Latin American Federation Research Articles

LAFeBS, alive, kicking, and growing: the story continues….

This Commentary describes a call for contributions to an upcoming Special Issue (SI) of Biophysical Reviews on the Latin American Federation of Biophysical Societies (LAFeBS). It details the reason for the SI, the SI Editors' contact information, and the relevant submission details for those wishing to contribute a review manuscript.

Clinical Practice Guidelines of the Latin American Federation of Endocrinology for the use of vitamin D in the maintenance of bone health: recommendations for the Latin American context

IntroductionThese guidelines aim to provide evidence-based recommendations for the supplementation of Vitamin D in maintaining bone health. An unmet need persists in Latin American regarding the availability of clinical and real-world data for rationalizing the use of vitamin D supplementation. The objective of these guidelines is to establish clear and practical recommendations for healthcare practitioners from Latin American countries to address Vitamin D insufficiency in clinical practice.MethodsThe guidelines were developed according to the GRADE-ADOLOPMENT methodology for the adaptation or adoption of CPGs or evidence-based recommendations. A search for high quality CPGs was complemented through a comprehensive review of recent literature, including randomized controlled trials, observational studies, and systematic reviews evaluating the effects of Vitamin D supplementation on bone health. The evidence to decision framework proposed by the GRADE Working Group was implemented by a panel of experts in endocrinology, bone health, and clinical research.ResultsThe guidelines recommend Vitamin D supplementation for individuals aged 18 and above, considering various populations, including healthy adults, individuals with osteopenia, osteoporosis patients, and institutionalized older adults. These recommendations offer dosing regimens depending on an individualized treatment plan, and monitoring intervals of serum 25-hydroxyvitamin D levels and adjustments based on individual results.DiscussionThe guidelines highlight the role of Vitamin D in bone health and propose a standardized approach for healthcare practitioners to address Vitamin D insufficiency across Latin America. The panel underscored the necessity for generating local data and stressed the importance of considering regional geography, social dynamics, and cultural specificities when implementing these guidelines.

Pain as a disease in the new International Classification of Diseases (ICD-11): Latin American expert consensus.

Aims: Pain diagnoses in the 10th version of the International Classification of Diseases (ICD-10) did not adequately support the current management of pain. Therefore, we aimed to review the new 11th revision (ICD-11) in order to analyze its usefulness for the management, coding, research and education of chronic pain from a Latin American perspective. Methods: The Latin American Federation of Associations for the Study of Pain convened a meeting of pain experts in Lima, Peru. Pain specialists from 14 Latin American countries attended the consensus meeting. Results: In ICD-11, chronic pain is defined as pain that persists or recurs longer than 3 months and is subdivided into seven categories: chronic primary pain and six types of chronic secondary pain. Chronic primary pain is now considered a disease in itself, and not a mere symptom of an underlying disease. Conclusion: The novel definition and classification of chronic pain in ICD-11 is helpful for better medical care, research and health statistics. ICD-11 will improve chronic pain management in Latin American countries, for both the pain specialist and the primary care physician.

