = 7.2, 95% CI 1.8-28.7). There was no excess risk of non-cancer-related deaths in either retinoblastoma form. Findings from this cohort with a high proportion of advanced-stage patients and extensive chemotherapy use may help guide policy and healthcare planning, emphasizing the need to enhance early diagnosis and treatment access in less developed countries.

RESUMO

PURPOSE: Predicting bronchopulmonary dysplasia (BPD) to assess the risk-benefit of therapy is necessary considering the side effects of medications. We developed and validated an instrument for predicting BPD and compared it with an instrument currently used for neonates born in a Brazilian hospital. METHODS: This was a retrospective cohort study of patients born between 2016 and 2020 with a gestational age (GA) between 23 and 30 weeks. Predictive equations were elaborated using methods of component variable selection collected on the 14th day of life; 70% of the sample was randomly selected for the construction of risk prediction equations and the remaining 30% for their validation, application, and comparison with the National Institute of Child Health and Human Development (NICHD) instrument. The sensitivity, specificity, and predictive values of the equations were calculated. RESULTS: The equation that used variables with p < 5% in Fisher's exact test presented the best results: specificity of 98% and positive predictive value of 93% and could be used for BPD prediction of all small-for-gestational-age (SGA) infants. The NICHD calculator applied to our population had a specificity of 93% and a positive predictive value of 75% and could not be applied to extremely SGA infants. CONCLUSION: Our tool can predict the risk of BPD on the 14th day of life, has higher specificity and positive predictive value to our population than the NICHD instrument, and can be suitable for SGA infants. The results must be confirmed by applying it to other populations to validate our tool.

RESUMO

Introduction Upper middle-income countries have epidemiological peculiarities that should be considered to identify the main predictive factors of intrahospital mortality regarding traumatic brain injury (TBI) to address modifiable problems. Objective To assess the in-hospital survival of patients with TBI and to identify the predictors of in-hospital death. Methods This is a retrospective dynamic cohort study of victims of TBI who were admitted to the Hospital de Urgência de Sergipe (HUSE, in the Portuguese acronym) between March 1, 2017 and April 29, 2018. The outcome considered was in-hospital death from any cause. Cox regression was used to assess predictors of in-hospital mortality. Results The sample comprised 596 patients, with a median age of 31.0 (12­94) years old, 504 (84%) of whom were men. Regarding TBI severity, 250 had mild TBI; 121 had moderate TBI; and 225 had severe TBI. The average follow-up was 20.6 4.0 days, with 60 in-hospital deaths and a 30-day mortality of 22.9%. Four independent predictors of in-hospital death were identified: acute subdural hemorrhage (ASDH) (risk ratio [RR] » 1.926; 95% confidence interval [CI] » 1.15­3.22; p » 0.013), swelling (risk ratio [RR] » 3.706; 95%CI » 2.21­6.19; p < 0.001), skull fracture (RR » 2.551; 95%CI » 1.36­ 4.75; p » 0.003), and severe TBI (RR » 2.039; 95%CI » 1.29­4.12; p » 0.005). Conclusions Acute subdural hemorrhage, swelling, skull cap fracture, and a Glasgow Coma Scale score of < 9 at admission were independent predictors of in-hospital mortality in patients with TBI.

Introdução Os países de renda média alta possuem peculiaridades epidemiológicas que devem ser levadas em consideração para identificar os principais fatores preditivos de mortalidade intrahospitalar por traumatismo cranioencefálico (TCE) a fim de abordar problemas modificáveis. Objetivo Avaliar a sobrevida hospitalar de pacientes com TCE e identificar os preditores de óbito hospitalar. Métodos Trata-se de um estudo de coorte dinâmico retrospectivo de vítimas de TCE que deram entrada no Hospital de Urgência de Sergipe (HUSE) entre 1° de março de 2017 e 29 de abril de 2018. O desfecho considerado foi óbito hospitalar por qualquer causa. A regressão de Cox foi usada para avaliar os preditores de mortalidade hospitalar. Resultados A amostra foi composta por 596 pacientes, com idade mediana de 31,0 (12­94) anos, sendo 504 (84%) homens. Em relação à gravidade do TCE, 250 tiveram TCE leve; 121 tiveram TCE moderado, e 225 tiveram TCE grave. O seguimento médio foi de 20,6 4,0 dias, com 60 óbitos hospitalares e mortalidade em 30 dias de 22,9%. Quatro preditores independentes de morte hospitalar foram identificados: hemorragia subdural aguda (ASDH, na sigla em inglês) (risk ratio [RR] » 1,926; intervalo de confiança [IC] 95% » 1,15­3,22; p » 0,013), inchaço (RR » 3,706; IC95% » 2,21­6,19; p < 0,001), fratura de crânio (RR » 2,551; IC95% » 1,36­4,75; p » 0,003) e TCE grave (RR » 2,039, IC95% » 1,29­4,12; p » 0,005). Conclusões Hemorragia subdural aguda, edema, fratura da calota craniana e pontuação na Escala de Coma de Glasgow < 9 na admissão foram preditores independentes de mortalidade hospitalar em pacientes com TCE.

