Assessing pediatric neurosurgery capacity in La Paz, Bolivia: an illustrative institutional experience of a lower-middle-income country in South America.

OBJECTIVE: The current pediatric neurosurgery capacity in lower-middle-income countries (LMICs) in South America is poorly understood. Correspondingly, the authors sought to interrogate the neurosurgical inpatient experience of the sole publicly funded pediatric hospital in one of the largest regional departments of Bolivia to better understand this capacity. METHODS: A retrospective review of all neurosurgical procedures performed at the Children's Hospital of La Paz, Bolivia (Hospital del Niño "Dr. Ovidio Aliaga Uria") between 2019 and 2023 was conducted after institutional approval using a recently implemented national electronic medical record system. RESULTS: A total of 475 neurosurgical admissions satisfied inclusion for analysis over the 5-year span. The majority of admissions were from within the La Paz Department (87%) via the emergency department (77%), without private insurance (83%). The most common indications for neurosurgical intervention were trauma (35%), followed by hydrocephalus (28%), congenital disease (12%), infection (5%), and craniosynostosis (3%). Overall, the median age at time of surgery was 2.0 years, and the median operating time was 1.5 hours with a minority of intraoperative complications (2%). The most common inpatient complication was unplanned return to the operating room (19%), most commonly seen in congenital indications. At final discharge, the median postoperative length of stay was 10 days. Twenty-seven (6%) of the 475 patients died during hospitalization, most commonly seen in tumor indications. Of the 448 patients who were discharged, 299 (67%) returned for at least one follow-up appointment. CONCLUSIONS: There is restricted breadth in neurosurgical indications and outcomes achievable at the Children's Hospital of La Paz, Bolivia. As such, the capacity of pediatric neurosurgery at institutions in LMICs in South America such as this one is very limited. Identifying and prioritizing actionable interventions to improve this capacity is institution- and LMIC-dependent, and as such, future efforts will need to be tailored appropriately.

Successful control of Echinococcosis in Argentina and Chile through a One Health approach, including vaccination of the sheep intermediate host.

Cystic echinococcosis control in South American countries requires a comprehensive integrative 'One Health' approach. While insular nations have seen successful in their elimination programmes, South American countries face persistent challenges in hostile environments, with Echinococcus granulosus s.l., posing a significant public health concern. Vaccination of intermediate hosts has demonstrated the efficacy of the EG95 vaccine in reducing transmission rates. For example, since 2009, Rio Negro Province in Argentina has added, with marked success, the EG95 vaccine to the control programme, supplementing dog deworming. The Aysen Region of Chile has also reported encouraging preliminary results in reducing cyst prevalence in vaccinated sheep after 3 years of vaccination. The challenges in aligning control strategies with socio-cultural factors, especially in indigenous communities, underlines the need for context-specific strategies. The Rio Negro programme demonstrated commendable compliance, underlining the importance of community engagement in achieving lasting success. The most promising strategies for effective echinococcosis control involved dog deworming and the routine vaccination of sheep and/or goats, underscoring the importance of sustained implementation until all grazing animals have been replaced. For lasting success, these interventions need to be combined with a robust surveillance system.

Intercontinental Comparison of Immunohistochemical Subtypes Among Individuals With Breast Cancer in South-East Asia and South America: A Scoping Systematic Review and Meta-Analysis of Observational Studies.

Background: Breast cancer (BC) remains a significant global concern, particularly among developing countries in South-East Asia (SEA) and South America (SA). The socioeconomic burdens of oncologic care in those countries were often originated from limited accessibility on attainable therapeutic options and reliability on identifying essential information of cancer cells, i.e., immunohistochemical (IHC) subtyping to determine suitable approaches. The triple-negative breast cancer (TNBC) is among the most aggressive category in breast malignancy, therefore, requiring more specific molecular pathway blocking to exhaust the cells. However, large-scale epidemiological investigation on its rate among BC remains unavailable to date. This study aimed to describe the prevalence of TNBC in the SEA and SA continents since it may guide the future direction of oncologic research and trials. Methods: This review focuses on observational studies from the SEA and SA continents from the last decade. Each study represents its country or cities, period of observation, population size, and the TNBC-BC rate as the main outcomes. Therefore, we may also limit the reporting bias originated from same-patient data on the specific occasions. The analysis will be derived to SEA-SA comparison, plus SEA/SA-specific session as processed in Comprehensive Meta-Analysis (CMA) version 3.0. The statistical analysis will be performed in random effects model (REM) within 95% confidence interval (CI). Results: From 46 studies included in the final analysis with a total enlisted population of 34,346 unique individuals with BC, the TNBC rate was higher in the SEA compared to the SA region (19.3% vs. 15.7%; P < 0.05 in 95% CI), with the highest prevalence observed in Vietnam (22.4%) and Peru (17.8%), if it was restricted on countries with two or more studies. Interestingly, both Laos and Argentina possessed significant differences compared to other countries within their respective continents, with the highest and lowest TNBC rates (P < 0.05). Conclusions: The IHC characteristics in SEA differ from those in the SA continent as mainly represented by TNBC prevalence, possibly shaping the course of future trials in the respective region based on IHC expressivity status.

