Archaeogenomic distinctiveness of the Isthmo-Colombian area.

The recently enriched genomic history of Indigenous groups in the Americas is still meager concerning continental Central America. Here, we report ten pre-Hispanic (plus two early colonial) genomes and 84 genome-wide profiles from seven groups presently living in Panama. Our analyses reveal that pre-Hispanic demographic events contributed to the extensive genetic structure currently seen in the area, which is also characterized by a distinctive Isthmo-Colombian Indigenous component. This component drives these populations on a specific variability axis and derives from the local admixture of different ancestries of northern North American origin(s). Two of these ancestries were differentially associated to Pleistocene Indigenous groups that also moved into South America, leaving heterogenous genetic footprints. An additional Pleistocene ancestry was brought by a still unsampled population of the Isthmus (UPopI) that remained restricted to the Isthmian area, expanded locally during the early Holocene, and left genomic traces up to the present day.

Evolution and environment of Caribbean coastal ecosystems.

Isolation of the Caribbean Sea from the tropical Eastern Pacific by uplift of the Isthmus of Panama in the late Pliocene was associated with major, taxonomically variable, shifts in Caribbean biotic composition, and extinction, but inferred causes of these biological changes have remained elusive. We addressed this through falsifiable hypotheses about how independently determined historical changes in oceanographic conditions may have been responsible. The most striking environmental change was a sharp decline in upwelling intensity as measured from decreases in intra-annual fluctuations in temperature and consequently in planktonic productivity. We then hypothesized three general categories of biological response based upon observed differences in natural history between the oceans today. These include changes in feeding ecology, life histories, and habitats. As expected, suspension feeders and predators became rarer as upwelling declined. However, predicted increases in benthic productivity by reef corals, and benthic algae were drawn out over more than 1 Myr as seagrass and coral reef habitats proliferated; a shift that was itself driven by declining upwelling. Similar time lags occurred for predicted shifts in reproductive life history characteristics of bivalves, gastropods, and bryozoans. Examination of the spatial variability of biotic change helps to understand the time lags. Many older species characteristic of times before environmental conditions had changed tended to hang on in progressively smaller proportions of locations until they became extinct as expected from metapopulation theory and the concept of extinction debt. Faunal turnover may not occur until a million or more years after the environmental changes ultimately responsible.

Plasmodium vivax Infections among Immigrants from China Traveling to the United States.

Beginning in 2023, we observed increased Plasmodium vivax malaria cases at an institution in Los Angeles, California, USA. Most cases were among migrants from China who traveled to the United States through South and Central America. US clinicians should be aware of possible P. vivax malaria among immigrants from China.

The human malaria-Aotus monkey model: a historical perspective in antimalarial chemotherapy research at the Gorgas Memorial Laboratory-Panama.

The human malaria-Aotus monkey model has served the malaria research community since its inception in 1966 at the Gorgas Memorial Laboratory (GML) in Panama. Spanning over five decades, this model has been instrumental in evaluating the in vivo efficacy and pharmacokinetics of a wide array of candidate antimalarial drugs, whether used singly or in combination. The animal model could be infected with drug-resistant and susceptible Plasmodium falciparum and Plasmodium vivax strains that follow a characteristic and reproducible course of infection, remarkably like human untreated and treated infections. Over the years, the model has enabled the evaluation of several synthetic and semisynthetic endoperoxides, for instance, artelinic acid, artesunate, artemether, arteether, and artemisone. These compounds have been evaluated alone and in combination with long-acting partner drugs, commonly referred to as artemisinin-based combination therapies, which are recommended as first-line treatment against uncomplicated malaria. Further, the model has also supported the evaluation of the primaquine analog tafenoquine against blood stages of P. vivax, contributing to its progression to clinical trials and eventual approval. Besides, the P. falciparum/Aotus model at GML has also played a pivotal role in exploring the biology, immunology, and pathogenesis of malaria and in the characterization of drug-resistant P. falciparum and P. vivax strains. This minireview offers a historical overview of the most significant contributions made by the Panamanian owl monkey (Aotus lemurinus lemurinus) to malaria chemotherapy research.

The stomatal response to vapor pressure deficit drives the apparent temperature response of photosynthesis in tropical forests.