RESUMO

Resumen Objetivo: Describir los tipos de cateterismo cardiaco que se realizan en el único laboratorio de hemodinamia pediátrica dentro de la red de salud pública de El Salvador, en colaboración con organizaciones sin fines de lucro. Material y método: Se realizó un estudio descriptivo retrospectivo de corte transversal en el periodo entre mayo de 2022 a enero de 2023, revisando los expedientes de todos los pacientes que pasaron a cateterismo cardiaco. Resultados: Se realizaron 54 procedimientos dentro de la sala de hemodinamia, 37 pacientes de sexo femenino. El peso fue de 20.6 ± 14.5 kg, de los procedimientos, 47 (87%) fueron terapéuticos y 7 (13%) diagnósticos. La oclusión del conducto arterioso se realizó en el 46% de los pacientes. No se reportaron complicaciones, los pacientes fueron dados de alta luego de 12 horas, todos los insumos fueron donados por fundaciones sin fines de lucro. Conclusiones: Nuestro laboratorio de hemodinamia realiza procedimientos de complejidad variada sin reportar hasta el momento complicaciones mayores. Nos vemos limitados debido al costo alto de algunos dispositivos, a la baja frecuencia de la utilización de estos y a la imposibilidad para adquirirlos en el mercado nacional.

Abstract Objective: To describe the types of cardiac catheterization that are performed in the only pediatric catheterization laboratory within the public health network of El Salvador, in collaboration with non-profit organizations. Material and method: A descriptive, retrospective, cross-sectional study was conducted in the period from May 2022 to January 2023, reviewing the records of all patients who underwent cardiac catheterization. Results: 54 procedures were performed in the catheterization room, 37 female patients. The weight was 20.6 ± 14.5 kg, of the procedures, 47 (87%) were therapeutic and 7 (13%) diagnostic. Occlusion of the ductus arteriosus was performed in 46% of the patients. No complications were reported, the patients were discharged after 12 hours, all supplies were donated by non-profit foundations. Conclusions: Our catheterization laboratory performs procedures of varied complexity without reporting any major complications to date. We are limited due to the high cost of some devices, the low frequency of their use and the impossibility of acquiring them in the national market.

RESUMO

OBJECTIVE: To describe the types of cardiac catheterization that are performed in the only pediatric catheterization laboratory within the public health network of El Salvador, in collaboration with non-profit organizations. MATERIAL AND METHOD: A descriptive, retrospective, cross-sectional study was conducted in the period from May 2022 to January 2023, reviewing the records of all patients who underwent cardiac catheterization. RESULTS: 54 procedures were performed in the catheterization room, 37 female patients. The weight was 20.6 ± 14.5 kg, of the procedures, 47 (87%) were therapeutic and 7 (13%) diagnostic. Occlusion of the ductus arteriosus was performed in 46% of the patients. No complications were reported, the patients were discharged after 12 hours, all supplies were donated by non-profit foundations. CONCLUSIONS: Our catheterization laboratory performs procedures of varied complexity without reporting any major complications to date. We are limited due to the high cost of some devices, the low frequency of their use and the impossibility of acquiring them in the national market.

