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En 2005 se publicaron recomendaciones para la tipificación de hemopatías malignas en Latinoamérica. Se consideró necesario realizar una reunión nacional para actualizarlas. Se convocaron y reunieron 95 profesionales expertos en el tema para analizar y contrastar alternativas y llegar a un consenso. Se alcanzaron opiniones de consenso en lo relativo a indicaciones, tipos y manejo de muestras, anticuerpos, nomenclatura e informe de resultados para el diagnóstico y seguimiento de las leucemias agudas. Las recomendaciones se describen en este artículo y se hace hincapié en la necesidad de que los laboratorios nacionales se apeguen a ellas., (Copyright: © 2019 SecretarÍa de Salud.)

Objectives: Describe the characteristics of the different cardiology medical residencies in Latin America., Method: Cross-sectional study that aims to evaluate the characteristics of cardiology residencies in Spanish-speaking countries of Latin America, through self-administered electronic surveys., Results: Three hundred seven residents of 147 residences were surveyed. Mean age was 31 years and 63% were male. Ninety eight percent carry out their training in the capital city. The average total training time is 4.8 years. Forty four percent complete their residency in internal medicine prior to starting cardiology, and 10% have no prior training. In cardiology training is 3 years in most countries. Fifty four percent present academic activities every day and 16% only once or less, consisting of theoretical classes (93%), clinical cases (85%), bibliographic workshops (69%), and writing scientific papers (68%). Supervision is carried out by the chief resident (45%), resident coordinator (44%), resident instructor (27%) or the department head (54%), while 2.6% do not present supervision. The main rotations were echocardiography (99%), hemodynamics (96%), coronary unit (93%), and electrophysiology (92%). Residents highlighted the need to improve academic activities (23%) and scientific production (12%)., Conclusions: There are important differences in the academic and practical training between the residences of the different countries of America.

The European-Latin American Consortium towards Eradication of Preventable Gallbladder Cancer (GBC) - EULAT Eradicate CVB is collecting high-quality data and samples in four Latin American countries with a high incidence of GBC: Argentina, Bolivia, Chile and Peru. The goal is to build a unique biorepository integrated with a customized informatics platform, identify, validate, and functionally characterize novel GBC risk biomarkers, and develop GBC prediction models integrating epidemiological and genetic-molecular risk factors. We decided to develop the electronic data collection application EULAT eCollect to facilitate the retrieval of socio-demographic, clinical, lifestyle, nutritional, and sample information from the 15,000 Latin Americans we are enrolling. The EULAT eCollect app reduces the time spent by study participants, limits the use of paper and ink, minimizes the costs and errors associated with completing written forms and their subsequent digitization, and allows close monitoring of local recruitment rates and data quality. We describe in this article the design and implementation of EULAT eCollect, which started with the specification of functional and non-functional requirements and ended with the implementation and subsequent validation of the four application modules: I Socio-demographic interview, II Sample information, III Case report form, and IV Food frequency questionnaire. We present both general and technical results and our experience with the Open Data Kit software, which may be of interest for future research projects, especially those on personalized cancer prevention conducted in low- and middle-income regions.

The obesity epidemic is a phenomenon that has been widely studied in recent decades but is still incompletely understood, and its control is far from the desirable level in view of the increasing prevalence figures observed worldwide. This paper conducts a narrative review with the aim of providing updated evidence on the global obesity epidemic, and particularly on the situation in Latin America and Argentina, identifying the main challenges and future directions for addressing this public health problem. It first describes the current burden and increasing trends in the prevalence of obesity, in the overall population and by population groups, and its possible association with genetic and epigenetic aspects. It also summarizes the direct and indirect socioeconomic consequences of this epidemic, as well as recent strategies and initiatives focused on obesity prevention, with special attention to those reported as the most efficient in the Latin American context. This review identified some pending challenges in the region, the integrated approach to the double burden of malnutrition and the growing childhood overweight; and it points out some emerging approaches, such as the syndemic approach, as potentially useful to understand and address this complex problem in the current context. In conclusion, it highlights the importance of implementing renewed, more efficient and evidence-based strategies to control the growing prevalence of obesity, which would also impact on the burden of related chronic diseases, and thus on the economy and well-being of Latin American societies.

Treatment-Resistant Depression (TRD) prevalence varies considerable between regions and epidemiology of TRD in Argentina is lacking. Based on the Treatment-Resistant Depression in America Latina (TRAL) study, epidemiology and burden of TRD in MDD patients from Argentina is reported in this paper. A sample of adult MDD patients (n=396) from 5 sites in Argentina, with clinical diagnosis were included. Patients with psychosis, schizophrenia, bipolar disorder, schizoaffective disorder, dementia, with severe chemical dependence or currently participating in another clinical trial were excluded. Patient reported outcomes and clinical assessment scales were used as outcomes. The prevalence of TRD in MDD patients in Argentina is 33.2%, based on TRAL data. Patients in TRD are older compared to those without TRD, and was more evident in married/consensual union MDD patients. Higher suicidality, greater comorbidity based on MINI, and worse scores in MADRS and PHQ-9 were identified in TRD patients. The prevalence identified in TRAL study for Argentina is substantial comparing with other Latin American countries and worldwide prevalence. TRD represents a disproportional burden to society, and efforts should be placed on reducing the burden of MDD and TRD in Argentina by improving early diagnosis, therapeutic management and ensuring that all patients have better access to mental healthcare.