Trends in tracheal, bronchial and lung cancer attributed to smoking in South America: Global Burden of Disease analysis 1990-2019.

Objective: To investigate the burden of tracheal, bronchus, and lung (TBL) cancer due to tobacco exposure in the last 30 years in 12 South American countries. Methods: We used the Global Burden of Disease (GBD) 2019 exposure-response function to analyze the total tobacco, smoking, and secondhand smoke exposure-related TBL cancer deaths and disability-adjusted life years (DALYs), for 12 South American countries, between 1990 and 2019. Metrics were described as absolute numbers or rates per 100 000 individuals. The relative change in burden was assessed by comparing the 1990-1994 to 2015-2019 periods. Results: In 2019, the all-ages number of TBL cancer deaths and DALYs associated with tobacco exposure in South America was 29 348 and 658 204 in males and 14 106 and 318 277 in females, respectively. Age-adjusted death and DALYs rates for the region in 2019 were 182.8 and 4035 in males and 50.8 and 1162 in females, respectively. In males, 10/12 countries observed relative declines in TBL death rates attributed to tobacco exposure while only 4 countries reduced their mortality in females. Conclusion: While significant efforts on tobacco control are under place in South America, substantial burden of TBL cancer persists in the region with significant sex-specific disparities. Increased country-specific primary data on TBL cancer and tobacco exposure is needed to optimize healthcare strategies and improve comprehension of regional trends.

Diversity and biogeography of South American mud turtles elucidated by multilocus DNA sequencing (Testudines: Kinosternidae).

Kinosternon is the most speciose genus of extant turtles, with 22 currently recognized species, distributed across large parts of the Americas. Most species have small distributions, but K. leucostomum and K. scorpioides range from Mexico to South America. Previous studies have found discordance between mitochondrial and nuclear phylogenies in some kinosternid groups, with the current taxonomy following the nuclear-based results. Herein, based on extended molecular, geographic, and taxonomic sampling, we explore the phylogeographic structure and taxonomic limits for K. leucostomum and the K. scorpioides group and present a fossil-calibrated nuclear time tree for Kinosternon. Our results reveal contrasting differentiation patterns for the K. scorpioides group and K. leucostomum, despite overlapping distributions. Kinosternon leucostomum shows only shallow geographic divergence, whereas the K. scorpioides group is polyphyletic with up to 10 distinct taxa, some of them undescribed. We support the elevation of K. s. albogulare and K. s. cruentatum to species level. Given the deep divergence within the genus Kinosternon, we propose the recognition of three subgenera, Kinosternon, Cryptochelys and Thyrosternum, and the abandonment of the group-based classification, at least for the K. leucostomum and K. scorpioides groups. Our results show an initial split in Kinosternon that gave rise to two main radiations, one Nearctic and one mainly Neotropical. Most speciation events in Kinosternon occurred during the Quaternary and we hypothesize that they were mediated by both climatic and geological events. Additionally, our data imply that at least three South American colonizations occurred, two in the K. leucostomum group, and one in the K. scorpioides group. Additionally, we hypothesize that discordance between mitochondrial and nuclear phylogenetic signal is due to mitochondrial capture from an extinct kinosternine lineage.

Pediatric neurosurgical medulloblastoma outcomes in La Paz, Bolivia: How a Lower Middle-Income Country (LMIC) institution in South America compares to the United States.