OBJETIVO: Describir los tipos de cateterismo cardiaco que se realizan en el único laboratorio de hemodinamia pediátrica dentro de la red de salud pública de El Salvador, en colaboración con organizaciones sin fines de lucro. MATERIAL Y MÉTODO: Se realizó un estudio descriptivo retrospectivo de corte transversal en el periodo entre mayo de 2022 a enero de 2023, revisando los expedientes de todos los pacientes que pasaron a cateterismo cardiaco. RESULTADOS: Se realizaron 54 procedimientos dentro de la sala de hemodinamia, 37 pacientes de sexo femenino. El peso fue de 20.6 ± 14.5 kg, de los procedimientos, 47 (87%) fueron terapéuticos y 7 (13%) diagnósticos. La oclusión del conducto arterioso se realizó en el 46% de los pacientes. No se reportaron complicaciones, los pacientes fueron dados de alta luego de 12 horas, todos los insumos fueron donados por fundaciones sin fines de lucro. CONCLUSIONES: Nuestro laboratorio de hemodinamia realiza procedimientos de complejidad variada sin reportar hasta el momento complicaciones mayores. Nos vemos limitados debido al costo alto de algunos dispositivos, a la baja frecuencia de la utilización de estos y a la imposibilidad para adquirirlos en el mercado nacional.

Assuntos

RESUMO

Anaerobic digestion (AD) as a waste management strategy for the organic fraction of municipal waste (OFMSW) has received attention in developed countries for several decades, leading to the development of large-scale plants. In contrast, AD of OFMSW has only recently drawn attention in developing countries. This systematic review was carried out to investigate the implementation of AD to treat the OFMSW in developing countries, focusing on assessing pilot and full-scale AD plants reported in the last ten years. Studies that met the selection criteria were analyzed and data regarding operating parameters, feedstock characteristics, and biogas, digestate, and energy production were extracted. As outlined in this systematic review, AD plants located in developing countries are mostly one-stage mesophilic systems that treat OFMSW via mono-digestion, almost exclusively with the aim of producing electrical energy. Based on the analysis done throughout this systematic review, it was noted that there is a large difference in the maturity level of AD systems between developing and developed countries, mainly due to the economic capacity of developed countries to invest in sustainable waste management systems. However, the number of AD plants reported in scientific papers is significantly lower than the number of installed AD systems. Research articles regarding large-scale implementation of AD to treat OFMSW in developed countries were analyzed and compared with developing countries. This comparison identified practices used in plants in developed countries that could be utilized in the large-scale implementation and success of AD in developing countries. These practices include exploiting potential products with high market-values, forming partnerships with local industries to use industrial wastes as co-substrates, and exploring different biological and physical pretreatment technologies. Additionally, the analysis of capital and operational costs of AD plants showed that costs tend to be higher for developing countries due to their need to import of materials and equipment from developed countries. Technical, economical, and political challenges for the implementation of AD at a large-scale in developing countries are highlighted.

Assuntos

RESUMO

Coaches contribute toward helping older adults achieve quality sport experiences, but there are few resources grounded in adult-oriented psychosocial approaches from which they can learn. The purpose of this Participatory Action Research study was to facilitate a personalized professional development program for a Colombian football (soccer) league of older adult men using an evidence-based self-assessment tool for Masters coaches. Data were collected from 23 coaches, who were also players in the league, via interviews, workshops, and observations. Data were analyzed via reflective thematic analysis that aimed to understand coaches' perceptions of how they learned through the workshops and how they implemented what they learned into their coaching. Findings indicate that personalized professional development enabled better structured leadership in the league, creating Quality Masters Sport Experiences.

Assuntos

RESUMO

Decreased physical activity (PA) has been associated with residents living in neighborhoods perceived as being disordered or having high crime levels. What is unknown are the characteristics of individuals who engage in moderate to vigorous levels of PA (MVPA) despite living in these vulnerable neighborhoods, or who may be referred to as positive deviants (PD). We examined the factors associated with PD for PA among Jamaicans. Between 2016 and 2017 the Jamaica Health and Lifestyle Survey, a cross-sectional nationally representative survey (n = 2807), was conducted on individuals aged 15 years and older. Regression analyses were performed to identify associations with PD, defined using engagement in MVPA among persons living in vulnerable neighborhoods (N = 1710). Being female (odds ratio [OR]a = 0.64 (0.48, 0.86); p = 0.003), obese while living in an urban area (ORa = 0.39; 95 % CI = 0.26, 0.59; p < 0.0001), unemployed (ORa = 0.53; 95 % CI = 0.39, 0.73; p < 0.0001), or a student (ORa = 0.62; 95 % CI = 0.39, 0.98); p = 0.041) was associated with a significantly lower likelihood of PD, while having a personal medical history of at least one chronic disease significantly increased likelihood (ORa = 1.43; 95 % CI = 1.08, 1.90; p = 0.014). Taking a PD approach may be one angle to consider in trying to determine what is working and for whom, so that this may be harnessed in policy, prevention and intervention programming to increase PA.

