Hepatic Rupture Associated With HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets) Syndrome: A Report of Two Cases and Literature Review.

Hepatic rupture is a rare complication of severe preeclampsia. A high index of suspicion is required in the presence of abdominal pain accompanied by hemodynamic decompensation in a pregnant woman. Hepatic rupture constitutes a medical emergency that demands immediate intervention, often with the support of other medical disciplines, in a highly specialized hospital setting.

Advanced Breast Cancer Guidelines in Latin America: Assessment, Adaptation, and Implementation of Fifth Advanced Breast Cancer Consensus Guidelines.

Purpose: As the fifth international consensus on advanced breast cancer (ABC5) established guidelines for the management of this disease, the aim of this article was to present the applicability of the consensus recommendations and to generate knowledge to improve access.

Methods: Sixty-one recommendation statements were selected and discussed by 15 breast cancer experts from Latin America (LA). After the discussion, the level of consensus was determined through a vote.

Dysphagia lusoria in a young patient with a concomitant aortic arch anomaly, successfully treated with surgery: a case report.

Dysphagia is a common condition in clinical practice; however, an unusual type of dysphagia due to compression of the esophagus by an abnormal right subclavian artery may be discovered in a rare subset of patients. The prognosis and treatment will depend on the severity of the symptoms and the compromise of surrounding structures. We present the case of an 18-year-old female who presented with gradually progressive dysphagia.

A Physical Rehabilitation Approach for Parkinson's Disease: A Systematic Literature Review.

Parkinson's disease (PD) is one of the most common neurological ailments. With diverse motor affectations (postural instability, resting tremor, bradykinesia, and rigidity), people with Parkinson's disease (PwP) have a broad spectrum of non-motor symptoms. These include autonomic function changes, cognitive deterioration, neuropsychiatric difficulties, and sleep interruptions.

Severe dysphagia due to an esophageal duplication cyst in sixth decade, unusual presentation of a rare pathology.

Background: Esophageal duplication cysts are rare congenital tumors usually diagnosed and treated during childhood. Most of them are located in the mediastinum and appear as a mass besides the esophagus. Unfortunately, symptoms are non-specific and depend on the size and location of the mass; therefore, they can easily be missed.

Age-Friendly Cities in Latin America: A Human Ecological Framework.

Despite the demographic aging of Latin America, the uptake of the WHO's Age-Friendly Cities Framework remains extremely low, with the notable exceptions of Chile, Mexico and Brazil. We argue for a broader human ecological framework, which focuses on the macro, meso and micro levels, to better address the context, challenges and opportunities for age-friendly cities in the Latin American region. The WHO's age-friendly city domains are primarily at the meso (community) scale, with a focus on built environment, services and participation.

Map of pain education in Latin America: current state and perspectives.

The Latin American Map of Pain Education initiative has developed steadily in recent years. A recent survey yields important new data on the current state and allows outlining of the next steps to improve pain education in Latin American countries. A survey conducted by Federación Latinoamericana de Asociaciones para el Estudio del Dolor (FEDELAT) with data from 19 Latin American countries showed that a generally observed barrier is the lack of adequately trained pain professionals and the insufficient number of pain centers.

Comparison of Pediatric Patients With and Without Multisystem Inflammatory Syndrome Associated With COVID-19: Retrospective Cohort From Ecuador.

Background: Multisystem inflammatory syndrome in children (MIS-C) has been associated with severe acute respiratory syndrome coronavirus 2 infection in the pediatric population cared for in the pediatric intensive care unit. We aimed to compare patients with pediatric acute respiratory distress syndrome (PARDS) with those who also present a MIS-C diagnosis (PARDS vs. PARDS + MIS-C).

First case of within-host co-infection of different SARS-CoV-2 variants in Ecuador.

Background: COVID-19 infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause mild symptoms to severe illness and death. Co-infections of SARS-CoV-2 with other respiratory viruses have been described. However, two SARS-CoV-2 lineage co-infection have been rarely reported.

Impact of the COVID-19 Pandemic on Pediatric Surgical Volume in Four Low- and Middle-Income Country Hospitals: Insights from an Interrupted Time Series Analysis.

Background: The impact of the COVID-19 pandemic on surgical care delivery in low- and middle-income countries (LMIC) has been challenging to assess due to a lack of data. This study examines the impact of COVID-19 on pediatric surgical volumes at four LMIC hospitals.

Methods: Retrospective and prospective pediatric surgical data collected at hospitals in Burkina Faso, Ecuador, Nigeria, and Zambia were reviewed from January 2019 to April 2021.