BACKGROUND: How pediatric medulloblastoma patients fare in Lower Middle-Income Country (LMICs) in South America is not well understood. Correspondingly, the aim of this study was to summarize the pediatric neurosurgical experience of an institution in La Paz, and compare outcomes to that of a generalized High Income Country (HIC) United States (US) experience. METHODS: A retrospective review of all pediatric neurosurgical medulloblastoma patients at the Children's Hospital of La Paz, Bolivia (Hospital del Niño "Dr. Ovidio Aliaga Uria") between 2014 and 2023 was conducted and compared to a generalized US experience abstracted from the US National Cancer Database (NCDB) and National Inpatient Sample (NIS) databases. Categorical, continuous and survival data were statistically summarized and compared. RESULTS: A total of 24 pediatric medulloblastoma patients underwent neurosurgical treatment at the Hospital del Niño. In this La Paz cohort, there were 15 (63%) males and 9 (38%) females, with a mean age of 5.6 years old at diagnosis. The majority of patients underwent subtotal resection (STR, 79%), while the remaining patients underwent biopsy only. Ten (42%) patients expired during their hospitalization, and mean length of stay overall was 39 days. Only 8 (33%) patients received adjuvant treatment after surgery. Median overall survival from diagnosis in the La Paz cohort was 1.9 months. Compared to the US databases, the La Paz cohort experienced significantly more emergency room admissions for surgery, less gross total resection, more STR, more return to operating room for ventriculoperitoneal shunting, more bacteremia, more tracheostomy procedures, more percutaneous gastrostomy placements, longer lengths of stay, less adjuvant chemotherapy, less radiation therapy, shorter follow-up, and ultimately, significantly shorter overall survival (all P < 0.050). CONCLUSIONS: Pediatric neurosurgical medulloblastoma outcomes at the Children's Hospital of La Paz, Bolivia are significantly inferior to that of a generalized US experience. Future research is required to identify institution- and country-specific initiatives to improve discrepancies between institutions in LMICs in South America compared to HICs.

Awake craniotomies in South America: Advancements, challenges, and future prospects.

BACKGROUND: Awake craniotomy has emerged as an advanced surgical technique, characterized by keeping the patient awake during brain surgery. In South America, awake craniotomies have grained traction in neurosurgical practices across various medical centres and hospitals, with notable practitioners contributing to its growth and refinement in the region. PURPOSE: This study aims to explore the integration and impact of awake craniotomies in South American neurosurgical practices. The focus is on understanding the benefits, challenges, and potential transformative effects of the procedure in the region. RESEARCH DESIGN: A comprehensive narrative review and analysis through a thorough examination of the existing literature. RESULTS: The findings indicate that awake craniotomies in South America offer substantial benefits, including cost savings thorugh reduced hospitalization time, quicker recovery and decreased morbidity. Enhanced safety, effective pain management and reduced anaesthesia also contribute to this. CONCLUSION: Whilst the adaptation of awake craniotomies in South America holds great promise in transforming neurosurgical care in the region, significant challenges hinder its widespread adoption. Inadequate infrastructure, limited access to equipment, financial instability, and shortages in trained healthcare providers represent challenges that need to be addressed.

Spatial distribution and characteristics of plastic pollution in the salt marshes of Bahía Blanca Estuary, Argentina.

This study delves into the magnitude and attributes of plastic pollution in the salt marshes of the Bahía Blanca Estuary, Argentina, with a specific focus on its spatial distribution. The investigation included the evaluation of microplastics (1-5 mm), mesoplastics (5-25 mm) and macroplastics (25-100 mm), discovering elevated levels along the high salt marsh strandline compared to low salt marsh and mudflat areas. Notably, the abundance of plastic reached staggering levels, reaching up to 20,060 items/m2 in the vicinity of an illegal dumpsite. Microplastics, particularly in the 2-4 mm range, were dominant, and the main plastic components were high-density polyethylene (HDPE), low-density polyethylene (LDPE), polypropylene (PP), and polystyrene (PS). Plastic films emerged as the predominant plastic type, while the presence of pellets hinted at potential sources such as illegal dumping and port-related activities. This contamination could be largely attributed to inappropriate waste management practices and urban runoff, which pose a substantial ecological threat to these ecosystems. Urgent remedial action is essential to protect these marshes, underscoring the critical need for comprehensive wetland management and educational initiatives to ensure their long-term sustainability.

Assessing empathy in healthcare services: a systematic review of South American healthcare workers' and patients' perceptions.

Background: Empathy in healthcare service refers to the ability of healthcare workers (HCWs) to put themselves in patients' shoes, which is necessary to ensure a good physician-patient relationship and provide quality care. Various studies have shown that empathy varies depending on the country, the instrument used, the evaluator, and the HCW's specialty. This systematic review aims to estimate the levels of empathy among HCWs in South American countries between 2000 and 2019. Methods: We conducted searches in 15 databases (PubMed, Scopus, Web of Science, EMBASE, Scielo, PsycoInfo, ScientDirect, Latindex, and LILIACS), four preprint servers (medRxiv, bioRxiv, SportRxiv, and Preprints), and other search engines such as Dimensions (20), Google Scholar, Yahoo!, and Alicia CONCyTec (c). We followed the PRISMA guidelines, and this study was registered in PROSPERO (CRD42023454007). Results: Out of 18,532 documents identified from November 10 to 28, 2021, 10 articles were included (n = 2,487 participants, of which 1989 were patients). Among the studies focusing on self-evaluated empathy, four relied on the Jefferson Scale of Empathy for medical professionals (JSE-HP). However, assessments from patients employing Jefferson Scale of Patient's Perceptions of Physician Empathy (JSPPPE) and Consultation and Relational Empathy (CARE) scale suggested high levels of empathy We found that both professionals and patients perceived that empathic care was provided, often at a medium or regular level. Surgery residents presented lower levels of empathy compared to obstetrics-gynecology and pediatrics physicians. Conclusion: Empathy is crucial in determining the quality of care and patient satisfaction during healthcare services provided by HCWs. Therefore, it is important to support professionals so that the various stressful situations they encounter in their work and daily life do not negatively influence the approach they provide to patients.