RESUMO

AIM: The aim was to evaluate the feasibility of protective measures for infants of low-income SARS-CoV-2 positive breastfeeding mothers. BACKGROUND: Breastfeeding mothers with SARS-CoV-2 positive should avoid exposing the infant through protective measures (PM), but it could be challenging in a low-income population. METHODS: A prospective, multicenter study was conducted between July and October 2020 (BRACOVID). The participants were recruited at birth and interviewed through a structured questionnaire at seven and 14 days in the home environment. The feasibility of PM during breastfeeding at home was defined by guidelines recommendations (mask using, handwashing, and distancing from newborn when not breastfeeding). Three groups according to the feasibility of guidelines: complete guidelines feasibility (CG): all PM; partial guidelines feasibility (PG): at least one PM feasible; no guidelines (NG): infeasibility to all of PM. Flu-like neonatal symptoms, mothers' breastfeeding practices. We evaluated the association between PM feasibility and socioeconomic factors. RESULTS: 117 infected mothers from 17 Brazilian hospitals were enrolled. 47 (40%) mothers followed all recommendations, 14 (11.9%) could not practice at least one recommendation, and 50 (42.7%) did not execute any of them. The breastfeeding rate was 98%. Factors associated with infeasibility were monthly family income < 92.7 dollars/person, high housing density (>1 inhabitant/room), teenage mothers, responsive feeding, and poor schooling. Regarding infants' flu-like symptoms, 5% presented symptoms at fourteen days (NG group). CONCLUSION: The guidelines were not applied to infants of SARs-CoV-positive mothers in 54.6% of the dyads since the recommendations were unviable in their environments. During pandemics, we should look for feasible and effective guidelines to protect neonates from low-income populations. IMPLICATIONS FOR NURSING MANAGEMENT: Poor socioeconomic conditions lead to the unfeasibility of protective measures for infants of low-income SARS-CoV-2 positive breastfeeding mothers during the isolation period in the pandemics. The orientations and the support provided to dyad should consider the socioeconomic factors to guide feasible measures in the home environment and promote adequate protections; only an individual approach will allow a safe environment for low-income infants.

RESUMO

The coronavirus 19 (COVID-19) pandemic has been one of the most significant challenges to public health in recent decades. The heterogeneity of government responses and the varying preparedness of health systems has determined that the pandemic's impact differs from country to country. Chile is no stranger to the challenges posed by rehabilitation in a developing country. We aimed to describe the approach to rehabilitation during the pandemic in Chile in the public health system since rehabilitation is considered a relevant health strategy from the prevention to management of complications, mitigation of sequelae, or new complications associated with COVID-19. For this, a descriptive study was conducted on the rehabilitation strategies implemented by Chile to respond to the COVID-19 pandemic. The analysis includes the context of the Chilean health system and the matrix of access to rehabilitation services in COVID-19. The Health Ministry (MINSAL) rehabilitation strategy includes five central axes: approaches, specific lines, transversal lines, intervention, and funding. Additionally, the policies were based and supported by the WHO recommendations. Intensive care unit beds were increased approximately 68%, and the primary care response was the reconversion of function depending on the epidemiological context. During the 2021-2022 period, the estimated number of people diagnosed with a post-COVID-19 condition was 80,528. With this, we can conclude that a developing country has managed to coordinate a rehabilitation policy for people with COVID-19 by generating a structure of the different health system levels. However, the effectiveness of this policy will need to be evaluated in the future.

Assuntos

Assuntos

RESUMO

Las malformaciones linfáticas y su manejo no han sido bien descritas en República Dominicana. Es por ello, que el objetivo de este artículo es la presentación de tres casos, con diferentes patrones y necesidades de tratamiento, de modo que sirva como referencia para trabajadores de la salud en países en vías de desarrollo.