Coagulopathy and thrombosis associated with coronavirus disease 2019 (COVID-19) represent a major issue in the management of this disease. In the past months, clinical studies have demonstrated that COVID-19 patients present with a particular hypercoagulable state, in which a markedly increased D-dimer concomitant with increased levels of fibrinogen are observed. This hypercoagulable state leads to an increased risk of thrombosis, which seems to be higher among those patients with critical symptoms of COVID-19. The best therapeutic approach to prevent thrombotic events in COVID-19 has not been determined yet and several questions regarding thromboprophylaxis therapy, such as the time to initiate anticoagulation, type of anticoagulant and dose regimen, have emerged among physicians. To address these concerns, several medical societies have published position papers to provide the opinion of thrombosis experts on the management of coagulopathy and thrombosis associated with COVID-19. In line with this, the Latin America Cooperative Group of Hemostasis and Thrombosis (Grupo CLAHT) has constituted a panel of experts in thrombosis and hemostasis to discuss the available data on this topic. The aim of this review is to summarize the current evidence regarding hemostatic impairment and thrombotic risk in COVID-19 and to provide a carefully revised opinion of Latin American experts on the thromboprophylaxis and management of thrombotic events and coagulopathy in patients with suspected COVID-19.

The incidence of the coronavirus disease 2019 (COVID-19) in Latin America and Spain and its impact particularly on hospital emergency departments have been great, sustained, and unpredictable. Unfortunately, this situation will continue in the medium term, regardless of the diverse concepts and definitions used to identify cases or hypotheses about the role of staff. In the context of the worldwide pandemic, a multinational group of experts from the Latin American Working Group to Improve Care for Patients With Infection (GT-LATINFURG) has drafted various opinion papers for use by emergency care systems in the member countries. The GT-LATINFURG is comprised of representatives from the 13 scientific associations affiliated with the Latin American Federation for Emergency Medicine (FLAME). Experts from the Spanish Society of Emergency Medicine (SEMES) also participated. The present consensus statement offers protocols and recommendations to facilitate the work of hospital emergency departments with regard to key issues the group identified, namely, the need for reorganization, triage, and routine test availability. Additional issues discussed include biomarkers; clinical, laboratory, radiologic, and microbiologic criteria for identifying patients with COVID-19; and risk and prognostic factors for mortality that emergency staff can use to quickly detect severe cases in our settings.

The current COVID-19 pandemic has the potential to overwhelm the capacity of hospitals and Intensive Care Units in Chile and Latin America. Thus local authorities have an ethical obligation to be prepared by implementing pertinent measures to prevent a situation of rationing of scarce healthcare resources, and by defining ethically acceptable and socially legitimate criteria for the allocation of these resources. This paper responds to recent ethical guidelines issued by a Chilean academic institution and discusses the main moral principles for the ethical foundations of criteria for rationing during the present crisis. It argues that under exceptional circumstances such as the current pandemic, the traditional patient-centered morality of medicine needs to be balanced with ethical principles formulated from a public health perspective, including the principles of social utility, social justice and equity, among others. The paper concludes with some recommendations regarding how to reach an agreement about rationing criteria and about their implementation in clinical practice.

The purpose a call for papers on "History and health" at Salud Colectiva was to contribute to the development of a historical perspective on health-disease processes. We are therefore interested in calling on the perspectives of history and the social sciences to shed light on the fact that both the definition of health conditions as well as populations' possibilities for accessing essential healthcare services are the result of social processes in which knowledge, ideology, politics, and interests come into play - far from a simple reflection of objective biomedical conditions. This implies, on the one hand, that the definition of which of a population's health problems are to be attended to - as well as how, where, and who is responsible for them - is the result of relations among diverse actors (healthcare professionals, public officials, firms, users, among others), and these relations are not free of conflict. At the same time, these actors mobilize the institutional frameworks, professional knowhow, and economic interests that they represent. On the other hand, the unequal distribution of economic, symbolic, and cultural resources implies differential access to healthcare services, both for individuals and for social groups.