As temperature rises, net carbon uptake in tropical forests decreases, but the underlying mechanisms are not well understood. High temperatures can limit photosynthesis directly, for example by reducing biochemical capacity, or indirectly through rising vapor pressure deficit (VPD) causing stomatal closure. To explore the independent effects of temperature and VPD on photosynthesis we analyzed photosynthesis data from the upper canopies of two tropical forests in Panama with Generalized Additive Models. Stomatal conductance and photosynthesis consistently decreased with increasing VPD, and statistically accounting for VPD increased the optimum temperature of photosynthesis (Topt) of trees from a VPD-confounded apparent Topt of c. 30-31°C to a VPD-independent Topt of c. 33-36°C, while for lianas no VPD-independent Topt was reached within the measured temperature range. Trees and lianas exhibited similar temperature and VPD responses in both forests, despite 1500 mm difference in mean annual rainfall. Over ecologically relevant temperature ranges, photosynthesis in tropical forests is largely limited by indirect effects of warming, through changes in VPD, not by direct warming effects of photosynthetic biochemistry. Failing to account for VPD when determining Topt misattributes the underlying causal mechanism and thereby hinders the advancement of mechanistic understanding of global warming effects on tropical forest carbon dynamics.

A medida que aumenta la temperatura, disminuye la absorción neta de carbono en los bosques tropicales, sin embargo, aún no se conocen bien los mecanismos que la subyacen. Las altas temperaturas pueden limitar la fotosíntesis directamente, por ejemplo, reduciendo la eficiencia de los procesos bioquímicos, pero también de forma indirecta a través del aumento del déficit de presión de vapor (DPV) que resulta en el cierre estomático. Para explorar los efectos independientes de la temperatura y el DPV en la fotosíntesis, analizamos datos de la absorción neta de carbono del dosel de dos bosques tropicales en Panamá utilizando modelos aditivos generalizados. La conductancia estomática y la fotosíntesis disminuyó consistentemente con el aumento de DPV, y considerando el DPV en modelas estadísticas, la temperatura óptima de la fotosíntesis (Topt) aumentó, de un Topt aparente influida por la DVP de c. 30­31°C a un Topt independiente del DPV de c. 33­36°C. Los árboles y las lianas mostraron respuestas similares a la temperatura y a la DVP en ambos bosques, a pesar de la diferencia de 1500 mm en la precipitación media anual. La fotosíntesis en los bosques tropicales está limitada en gran medida por los efectos indirectos del aumento de la temperatura, a través de cambios en el DPV y no por los efectos directos en los procesos bioquímicos. Si no se tiene en cuenta el DPV al determinar el Topt, se atribuye erróneamente el mecanismo causal subyacente y, por lo tanto, se obstaculiza el avance en la comprensión de los efectos del calentamiento global en la dinámica del carbono.

Scaling the high latitudes: evolution, diversification, and dispersal of Coryphella nudibranchs across the Northern Hemisphere.

Nudibranch molluscs Coryphella are widely distributed and species-rich gastropod group lacking fossil record and displaying a complex distribution across both Southern and Northern hemispheres. In this paper we provide a detailed review of the morphology, ecology, and distribution of Coryphella, estimation of divergence times between species, an ancestral area reconstruction, and a population analysis of widely distributed trans-Arctic species Coryphella verrucosa to investigate the evolution, phylogeographic patterns and reconstruct possible historical routes of oceanic dispersal. The inclusion of a larger sample size and five molecular markers has revealed a complex evolutionary history of Coryphella, shaped by transgression, vicariance, and dietary shifts, and overall driven by the pervasive effect of glacial cycles. We also revealed the presence of additional cryptic diversity, which suggests that further sampling may produce additional species in this group of nudibranchs. Tree calibration indicates the genus Coryphella originates in the middle Miocene in the Pacific Ocean and the early divergence within this group also occurred in the Pacific, specifically in different regions of the North Pacific. The ancestral area reconstruction inferred five independent instances of transgression from the Pacific Ocean to the Atlantic via different migration routes, including the Panamanian seaway and the Bering Strait. Among them, we identified three cases of successful transition to the Arctic waters from the North Pacific via the Bering Strait, associated with interglacial conditions of middle Pleistocene. Consequently, Pleistocene glacial cycles likely prompted pulses of boreal faunal elements to disperse southwards followed by range disjunction and temporary isolation of distant populations and resulting in allopatric speciation. Evidence from the population structure of contemporary trans-Arctic species suggests an occurrence of independent recolonization pathways of Arctic waters from both southernly and northernly refugia after the Last Glacial Maximum.