Mortality from Breast Cancer in Women under 50 Years of Age in Colombia / Mortalidade por câncer de mama em mulheres com menos de 50 anos de idade na Colômbia

Abstract Objective To calculate and analyze the mortality rates from breast cancer in women under 50 years of age in Colombia and to compare them with those of other countries in the region. Methods Based on data from the registry of deaths in 2018 and the results of the National Population and Housing Census of Colombia for the same year, specific mortality rates in women with breast cancer, specific mortality according to age group, standardized by age, proportional mortality, potential years of life lost, and years of life expectancy lost in women under 50 years of age who died from breast cancer were calculated. The mortality rate of regional countries was consulted on the Global Cancer Observatory webpage. Results In the group from 20 to 49 years, the specific mortality rate was higher in the age range from 45 to 49 years, with a rate of 23.42 × 100,000, a value that was above the specific mortality rate due to breast cancer in women in Colombia, 15.17 × 100.000. In the age range of 45 to 49 years, the potential years of life lost were 42.16. Of the 0.275 years of life expectancy lost by the population due to this neoplasia, women under 50 years of age represented 0.091 (33%). Colombia is the fifth in the rank of mortality in Latin American countries in this age group. Conclusion Breast cancer in patients from 30 to 59 years is the number one cause for the decrease in life expectancy of women in Colombia. Women under 50 years of age represent one third of this decrease. This neoplasm is also the leading cause of mortality in women younger than 50 years in South America.

Influence of ecoregion and river type on neotropical Chironomidae (Diptera) from humid mountain to semiarid lowland

Introduction: Chironomidae (Diptera) is the most widespread and abundant aquatic insect family in freshwater ecosystems. Chironomids are considered good indicators of water quality but are seldom identified at the genus level in broad spatial scale studies. Objective: To identify environmental conditions associated with chironomids in an altitudinal gradient. Methods: We compared ecoregions, river types, and seasons, for chironomids in neotropical streams and rivers (18 river sites; 2014-2018; Yungas rainforest and Western Chaco dry forest, Argentina). We used non-metric multidimensional scaling, dissimilarity, envfit analysis and rank-abundance curves. Results: Chironomid "assemblages''matched both ecoregions and river types. However, ecoregions presented a better fit with species composition. The stenothermal taxa of Orthocladiinae were dominant at high elevations and the eurythermal Chironominae in lowland rivers. Altitude, water temperature and conductivity were important. Seasonal differences were smaller than ecoregional differences. Conclusions: Ecoregions, altitude, water temperature and conductivity correlated with chironomid communities. Orthocladiinae were dominant at high elevations and Chironominae in lowland rivers.

Introducción: Chironomidae (Diptera) es la familia de insectos acuáticos más extendida y abundante en los ecosistemas dulceacuícolas. Los quironómidos se consideran buenos indicadores de la calidad del agua, pero rara vez se identifican a nivel de género en estudios de amplia escala espacial. Objetivo: Identificar las condiciones ambientales asociadas a los quironómidos en un gradiente altitudinal. Métodos: Comparamos ecorregiones, tipos de ríos y estaciones para quironómidos en arroyos y ríos neotropicales (18 sitios en ríos; 2014-2018; en un bosque tropical de Yungas y un bosque seco del Chaco Occidental, Argentina). Utilizamos escalamiento no métrico multidimensional, disimilitud, análisis de envfit y curvas de rango-abundancia. Resultados: Los "ensamblajes''de quironómidos coincidieron tanto con las ecorregiones como con los tipos de ríos. Sin embargo, las ecorregiones presentaron un mejor ajuste con la composición de especies. Los taxones estenotérmicos de Orthocladiinae fueron dominantes en las elevaciones altas y los euritermales de Chironominae en los ríos de las tierras bajas. La altitud, la temperatura del agua y la conductividad fueron importantes. Las diferencias estacionales fueron menores que las diferencias ecorregionales. Conclusiones: las ecorregiones, la altitud, la temperatura del agua y la conductividad se correlacionaron con las comunidades de quironómidos. Orthocladiinae fue dominante en los sitios altos y Chironominae en los ríos de tierras bajas.