Lymphatic malformations and its management are not well described in the Dominican Republic. That is why this article's objective is to present 3 cases, with different patterns and treatment needs, so it will work as a reference for healthcare workers in developing countries.

Assuntos

RESUMO

This paper explores transportation mode choice patterns of a population in Latin America before and during the COVID-19 pandemic based on survey data from the city of Santo Domingo (Dominican Republic). An online survey consisting of two waves was conducted between April and June 2020 among randomly chosen transport system users. The survey consisted of both a stated choice experiment, revealed preference, and psychometric indicators. Hybrid choice models were developed and included two latent variables (1) satisfaction with public transport and (2) the response to COVID-19. The results indicate that there is a strong habit of private vehicle use in the Dominican population. The main deterrents for public transport use are limited capacity and reduced safety (including regarding social distancing). The findings particularly highlight the success of the metro as a public transport mode in the city of Santo Domingo. Both cost and time are significant factors in mode choice, before and during the pandemic, but more so for OMSA bus use than for metro use. One of the conclusions from this study is that ignorin covid-related latent effects on public transport service during the pandemic may yield biased (lower) estimations of Value of Travel Time Savings. Finally, the results also show that mode captivity for public transport users plays an important role during the pandemic. These users have no access to alternative transportation and are obliged to continue using public transport. This implies that governments would be wise to urge transport operators not to reduce capacity and frequency during the pandemic.

RESUMO

Today's lifespan of companies tends to be low in the so-called micro-, small-, and medium-sized enterprises (MSMEs). Organizational life cycle (OLC) theory indicates that organizational aging is related, but not determined, by the firm chronological age or its size. Therefore, a firm's aging should be analyzed by other factors such as flexibility. The literature considers flexibility as an essential capability, a source of competitive advantage, and an enabler of long-term growth for MSMEs. However, little attention in emerging economies has been paid to examine the nuances of this concept in relation to the OLC in this type of companies. Additionally, studies tend to analyze flexibility as a general term, ignoring that it is a polymorphic concept. That is why there is a need to research the different categories of flexibility. Drawing on a quantitative approach conducting a factor analysis, a two-step cluster, and decision tree analysis to interrogate data from 257 MSMEs in Mexico, this study provides evidence of different dimensions of strategic and structural flexibility that help to characterize and predict the growth, maturity, and declining stages of MSMEs. Our results show that mature firms present more strategic and structural flexible characteristics than those involved in growth or decline stages. The flexible factors that help classify and predict an MSME in the maturity stage include open communication, decentralized decision making, and formalization. We provide a model with these results to illuminate unaddressed issues regarding the broad term of flexibility and its relationship to OLC.

RESUMO

Background: Conditioning regimens are critical for allogeneic hematopoietic cell transplantation (allo-HCT). After unfavorable results using BuCy2 at the beginning of our HCT Program, a restructuring was made with the consequent development of a modified HCT method including a reduced conditioning regimen. The objective of this study was to describe the outcomes using Reduced BuCy2 (rBuCy2) in allo-HCT. Materials and Methods: Data from 38 consecutive patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) who underwent allo-HCT conditioned with rBuCy2 in a 21-year period were retrospectively analyzed. Results: Most patients were males (53%) and the median age was 35 years. The most common disease was myelodysplastic syndrome (55%). Toxicity grades III-IV were observed in 44%; and acute and chronic graft-versus-host disease were observed in 26% and 34%, respectively; the median follow-up was 26 months; 30-day non-relapse mortality (NRM) was 3%, and 1 and 2-year NRM were 8%. Ten-year overall survival (OS) was 60%, and 86%, for AML and MDS, respectively. Conclusion: Our rBuCy2 maintains a myeloablative effect, along with immunosuppression for fast engraftment and more importantly, this regimen reduces grades III-IV acute GVHD and NRM in allo-HCT and improves the OS and it appears to be an option for low and middle-income countries.