Wood trait preferences of Neotropical xylophagous beetles (Coleoptera: Cerambycidae).

Tree life history strategies are correlated with functional plant traits, such as wood density, moisture content, bark thickness, and nitrogen content; these traits affect the nutrients available to xylophagous insects. Cerambycid beetles feed on substrates that vary in these traits, but little is known about how they affect community composition. The goal of this project is to explore the community composition of two cerambycid subfamilies (Cerambycinae and Lamiinae) according to the wood traits in the wood they eat. In a salvage project conducted adjacent to the Panama Canal, trees were felled and exposed to Cerambycidae for oviposition. Disks from branches of differing thickness from the same plant individuals were used to calculate wood density, moisture content, and bark thickness in the field; nitrogen data were acquired offsite. Thick and thin branches tended to differ in wood trait values; therefore, data were analyzed separately in subsequent analyses. In thin branches, cerambycid abundance and species richness were higher in samples with less dense, moister wood, and thicker bark. Thick branches showed similar trends, but the wood traits accounted for little variability in beetle abundance or species richness. There were no significant regressions between beetle data and nitrogen. Cerambycines emerged more slowly, and from denser, drier wood, than lamiines. Cerambycines might be more drought-tolerant than lamiines, and therefore more resistant to the longer, more severe dry seasons that are predicted to occur due to climate change.

La historia de vida de los árboles se correlaciona con los rasgos funcionales de la planta, como la densidad de la madera, el contenido de humedad, el grosor de la corteza, y el contenido de nitrógeno; estos rasgos afectan los nutrientes disponibles para los insectos xilófagos. Los escarabajos cerambícidos se alimentan de sustratos que varían en estos rasgos, pero se sabe poco sobre cómo afectan la composición de la comunidad. El objetivo de este proyecto es explorarla composición comunitaria de dos subfamilias de cerambícidos (Cerambycinae y Lamiinae) según las características de la madera que consumen. En un proyecto de salvamento realizado junto al Canal de Panamá, se talaron árboles y se expusieron a Cerambycidae para la oviposición. Se usaron discos de ramas de diferente grosor de las mismas plantas para calcular la densidad de la madera, el contenido de humedad y el grosor de la corteza en el campo; los datos de nitrógeno fueron adquiridos fuera del sitio. Las ramas gruesas y delgadas tendieron a diferir en los valores de las características de la madera; por lo tanto, los datos se analizaron por separado en análisis posteriores. En ramas delgadas, la abundancia de cerambícidos y la riqueza de especies fueron mayores en muestras con madera menos densa, más húmeda y con corteza más gruesa. Las ramas gruesas mostraron tendencias similares, pero las características de la madera explicaron poca variabilidad en la abundancia de escarabajos o la riqueza de especies. No hubo regresión significativas entre los datos del escarabajo y el nitrógeno. Cerambycines surgieron más lentamente y de maderas más densas y secas que los lamiines. Cerambycines podrían ser más tolerantes a la sequía que lamiines y, por lo tanto, más resistentes a las estaciones secas más largas y severas que se prevé que ocurran debido al cambio climático.

Colubrid snake envenomation: Erythrolamprus bizona "false coral" snakebite - clinical aspects and importance of identifying mimics.

Colubrids represent a diverse group of snakes historically regarded as harmless. With over 300 genera, the Colubridae family is the largest, encompassing approximately two-thirds of extant snake species. We describe a case of an 18-year-old male who suffered a colubrid snakebite from Erythrolamprus bizona, commonly known as the double-stranded coral snake mimic or false coral snake, which he misidentified as Lampropeltis sp., a fangless colubrid snake. Patient experienced localized erythema and edema, which later spread to the entire left hand along with moderate pain. Laboratory tests revealed leukocytosis and elevated creatine kinase. Symptoms resolved one week later. This case highlights the public health significance of ophidian accidents due to apparently "non-venomous snakes" or low-risk snakes such as the opisthoglyphous colubrid E. bizona. It also underscores the need to correctly identify and differentiate these snakes from other harmless colubrids, particularly double-stranded coral snake mimics in areas of geographic overlap and avoid their manipulation if uncertain of their taxonomic status.