Subregional efforts to improve childhood cancer care in the Andean countries.

Cancer is one of the leading causes of death in children and adolescents younger than 19 years. An estimated 10 000 deaths are caused by this disease annually in this age group in Latin America and the Caribbean. In high-income countries, the survival of children and adolescents with neoplasms can reach 85%; however, in middle- and low-income countries, despite progress, survival rates are significantly lower (between 10% and 60%). Important inequities exist is survival from childhood cancer that need to be addressed through decisive actions from the health systems. This report describes the work of the ministries of health and the Secretariat of the Andean Health Organization (Organismo Andino de Salud - Convenio Hipólito Unánue (ORAS-CONHU)), to develop the Andean Cancer Prevention and Control Policy, with consideration given to childhood cancers. The policy was based on analysis of the cancer situation in the six Andean countries - Bolivia (Plurinational State of), Colombia, Chile, Ecuador, Peru and Venezuela (Bolivarian Republic of) - between 2015 and 2020, and it was approved in 2022. An in-depth study is currently being carried out on the situation of childhood cancer in the Andean countries.

El cáncer es una de las principales causas de muerte en la población infantil y adolescente menor de 19 años. Se estima que esta enfermedad ocasiona cada año 10 000 muertes en este grupo etario en América Latina y el Caribe. En los países de ingresos altos, la supervivencia de la población infantil y adolescente con neoplasias puede llegar al 85%; sin embargo, a pesar de los avances, en los países de ingresos bajos y medianos las tasas de supervivencia son significativamente más bajas (entre un 10% y un 60%). Existen desigualdades importantes en materia de supervivencia al cáncer infantil que es preciso abordar mediante medidas decisivas por parte de los sistemas de salud. En este informe se describe el trabajo realizado por los ministerios de salud y la Secretaría del Organismo Andino de Salud ­ Convenio Hipólito Unánue (ORAS-CONHU) para formular la Política Andina de Prevención y Control del Cáncer, con especial énfasis en el cáncer infantil. La política se basó en el análisis de la situación en materia oncológica de los seis países andinos ­Bolivia (Estado Plurinacional de), Chile, Colombia, Ecuador, Perú y Venezuela (República Bolivariana de)­ entre el 2015 y el 2020, y se aprobó en el 2022. En estos momentos, se está llevando a cabo un estudio pormenorizado sobre la situación del cáncer infantil en los países andinos.

O câncer é uma das principais causas de morte em crianças e adolescentes menores de 19 anos. Estima-se que, nessa faixa etária, a doença cause 10 mil mortes por ano na América Latina e no Caribe. Em países de renda alta, a sobrevida de crianças e adolescentes com neoplasias pode chegar a 85%; no entanto, em países de renda média e baixa, apesar de alguns avanços, as taxas de sobrevida são significativamente menores (entre 10% e 60%). Existem iniquidades importantes na sobrevivência ao câncer infantil que precisam ser abordadas por meio de ações decisivas dos sistemas de saúde. Este relatório descreve o trabalho dos ministérios da saúde e da Secretaria do Organismo Andino de Saúde ­ Convênio Hipólito Unanue (ORAS-CONHU) para desenvolver a Política Andina de Prevenção e Controle do Câncer, com atenção para os cânceres infantis. A política, baseada em uma análise da situação do câncer nos seis países andinos ­ Bolívia (Estado Plurinacional da), Colômbia, Chile, Equador, Peru e Venezuela (República Bolivariana da) ­ entre 2015 e 2020, foi aprovada em 2022. Um estudo aprofundado está sendo realizado atualmente para avaliar a situação do câncer infantil nos países andinos.

Infecciones por helmintos intestinales en Chile: Análisis retrospectivo en Santiago, años 2015-2019