Caustic ingestion represents a serious social-medical problem due to the devastating and irreversible consequences it can produce in the upper digestive tract. In Ibero-America, there are no published reliable data on the incidence or prevalence of caustic-induced injuries, and most of the available information on clinical presentation, diagnosis, treatment, and prognosis is based on retrospective clinical series and, indeed, its clinical management is often based primarily on expert opinion. Re cently as an initiative of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition (LASPGHAN) and with the cooperation of the Spanish Society for Pediatric Gastroente rology, Hepatology and Nutrition (SEGHNP), we have designed a Clinical Practice Guideline that include a series of statements and recommendations aimed at optimizing patient medical care which is based on the systematic review of evidence. Two (2) separate papers focused on the evaluation of physiopathological and clinical-endoscopic diagnostic features of caustic esophagitis in children (1st. Paper) and, on the other hand, the most relevant therapeutic considerations (2nd. Paper). We expect this guideline to become a useful tool for the physician in the difficult decision-making process when assessing patients after caustic ingestion.

Ever since antimicrobial activity was observed at the end of the XIX century and antibiotics were produced on a large scale in the 40s, microorganisms have developed multiple resistance mechanisms, making treatment of infectious diseases difficult. For instance, several Gram-positive and Gram-negative bacteria lowered their sensitivity to ß-Lactam antibiotics as a result of their inadequate use and abuse. For this reason, microbial resistance to these drugs represents an increasing health problem in Latin America due to the emergence of drug-resistant bacterial strains. This review aims to summarize and analyze scientific literature reporting resistance to ß-lactam antibiotics in Latin America. We compiled scientific papers published during the last five years from PubMed, SciELO, and LILACS-BIREME. We found that: (i) it is common to identify resistance genes for ß-lactams in the soil and animal farms, and (ii) over 40% of strains isolated from clinical samples developed resistance against ß-lactam antibiotics.

Objective: this paper aims to describe the first phase of a project whose general goal was to develop a consensus-based set of advanced practice nurse competencies applicable to Latin American countries and, based on these competencies, produce an advanced practice nurse curricular prototype adapted to Latin American countries. The project was framed in a competency-based approach to advanced practice nursing education. The specific aims of the first phase of the project described in this paper were: 1) to identify a set of potential advanced practice nurse competencies that would serve as the template for Core Advanced Practice Nurse Competencies in Latin American countries and 2) to establish consensus for Core Advanced Practice Nurse Competencies in Latin American countries., Method: advanced practice nurse competencies were derived from a comprehensive review of published competencies and informed the development of a survey designed to assess the relevance of advanced practice nurse competencies in Latin American countries. The survey was distributed to nurse leaders and nurse educators. Data were analyzed using descriptive statistics., Results: consensus for Core Competencies was established., Conclusion: the Core Advanced Practice Nurse Competencies presented can provide a structured framework to build educational programs aligned to the needs of the regional environment.

Objetive: To describe the characteristics of the scientific production of midwives in Latin American obstetrics and gynecology journals indexed to Scopus during the period 2011 to 2016., Methods: This paper reports a descriptive bibliometric study, with intentional non-probabilistic sampling. We analyzed articles of research papers published by midwives in medical specialty journals in obstetrics and gynecology of Latin America indexed to Scopus, in the 2011 to 2016 period., Results: We found eight obstetrics and gynecology journals in Latin America indexed in Scopus. There were 1,696 articles published between 2011 and 2016, of which 4.9% were authored or co-authored by midwives. Of these publications, 93.8% were related to topics of the specialty, 62.5% had midwives as corresponding authors, 64.1% of papers were in Spanish, only 3.1% were published in English, and 57.8% of midwives worked in Chile at the time of publication. In 2016, there was one-fifth the number of publications compared to 2012., Conclusions: We found little scientific production by midwives in Latin American obstetrics and gynecology journals indexed in Scopus. Strategies that encourage and allow research and scientific production by midwives are needed.

This paper describes and analyzes the psychiatric reform process in three Latin American countries (Brazil, Chile and Colombia) based on the Caracas Declaration of 1990. It compares the psychiatric reform processes in these three countries and highlights the role of national mental health laws in these processes. Our goal when investigating the experiences in other countries of Latin America is to draw conclusions for the Argentine psychiatric reform and for the future of such reforms in the region.

Objective: To estimate the proportion of abstracts presented at meetings of the Latin American Society for Pediatric Research that are fully-published, to describe the reasons for not publishing papers, and to assess the impact of funding on the publication rate., Methods: Abstracts presented at meetings held between 2005 and 2009 were included. Authors were contacted and invited to take a survey on the publication of their work or the reasons not to do it., Results: Information was collected on 232 (71.4%) of the 325 abstracts presented. Of these, 58.6% were fully-published (136/232). Funded studies (40.0%) had more chances of publication (OR: 2.2; 95% CI: 1.2-3.9). "Lack of time" was the most common reason for failure to publish (35/96)., Conclusion: 58.6% of abstracts presented at meetings of the Latin American Society for Pediatric Research, were published as full-text articles; lack of time was the most common reason for failure to publish. Funded research had more chances of being published.