Effect of Education on Adherence to Recommended Prenatal Practices among Indigenous Ngäbe-Buglé Communities of Panama.

Background and Objectives: The primary objective of this study was to assess the adherence of Ngäbe-Buglé women to WHO-recommended prenatal practices. The secondary objective was to compare adherence levels between women who received prenatal education from official medical providers and those educated through traditional or community-based sources within Ngäbe-Buglé communities. Materials and Methods: An eight-question survey was verbally administered to 137 Ngäbe-Buglé women at clinics set up by the non-profit NGO Floating Doctors in eight communities. A two-sided Fisher's Exact test with a p = 0.05 was used to compare the results of mothers who received prenatal education from evidence-based sources to other groups. Results: Out of the 137 surveyed women, 65 reported taking prenatal vitamins, 21 had prenatal check-ups, 136 avoided alcohol, 31 increased caloric intake, and 102 maintained their activity levels. Significant differences were observed in prenatal vitamin adherence between those educated by official sources versus unofficial sources (p = 0.0029) and official sources compared to those with no prenatal education (p < 0.0001). The difference was also significant for education from an unofficial source versus no education (p = 0.0056). However, no significant differences were found in other prenatal practices based on education sources. Conclusions: Our findings highlight deficiencies in both prenatal education and adherence to recommended practices among Ngäbe-Buglé women. Prenatal education significantly improved adherence to taking prenatal vitamins, suggesting its effectiveness as an intervention. Future interventions should prioritize culturally competent prenatal education and address barriers to accessing prenatal healthcare in Ngäbe-Buglé communities.

Genome Analysis of Triploid Hybrid Leishmania Parasite from the Neotropics.

We discovered a hybrid Leishmania parasite in Costa Rica that is genetically similar to hybrids from Panama. Genome analyses demonstrated the hybrid is triploid and identified L. braziliensis and L. guyanensis-related strains as parents. Our findings highlight the existence of poorly sampled Leishmania (Viannia) variants infectious to humans.

Human Lobomycosis Caused by Paracoccidioides (Lacazia) loboi, Panama, 2022.

We report a patient from Panama who had lobomycosis caused by Paracoccidioides (Lacazia) loboi. We used combined clinical-epidemiologic and phylogenetic data, including a new gene sequence dataset on this fungus in Panama, for analysis. Findings contribute useful insights to limited knowledge of this fungal infection in the Mesoamerican Biologic Corridor.

Detection of Leishmania RNA Virus 1 in Leishmania (Viannia) panamensis Isolates, Panama.

We detected Leishmania RNA virus 1 (LRV1) in 11 isolates of Leishmania (Viannia) panamensis collected during 2014-2019 from patients from different geographic areas in Panama. The distribution suggested a spread of LRV1 in L. (V.) panamensis parasites. We found no association between LRV1 and an increase in clinical pathology.

Selection and Admixture in a Polytypic Aposematic Frog.

AbstractPhenotypic differentiation within polytypic species is often attributed to selection, particularly when selection might be acting on a trait that serves as a signal for predator avoidance and mate choice. We evaluated this hypothesis by examining phenotypic and genotypic clines between populations of the strawberry poison frog Oophaga pumilio, a polytypic species that exhibits aposematic color pattern variation that is thought to be subject to both natural and sexual selection. Our aim was to assess the extent of admixture and to estimate the strength of selection acting on coloration across a region of Panama where monomorphic populations of distinctly colored frogs are separated by polymorphic populations containing both color variants alongside intermediately colored individuals. We detected sharp clinal transitions across the study region, which is an expected outcome of strong selection, but we also detected evidence of widespread admixture, even at sites far from the phenotypic transition zone. Additionally, genotypic and phenotypic clines were neither concordant nor coincident, and with one exception, selection coefficients estimated from cline attributes were small. These results suggest that strong selection is not required for the maintenance of phenotypic divergence within polytypic species, challenging the long-standing notion that strong selection is implicit in the evolution of warning signals.

Shifts in the coral microbiome in response to in situ experimental deoxygenation.