Introducción: Existe escasa evidencia epidemiológica actual sobre helmintos intestinales en Chile. Objetivo: Describir la prevalencia de infecciones por helmintos intestinales en un centro de salud en Santiago, Chile. Métodos: Análisis retrospectivo de helmintos intestinales diagnosticados en muestras parasitológicas de rutina en el Laboratorio de Microbiología de Clínica Alemana de Santiago, entre los años 2015 y 2019. Las pruebas diagnósticas se seleccionaron según la solicitud médica. Los datos se obtuvieron de los sistemas informáticos del laboratorio y se analizaron de manera anonimizada. Resultados: Se detectaron 127 infecciones por helmintos en 11.809 muestras estudiadas (1,1%). Estas infecciones fueron: 78 (61,4%) Enterobius vermicularis, 25 (19,6%) Dibothriocephalus/Adenocephalus spp., 9 (7,1%) Taenia spp., 6 (4,7%) Pseudoterranova spp., 5 (3,9%) Strongyloides stercoralis y 4 (3,1%) Ascaris lumbricoides. Enterobius vermicularis predominó en niños y adolescentes; Dibothriocephalus/ Adenocephalus spp. predominó en adultos. Conclusión: El estudio proporciona información epidemiológica actual sobre la distribución de helmintos intestinales en muestras clínicas en Santiago, Chile. Enterobius vermicularis fue prevalente, seguido de helmintos transmitidos por alimentos mientras que los transmitidos por el suelo solo se detectaron ocasionalmente. El surgimiento de difilobotriasis y anisakidosis (pseudoterranoviasis), es relevante y posiblemente se relacione con cambios en las condiciones de vida y la cultura alimentaria en Chile.

Background: Epidemiological information on the current prevalence of intestinal helminths in Chile is scarce. Aim: To describe the prevalence of different intestinal helminth infections in a healthcare center in Santiago, Chile. Methods: We performed a retrospective analysis of intestinal helminths diagnosed in routine parasitological samples in the microbiological laboratory of Clínica Alemana Santiago, Chile, between 2015 and 2019. Diagnostic tests were applied according to the sender's request. Data were obtained from laboratory information systems and analyzed in an anonymized manner. Results: Among 11,809 samples, 127 (1.1%) helminth infections were detected, of those, 78 (61.4%) were Enterobius vermicularis, 25 (19.6%) Dibothriocephalus/Adenocephalus spp., 9 (7.1%) Taenia spp., 6 (4.7%) Pseudoterranova spp., 5 (3.9%) Strongyloides stercoralis, and 4 (3.1%) Ascaris lumbricoides. Enterobius vermicularis was predominant among children and adolescents, while Dibothriocephalus/Adenocephalus spp. was the most frequent helminth in adults. Conclusion: The study provides updated epidemiological information on distribution of helminth infections in clinical samples in Santiago, Chile. After E. vermicularis, food-borne helminths were second most prevalent, while soiltransmitted helminths were very rarely detected. The emergence of diphyllobothriasis and anisakidosis (pseudoterranoviasis) is noteworthy and possibly related to changes in living conditions and food culture in Chile.

Species tree analyses and speciation-based species delimitation support new species in the relict catfish family Diplomystidae and provide insights on recent glacial history in Patagonia.

Diplomystidae is an early-diverged family of freshwater catfish endemic to southern South America. We have recently collected five juvenile specimens belonging to this family from the Bueno River Basin, a basin which the only previous record was a single juvenile specimen collected in 1996. This finding confirms the distribution of the family further South in northern Patagonia, but poses new questions about the origin of this population in an area with a strong glacial history. We used phylogenetic analyses to evaluate three different hypotheses that could explain the origin of this population in the basin. First, the population could have originated in Atlantic basins (East of the Andes) and dispersed to the Bueno Basin after the Last Glacial Maximum (LGM) via river reversals, as it has been proposed for other population of Diplomystes as well as for other freshwater species from Patagonia. Second, the population could have originated in the geographically close Valdivia Basin (West of the Andes) and dispersed south to its current location in the Bueno Basin. Third, regardless of its geographic origin (West or East of the Andes), the Bueno Basin population could have a longer history in the basin, surviving in situ through the LGM. In addition, we conducted species delimitation analyses using a recently developed method that uses a protracted model of speciation. Our goal was to test the species status of the Bueno Basin population along with another controversial population in Central Chile (Biobío Basin), which appeared highly divergent in previous studies with mtDNA. The phylogenetic analyses showed that the population from the Bueno Basin is more related to Atlantic than to Pacific lineages, although with a deep divergence that predated the LGM, supporting in situ survival rather than postglacial dispersal. In addition, these analyses also showed that the species D. nahuelbutaensis is polyphyletic, supporting the need for a taxonomic reevaluation. The species delimitation analyses supported two new species which are described using molecular diagnostic characters: Diplomystes arratiae sp. nov. from the Biobío, Carampangue, and Laraquete basins, maintaining D. nahuelbutaensis valid only for the Imperial Basin, and Diplomystes habitae sp. nov. from the Bueno Basin. This study greatly increases the number of species within both the family Diplomystidae and Patagonia, and contributes substantially to the knowledge of the evolution of southern South American freshwater biodiversity during its glacial history. Given the important contribution to the phylogenetic diversity of the family, we recommend a high conservation priority for both new species. Finally, this study highlights an exemplary scenario where species descriptions based only on DNA data are particularly valuable, bringing additional elements to the ongoing debate on DNA-based taxonomy.