Incidental neuroendocrine tumor of a complete subserosal appendix: an unusual presentation of a rare anatomical variation. A case report and review of literature.

Background: Appendix' anatomical variations are a rare occurrence which can mislead diagnosis and delay appropriate treatment.

Case Presentation: We present a 9-year-old female patient that came with a clinical picture compatible with acute appendicitis. However, a cecal mass was identified instead of an inflamed appendix during surgery.

Apnea-Hypopnea Index in Chronic Obstructive Pulmonary Disease Exacerbation Requiring Noninvasive Mechanical Ventilation with Average Volume-Assured Pressure Support.

Introduction: This study intends to determine the Apnea-Hypopnea Index in patients hospitalized with acute hypercapnic respiratory failure from chronic obstructive pulmonary disease exacerbation, who require noninvasive ventilation with average volume-assured pressure support (AVAPS), as well as describes the clinical characteristics of these patients.

Materials And Methods: We designed a single-center prospective study. The coexistence of Apnea-Hypopnea Index and clinical, gasometric, spirometric, respiratory polygraphy, and ventilatory characteristics were determined.

Availability and Quality of Grief and Bereavement Care in Pediatric Intensive Care Units Around the World, Opportunities for Improvement.

Pediatric Intensive Care Units (PICUs) provide multidisciplinary care to critically ill children and their families. Grief is present throughout the trajectory of illness and can peak around the time of death or non-death losses. The objective of this study was to assess how PICUs around the world implement grief and bereavement care (GBC) as part of an integrated model of care.

Pain Assessment and Management in Pediatric Intensive Care Units Around the World, an International, Multicenter Study.

The adequate assessment and management of pain remains a challenging task in the Pediatric Intensive Care Unit (PICU). Our goal is to describe how pain is assessed and managed in PICUs around the world and to examine how human and material resources impact achievement of this goal. An international multicenter cross-sectional observational study was designed with the participation of 34 PICUs located in urban, suburban, and rural areas of 18 countries.

Fighting Against Stroke in Latin America: A Joint Effort of Medical Professional Societies and Governments.

Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. The second meeting in March 2020 reviewed the achievements in 2 years and discussed new objectives.

Management of COVID-19 at the pandemic's first wave in Ecuador.

During March and April 2020, Ecuador was the country with the highest death toll in Latin America due to the coronavirus disease 2019 pandemic. Simultaneously, research was being developed and published globally, and to a certain extent, guided therapeutic approaches in real time, mostly in under-resourced settings. We present the case of a 59-year-old male physician residing in Guayaquil, who presented with severe coronavirus disease 2019, in which mechanical ventilation, prone position, and pulmonary protective ventilatory strategy were used.

Global Chronic Total Occlusion Crossing Algorithm: JACC State-of-the-Art Review.

The authors developed a global chronic total occlusion crossing algorithm following 10 steps: 1) dual angiography; 2) careful angiographic review focusing on proximal cap morphology, occlusion segment, distal vessel quality, and collateral circulation; 3) approaching proximal cap ambiguity using intravascular ultrasound, retrograde, and move-the-cap techniques; 4) approaching poor distal vessel quality using the retrograde approach and bifurcation at the distal cap by use of a dual-lumen catheter and intravascular ultrasound; 5) feasibility of retrograde crossing through grafts and septal and epicardial collateral vessels; 6) antegrade wiring strategies; 7) retrograde approach; 8) changing strategy when failing to achieve progress; 9) considering performing an investment procedure if crossing attempts fail; and 10) stopping when reaching high radiation or contrast dose or in case of long procedural time, occurrence of a serious complication, operator and patient fatigue, or lack of expertise or equipment. This algorithm can improve outcomes and expand discussion, research, and collaboration.

Real-World Data on Adult T-Cell Leukemia/Lymphoma in Latin America: A Study From the Grupo de Estudio Latinoamericano de Linfoproliferativos.

Purpose: Adult T-cell leukemia/lymphoma (ATLL) is an aggressive disease caused by the human T-cell leukemia virus type 1. Real-world data of ATLL in Latin America are lacking.

Patients And Methods: We analyzed patients with ATLL (acute, lymphomatous, chronic, and smoldering) encountered in 11 Latin American countries between 1995 and 2019.

Cavitary Pneumonia Due to Methicillin-Resistant Staphylococcus aureus in a Non-Immunocompromised Patient After an Endoscopy: A Case Report.

BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia has well-defined characteristics. We present a case of cavitary pneumonia due to MRSA in a patient who had undergone a recent outpatient gastroscopic procedure. CASE REPORT A 32-year-old man presented at the Emergency Department with tonic-clonic seizures of 2 min durations.