IMPORTANCE: Marine hypoxia is a threat for corals but has remained understudied in tropical regions where coral reefs are abundant. Though microbial symbioses can alleviate the effects of ecological stress, we do not yet understand the taxonomic or functional response of the coral microbiome to hypoxia. In this study, we experimentally lowered oxygen levels around Siderastrea siderea and Agaricia lamarcki colonies in situ to observe changes in the coral microbiome in response to deoxygenation. Our results show that hypoxia triggers a stochastic change of the microbiome overall, with some bacterial families changing deterministically after just 48 hours of exposure. These families represent an increase in anaerobic and opportunistic taxa in the microbiomes of both coral species. Thus, marine deoxygenation destabilizes the coral microbiome and increases bacterial opportunism. This work provides novel and fundamental knowledge of the microbial response in coral during hypoxia and may provide insight into holobiont function during stress.

Lianas increase lightning-caused disturbance severity in a tropical forest.

Lightning is an important agent of plant mortality and disturbance in forests. Lightning-caused disturbance is highly variable in terms of its area of effect and disturbance severity (i.e. tree damage and death), but we do not know how this variation is influenced by forest structure and plant composition. We used a novel lightning detection system to quantify how lianas influenced the severity and spatial extent (i.e. area) of lightning disturbance using 78 lightning strikes in central Panama. The local density of lianas (measured as liana basal area) was positively associated with the number of trees killed and damaged by lightning, and patterns of plant damage indicated that this occurred because lianas facilitated more electrical connections from large to small trees. Liana presence, however, did not increase the area of the disturbance. Thus, lianas increased the severity of lightning disturbance by facilitating damage to additional trees without influencing the footprint of the disturbance. These findings indicate that lianas spread electricity to damage and kill understory trees that otherwise would survive a strike. As liana abundance increases in tropical forests, their negative effects on tree survival with respect to the severity of lightning-related tree damage and death are likely to increase.

Unraveling the complex phylogeographic history of freshwater fishes in Lower Central America: A study of the electric fish Brachyhypopomus occidentalis.

Lower Central America (LCA) has a complex biogeographic history shaped by the rise of the Isthmus of Panama and the global climatic oscillations of the Pleistocene. These events have been crucial in structuring biodiversity in LCA, but their consequences for the distribution and partitions of genetic diversity across the region remain to be elucidated. We combined complete mitochondrial genomes and nuclear ultraconserved elements (UCEs) to study the phylogeographic history and population genetic structure of the electric fish Brachyhypopomus occidentalis in LCA. Our results are consistent with the known phylogeographic history of B. occidentalis in LCA, but we update this history in several important ways that help illuminate the phylogeographic history of freshwater fishes in the region. We provide: i) support for three waves of colonization, two of which occurred prior to the final closure of the Panama Isthmus; ii) a more precise understanding of each colonization event, with evidence for a larger footprint of the first event, as well as genetic exchange across the continental divide in subsequent events; and iii) evidence for high levels of previously unrecognized population genetic structure across LCA. This updated model of colonization and diversification of B. occidentalis consists of three waves of dispersal and colonization, which triggered the evolution of geographic breaks in both nuclear and mitochondrial genomes across LCA. These processes are tightly linked to the dynamic uplift of the Isthmus, recent volcanic activity in the region, and the sea-level oscillations of the Pleistocene. These results improve previous phylogeographic inferences regarding the distribution and diversification of freshwater fishes in LCA, and generate testable hypotheses to guide future research exploring the factors shaping biodiversity in the region.

Detection of parechovirus A in respiratory, gastrointestinal, and neurological clinical samples of pediatric patients from Panama (2014-2015).