Temporal patterns of breast cancer incidence, mortality, disability-adjusted life years and risk factors in 12 South American Countries, 1990-2019: an examination using estimates from the global burden of disease 2019 study.

BACKGROUND AND AIM: Breast cancer (BC) is one of the leading causes of cancer deaths in females in South America. This study aims to examine the BC burden in 12 South American countries between 1990 and 2019. DATA AND METHODS: The estimates of BC burden and risk factors were procured from the Global Burden of Disease 2019 study for the period 1990-2019. Development levels of countries were gauged using socio-demographic index (SDI). Decomposition analysis was employed to categorize the change in incidence between 1990 and 2019 into three factors: population growth, population aging and age-specific incidence rate. Estimated annual percent changes were calculated for each country and bivariate association between country-level age-standardized rates and SDI was examined using pooled regression. RESULTS: The age-standardized rates of breast cancer were the highest in Uruguay [incidence: 72.65 per 100,000 (55.79-92.57); mortality: 29.97 per 100,000 (27.54-32.27); disability-adjusted life years (DALYs: 810.49 per 100,000 (746.22-884.55)] and lowest in Peru [incidence: 27.63 per 100,000 (20.44-36.85); mortality: 10.79 per 100,000 (8.14-14.11); DALYs: 318.27 per 100,000 (234.47-421.16)]. Mortality-to-incidence ratio (MIR) across countries varied from 0.30 in Colombia to 0.55 in Bolivia in 2019. SDI had a positive and strong association with age-standardized incidence rate [Formula: see text] and weaker positive association with age-standardized mortality rate [Formula: see text] and age-standardized DALYs rate [Formula: see text]. Most countries experienced more than 70% increase in incident cases owing to population aging and age-specific incidence rates. Alcohol Use, diet high in red meat and smoking contributed the maximum DALYs in most countries in 2019 whereas DALYs due to high body-mass index and high fasting plasma glucose increased most substantially between 1990 and 2019. CONCLUSION: With increasing incidence, high MIR and rising BC burden due to modifiable risk factors, several public health interventions are required in South America focusing on prevention, BC awareness among general public, cost-effective early detection and treatments that suit the socio-economic setup of South American countries.

Challenges and opportunities in prostate cancer surgery in South America: Insights into robot-assisted radical prostatectomies-A perspective.

Background and Aims: Prostate cancer imposes a significant health burden, particularly in South America with its high incidence and mortality rates. This article explores the emergence of robot-assisted radical prostatectomy (RARP) as a potential solution in the region. Methods: This study relies on a comprehensive review of relevant literature. The analysis highlights the advantages of RARP, identifies impediments to its implementation, and proposes strategies to overcome these barriers. Results: RARP demonstrates notable benefits, including improved functional outcomes, reduced complications, and minimized incisions. However, the integration of RARP in South America is hindered by challenges such as regional disparities, financial limitations, and data gaps. Limited healthcare infrastructure and a scarcity of skilled professionals further compound the issues. Conclusion: Despite its potential, RARP faces obstacles to widespread adoption in South America. Strategic solutions encompassing technology investment, healthcare infrastructure enhancement, and workforce training are imperative. Overcoming these challenges can establish RARP as a crucial tool in managing prostate cancer in the region, ultimately enhancing patient care and treatment outcomes.

Systematic literature review of primary and secondary cervical cancer prevention programs in South America.

Objective: To identify the 2022 recommendations made by ministries of health in the 13 countries and areas of South America for human papillomavirus (HPV) vaccination and cervical cancer screening. Methods: A systematic review of scientific literature and official documents was conducted between July 7 and October 17, 2022. The review included an initial search on official websites (e.g. ministries of health, national cancer institutes and health departments) of South American countries to identify current guidelines or recommendations for HPV vaccination and cervical cancer screening. Results: Recommendations for HPV vaccination were found for 11 countries, with the exceptions of French Guiana and the Bolivarian Republic of Venezuela. Recommendations were found for cervical cancer screening in official documents from 11 countries, with the exceptions of the Bolivarian Republic of Venezuela, where one article was found that was not an official recommendation, and Suriname, for which no documents were found on websites or in other publications. A total of 12 countries use cytology to screen for cervical cancer. Four countries (Bolivia [Plurinational State of], Colombia, Guyana and Peru) use visual inspection with acetic acid and the screen-and-treat strategy. Six countries (Argentina, Chile, Colombia, Ecuador, Paraguay and Peru) are transitioning from cytology to HPV testing. Conclusions: No documents were found about a national HPV vaccination program in French Guiana and Venezuela, and no official guidelines for cervical cancer screening were found for Suriname and Venezuela; thus, it will be difficult to eliminate this public health problem in these countries. Countries in South America must update their guidelines for HPV vaccination and cervical cancer screening as new evidence emerges. Official websites with information about HPV vaccination and cervical cancer screening are important sources that can be accessed by health professionals and the population.