RESUMO

BACKGROUND: Previous studies have observed that psychosocial factors are associated with an increase in work-related musculoskeletal disorders (WMSDs) in European countries. However, the influence of psychosocial factors on the WMSD symptoms has not been studied in detail. Additionally, working conditions differ between developing and developed countries. OBJECTIVE: In this study, the influence of psychosocial factors on WMSD symptoms among men and women in the footwear industry in northeastern Brazil is investigated. METHODS: A questionnaire survey was conducted to evaluate workers' perceptions of psychosocial factors and WMSD symptoms. The influence of psychosocial factors on WMSD symptom trends was observed through ordinal logistic regression models. RESULTS: It was found that different psychosocial factors are related to WMSD symptom intensification. Factors such as "job insecurity" and "low social support," which are not associated with the worsening of WMSD symptoms in developed countries, showed a noticeable influence in the sample analyzed. CONCLUSION: These findings may be associated with differences in working conditions and economic problems in developing countries, suggesting that some psychosocial factors have a different effect on workers' perceptions in developing countries.

Assuntos

RESUMO

Nicaragua is one of the countries with the lowest levels of development in Latin America, with a collectivist culture, where information on people in a homeless situation is very limited. The study examines a sample of people living homeless in the city of León (Nicaragua), their level of overall happiness, their future expectations, their perception of the evolution of their situation, their causal attributions of homelessness, and the aspects they believe are most important for overcoming their situation. Forty-one of the 68 homeless people contacted in León (Nicaragua) responded to a structured interview. The results show that the interviewees reported very low levels of overall happiness, although their future expectations were positive. The interviewees attributed homelessness situation (their own and other people's) primarily to individualistic causes and problems in family relationships, and they had a tendency to consider both themselves and other people living homeless responsible for their homelessness. The results are compared to the data obtained using similar methodologies and instruments for people living homeless in Madrid (Spain) and trash pickers in León (Nicaragua)-two groups in situations of extreme poverty and social exclusion.

Assuntos

RESUMO

Green infrastructure, and specifically urban afforestation, is one of the most important activities of city management today, because of the multitude of ecosystem services it provides. The pattern of tree planting in urban areas is related to age, ethnicity, education, and household income. Unfortunately, this issue has not been evaluated, nor has it received significant subsidized governmental actions, funding, study, or public policies in large tropical cities in developing countries. Thus, we aimed to investigate if there was a pattern of urban afforestation related by socio-territorial inequalities, in the city of São Paulo, or if there was a relationship between the number of seedlings planted over the past 4 years and zoning, socioeconomic, health, and environment variables in the neighborhoods of São Paulo, as well as to evaluate the ecosystem services provided by the planted species. Our results showed that tree planting was not oriented to increase cover of less-vegetated areas of the city and where more respiratory diseases have been registered. In fact, the number of seedlings planted over the past 4 years was very influenced by socioeconomic status of inhabitants. In this sense, wealth and education proved to be a better predictor than zoning, health, and environmental variables for the tree planting. Finally, our results reveal that supporting, provision, and cultural functions and services are being provided to São Paulo city by the selected woody species. In Sao Paulo, urban afforestation must extend to the neighborhoods that need the services the most.

Assuntos

RESUMO

Background: Stroke is a leading cause of death and disability worldwide, particularly in low- and middle-income countries. We aimed to identify the main barriers to optimal acute management of stroke in a referral center. Methods: Demographic data was collected from patients assessed with acute stroke in the emergency department of the Instituto Nacional de Neurología y Neurocirugía (INNN) from January to June 2019. Additionally, a telephone interview was conducted with patients/primary caregiver to know which they considered the main reason for the delay in arrival at INNN since the onset of stroke. Results: 116 patients were assessed [age 65 ± 15 years, 67 (57.8%) men]. Patients consulted other facilities prior to arrival at INNN in 59 (50.9%) cases (range of hospitals visited 1-4), 83 (71.6%) arrived in a private car, with prenotification in only 4 (3.4%) of the total sample. The mean onset-to-door time was 17 h (45 min-10 days). Telephone interviews were done in 61 patients/primary caregivers, stating that they consider the multiple evaluations in other facilities [n = 26/61 (42.6%)] as the main reason for delay in arrival at the ED, followed by ignorance of stroke symptoms and treatment urgency [n = 21/61 (34.4%)]. Conclusion: In this small, retrospective, single center study, the main prehospital barrier to optimal acute management of stroke in a developing country is multiple medical evaluations prior to the patient's transport to a specialized stroke hospital, who mostly arrived in a private car and without prenotification. These barriers can be overcome by strengthening public education and improving patient transfer networks and telemedicine.