Parechovirus A (PeV-A, Parechovirus, Picornaviridae) are human pathogens associated with mild to severe gastrointestinal and respiratory diseases in young children. While several studies have investigated the association of PeV-A with human disease, little is known about its epidemiology or detection in Latin America. Between the years 2014 and 2015, a total of 200 samples were collected from Panamanian pediatric patients aged < 16 years old exhibiting symptoms associated with respiratory (n = 64), gastrointestinal (n = 68), or neurological (n = 68) diseases. These samples were gathered from patients who had previously received negative diagnoses for the main respiratory viruses, rotavirus, and neurological viruses like herpes virus, enterovirus, and cytomegalovirus. The presence of PeV-A was analyzed by real time RT-PCR.Eight positive PeV-A infections (4.0%, 95% CI: 1.7 to 7.7) were detected: two in respiratory samples (3.0%, 95% CI: 0.3 to 10.8), five in gastrointestinal samples (7.3%, 95% CI: 2.4 to 16.3), and one in cerebrospinal fluid (1.5%, 95% CI: 1.4 to 7.9). The study provides evidence of PeV-A circulation in Panama and the data collectively, remarked on the importance of considering PeV-A in the Panamanian pediatric diagnostic landscape, especially when conventional testing for more common viruses yields negative results.

Bridging two oceans: small toothed cetaceans (Odontoceti) from the Late Miocene Chagres Formation, eastern Caribbean (Colon, Panama).

Fossil cetaceans are often found in Miocene marine outcrops across the globe. However, because this record is not homogeneous, the dissimilar increase in occurrences, along with the sampling bias has created regions with extensive records and others with great scarcity. Among these, the Caribbean has remained enigmatic due to the lack of well-preserved cetacean fossils. Here, we report new Caribbean fossil cetaceans from the Upper Miocene Chagres Formation exposed along Piña beach, Eastern Panama, including a scaphokogiine kogiid, an Acrophyseter-like physeteroid and the phocoenid Piscolithax. Along with previous records of the iniid Isthminia panamensis and the kogiine Nanokogia isthmia, the Chagres cetacean fauna shows some similarities with other Late Miocene cetacean communities such as the Californias in the North Pacific, although their closest affinities lie with the eastern South Pacific Pisco Formation, Peru. Such findings indicate that though deep and intermediate Caribbean-Pacific water interchange was reduced by the Middle Miocene due to the shallowing of the Central American Seaway, shallow waters marine connection that persisted until the Pliocene might have facilitated the dispersal of coastal species across both sides of the Isthmus.

Cyberbullying victimization and suicidal ideation among in-school adolescents in three countries: implications for prevention and intervention.

BACKGROUND: Countries in South and Central America and the Caribbean are among the countries with the highest adolescent cyberbullying crimes. However, empirical evidence about the effect of cyberbullying victimization on suicidal ideation among in-school adolescents in these countries remains limited. The present study examined the association between cyberbullying victimization and suicidal ideation among in-school adolescents in Argentina, Panama, St Vincent, and the Grenadines. METHODS: A representative cross-sectional data from 51,405 in-school adolescents was used. Hierarchical logistic regression analysis was used to estimate the association between cyberbulling victimization and suicidal ideation. RESULTS: Overall, 20% and 21.1% of the adolescents reported cyberbullying victimization and suicidal ideation, respectively in the past year before the survey. Suicidal ideation was higher among adolescents who experienced cyberbullying victimization (38.4%) than those who did not experience cyberbullying victimization (16.6%). Significantly higher odds of suicidal ideation were found among adolescents who had experienced cyberbullying victimization than those who had not experienced cyberbullying victimization [aOR = 1.88, 95% CI: 1.77-1.98]. CONCLUSION: This finding calls for developing and implementing evidence-based programs and practices by school authorities and other relevant stakeholders to reduce cyberbullying victimization among adolescents in this digital age. Protective factors such as parental support and peer support should be encouraged.

Global Initiative for Childhood Cancer: progress and challenges in Panama.

Despite being classified as a high-income country, Panama still faces challenges in providing care for children and adolescents with cancer. Annually, 170 new cases of childhood cancer are diagnosed in Panama, and the survival rate is around 60%. To improve this, the establishment of a Pediatric Cancer Commission comprised of healthcare professionals and nonprofit organizations has been a critical step toward the objectives outlined in the CureAll framework of the World Health Organization Global Initiative for Childhood Cancer (GICC). To improve childhood cancer care in Panama, a workshop for cancer in children and adolescents was conducted with the support of St. Jude Children's Research Hospital, Children's Hospital Colorado, the Ministry of Health of Panama, and the Pan American Health Organization. The commissions established were on: Nursing, Palliative Care, Psychosocial, Hospital Registry, Early Diagnosis, and Health Services. Each commission has a specific project to be implemented in the period 2021-2029 to continue the progress toward improving childhood cancer care. Since the start of implementation of the GICC in Panama, important achievements have included the launch in 2021 of the Guide for the Diagnosis of Cancer in Children and Adolescents, and training programs for primary care health personnel. Through these programs, more than 1 000 health professionals have been trained on diagnosis of cancer in childhood and adolescence. Challenges remain, such as access to quality care, and it is essential to continue efforts to improve childhood cancer care.