Initial assessment of multi-compound antineoplastic drug surface contamination in Argentinean healthcare centers: Insights into occupational exposures in South America.

INTRODUCTION: Antineoplastic drug contamination can result in severe health effects for healthcare workers exposed to them. Despite the worldwide growing concern regarding these drugs and sustained monitoring efforts in developed countries, there is almost no data about surface contamination levels in Argentina, in particular, and South America, in general. METHODS: Antineoplastic drug contamination was measured in three Argentinean public hospitals (pharmacy and daycare center areas) by surface wiping and liquid chromatography coupled with tandem mass spectrometry. RESULTS AND DISCUSSION: Eleven drugs were detected, in 51 of 58 sampled surfaces, in variable concentrations from 0.00064 to 7.3 ng cm-2, with cyclophosphamide, gemcitabine, and paclitaxel as the most prevalent drugs. This highly variable antineoplastic distribution reflects differences in facility layout, number of patients, antineoplastic drug use, etc., at each hospital. Values exceeding the 1 ng cm-2 threshold were detected in 13 surfaces of the two hospitals handling the largest amounts of antineoplastic drugs. The cyclophosphamide 75th percentile averaged 0.030 ng cm-2 comparable to the high values reported more than 10 years ago for developed countries, emphasizing the potential of reducing antineoplastic contamination by implementing routine monitoring and improved cleaning and handling procedures. CONCLUSION: This study is the first survey of multi-compound surface antineoplastic contamination in Argentinean (and South American) hospitals, providing a baseline against which future studies can be compared. Widespread antineoplastic contamination has been detected on numerous surfaces, with concentrations surpassing suggested threshold exposure levels (1 ng cm-1) for some surfaces in two of the sampled hospitals.

Advances on the Amaryllidacea Alkaloids Collected in South Africa, Andean South America and the Mediterranean Basin.

The alkaloids are one of the most represented family of natural occurring biological active compounds. Amaryllidaceae are also very well known for their beautiful flower and are thus used as ornamental plants in historic and public gardens. The Amaryllidacea alkaloids constitute an important group that is subdivided into different subfamilies with different carbon skeletons. They are well known from ancient times for their long application in folk medicine, and in particular, Narcissus poeticus L. was known to Hippocrates of Cos (ca. B.C. 460-370), who treated uterine tumors with a formulate prepared from narcissus oil. To date, more than 600 alkaloids of 15 chemical groups exhibiting various biological activities have been isolated from the Amaryllidaceae plants. This plant genus is diffused in regions of Southern Africa, Andean South America and the Mediterranean basin. Thus, this review describes the chemical and biological activity of the alkaloids collected in these regions in the last two decades as weel those of isocarbostyls isolated from Amaryllidaceae in the same regions and same period.

Description and life cycle of a new species of the genus Arachnanthus (Cnidaria: Anthozoa: Ceriantharia) from the Southwestern Atlantic Ocean.

Background: Ceriantharia is a subclass of the phylum Cnidaria, which comprises tube-dwelling marine invertebrates. This subclass is composed of three families, including Arachnactidae, with two known genera. Currently, the genus Arachnanthus has five valid species recorded from Australia, the Mediterranean Sea and both the Southern and Northern Pacific Ocean. However, at the moment, there is no record of organisms of this family from the South Atlantic Ocean. Besides that, the life cycle of any species of the genus Arachnanthus is known. The present study describes a new species of the genus Arachnanthus and its life cycle, based on specimens from Uruguay and South of Brazil. Methods: Larvae were collected by plankton net in Rio Grande-Brazil and the development and external morphology of these specimens were observed in the laboratory during two years, and subsequently described. Additionally, nine adult ceriantharians correspondent to the larvae from Rio Grande were collected in Uruguay and their external and internal anatomies, and cnidome were described. Results: Arachnanthus errans sp. nov. exhibited a free-swimming, short-lived cerinula larvae that spent short-time on the plankton. The larva developed into small and translucent polyps with a short actinopharynx, one pair of mesenteries attached to a siphonoglyph, and a medium first pair of metamesenteries. Further, the adult polyp displayed an unprecedented locomotion behavior in Ceriantharia that is first reported here, it can crawl under and in between the sediment.