Pese a estar clasificado como un país de ingresos altos, Panamá aún debe hacer frente a distintos desafíos relacionados con la atención a la población infantil y adolescente con cáncer. Cada año, en Panamá se diagnostican 170 casos nuevos de cáncer pediátrico, con una tasa de supervivencia en torno al 60%. Para mejorar esta situación, la creación de una Comisión de Cáncer Pediátrico, conformada por profesionales de la salud y organizaciones sin fines de lucro, constituye un paso fundamental para lograr los objetivos planteados en el marco CureAll de la Iniciativa Mundial contra el Cáncer Infantil (GICC, por su sigla en inglés) de la Organización Mundial de la Salud.A fin de mejorar la atención de los pacientes pediátricos con cáncer en Panamá, se realizó un taller sobre el cáncer en la población infantil y adolescente. El evento contó con el apoyo del St. Jude Children's Research Hospital, el Children's Hospital Colorado, el Ministerio de Salud de Panamá y la Organización Panamericana de la Salud. Se crearon comisiones sobre enfermería, cuidados paliativos, aspectos psicosociales, registros hospitalarios, diagnóstico temprano y servicios de salud. Cada comisión está a cargo de un proyecto específico, que deberá ponerse en práctica en el período 2021-2029 para proseguir con los avances encaminados a mejorar la atención oncológica pediátrica.Desde que se inició el proceso de aplicación de la Iniciativa Mundial contra el Cáncer Infantil en Panamá se han obtenido logros importantes, como la publicación de la Guía para la detección temprana y atención oportuna de la sospecha del cáncer en niños y adolescentes 2021 y los programas de capacitación para el personal de atención primaria de salud. Estos programas han permitido capacitar a más de 1 000 profesionales de la salud en materia de diagnóstico del cáncer en la niñez y la adolescencia. Subsisten algunos desafíos, como el acceso a una atención de calidad, y es crucial proseguir con las medidas tendientes a mejorar la atención oncológica de los pacientes pediátricos.

Apesar de ser classificado como um país de alta renda, o Panamá enfrenta desafios para oferecer atendimento a crianças e adolescentes com câncer. Anualmente, são diagnosticados 170 casos novos de câncer infantil no Panamá, e a taxa de sobrevida gira em torno de 60%. Para melhorar essa situação, a criação de uma Comissão de Câncer Pediátrico, composta por profissionais de saúde e organizações sem fins lucrativos, foi uma etapa fundamental para atingir os objetivos delineados na estratégia CureAll da Iniciativa Global para o Câncer Infantil (GICC) da Organização Mundial da Saúde.Para melhorar o atendimento aos pacientes com câncer infantil no Panamá, realizou-se uma oficina sobre câncer em crianças e adolescentes, com o apoio do St. Jude Children's Research Hospital, do Children's Hospital Colorado, do Ministério da Saúde do Panamá e da Organização Pan-Americana da Saúde. As comissões estabelecidas foram as seguintes: Enfermagem, Cuidados Paliativos, Aspectos Psicossociais, Registro Hospitalar, Diagnóstico Precoce e Serviços de Saúde. Cada comissão tem um projeto específico a ser implementado no período de 2021 a 2029 a fim de continuar avançando na melhoria do atendimento a pacientes com câncer infantil.As realizações mais importantes alcançadas desde o início da implementação da GICC no Panamá incluem o lançamento do Guia para o Diagnóstico de Câncer em Crianças e Adolescentes em 2021 e os programas de capacitação para profissionais de saúde da atenção primária. Por meio desses programas, mais de mil profissionais de saúde receberam capacitação no diagnóstico de câncer na infância e adolescência. Ainda existem desafios, como o acesso a atendimento de qualidade; portanto, é essencial continuar os esforços para melhorar o atendimento de pacientes com câncer infantil.