Burnout in Neurosurgery

Burnout is a pervasive psychosocial syndrome that manifests as a chronic response to interpersonal stressors encountered in the occupational setting. Neurosurgeons exhibit a high prevalence rate of burnout, ranging from 33% to 67%. The primary objective of this study is to examine the prevalence of Burnout syndrome within the neurosurgical community and identify the contributing factors. A prospective observational study was conducted utilizing an anonymous survey format, incorporating the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) questionnaire. Additional inquiries were made regarding demographic characteristics, occupational factors, lifestyle choices, and the Hospital Anxiety and Depression Scale (HADS) questionnaire. The survey was disseminated between March 23rd, 2023, and April 4th, 2023, utilizing the email registries of the Spanish Society of Neurosurgery (SENEC) and the Latin American Federation of Neurosurgical Societies (FLANC). Descriptive analysis was performed, comparing responses between participants with and without burnout syndrome using cross-tabulation and the Chi-square test to assess the presence of dependency. A total of 282 neurosurgeons completed the survey. The sample comprised 30.1% females and 69.9% males, with a median age within the 30-40 range. Among the surveyed neurosurgeons, 66.7% exhibited a prevalence of burnout, while 23.4% met the criteria for defined burnout. Significantly higher rates of burnout syndrome were observed among residents, specifically those in their fifth year of residency, as well as those whose departments perform a moderate range of surgeries (500-1000), participating in on-call duties, lacking regular physical exercise (at least twice a week), engaging infrequently in social activities with friends, lacking extracurricular hobbies, and obtaining scores exceeding 10 points in any of the HADS subscales. Burnout syndrome affects nearly a quarter of the neurosurgical specialists included in this study. Moreover, a distinct profile associated with defined burnout among neurosurgeons emerges, encompassing characteristics such as being a fifth-year resident, belongs to departments with a moderate number of surgeries, with few extra-occupational distractions and exhibiting symptoms of depression or anxiety.

The Latin American Federation of Biophysical Societies (LAFeBS).

The Latin American Federation of Biophysical Societies (LAFeBS) was constituted in 2007 in Montevideo, Uruguay, as a collaborative effort among the Biophysical Societies of Argentina, Brazil, and Uruguay. This visionary collaboration foresees the future of Biophysics in Latin America. In this commentary, we will briefly review the history of LAFeBS, the remarkable path undertaken since its foundation 16years ago, and its key initiative, the Latin American Postgraduate Program in Biophysics (POSLATAM).

Early repeat resection for residual glioblastoma: decision-making among an international cohort of neurosurgeons.

The importance of extent of resection (EOR) in glioblastoma (GBM) has been thoroughly demonstrated. However, few studies have explored the practices and benefits of early repeat resection (ERR) when residual tumor deemed resectable is unintentionally left after an initial resection, and the survival benefit of ERR is still unknown. Herein, the authors aimed to internationally survey current practices regarding ERR and to analyze differences based on geographic location and practice setting. The authors distributed a survey to the American Association of Neurological Surgeons and Congress of Neurological Surgeons Tumor Section, Society of British Neurological Surgeons, European Association of Neurosurgical Society, and Latin American Federation of Neurosurgical Societies. Neurosurgeons responded to questions about their training, practice setting, and current ERR practices. They also reported the EOR threshold below which they would pursue ERR and their likelihood of performing ERR using a Likert scale of 1-5 (5 being the most likely) in two sets of 5 cases, the first set for a patient's initial hospitalization and the second for a referred patient who had undergone resection elsewhere. The resection likelihood index for each respondent was calculated as the mean Likert score across all cases. Overall, 180 neurosurgeons from 25 countries responded to the survey. Neurosurgeons performed ERRs very rarely in their practices (< 1% of all GBM cases), with an EOR threshold of 80.2% (75%-95%). When presented with 10 cases, the case context (initial hospitalization vs referred patient) did not significantly change the surgeon ERR likelihood, although ERR likelihood did vary significantly on the basis of tumor location (p < 0.0001). Latin American neurosurgeons were more likely to pursue ERR in the provided cases. Neurosurgeons were more likely to pursue ERR when the tumor was MGMT methylated versus unmethylated, with a resection likelihood index of 3.78 and 3.21, respectively (p = 0.004); however, there was no significant difference between IDH mutant and IDH wild-type tumors. Results of this survey reveal current practices regarding ERR, but they also demonstrate the variability in how neurosurgeons approach ERR. Standardized guidelines based on future studies incorporating tumor molecular characteristics are needed to guide neurosurgeons in their decision-making on this complicated issue.

Biophysical Reviews special issue call: LAFeBS-highlighting biophysics in Latin America.

This Commentary describes a call for contributions to an upcoming Special Issue (SI) of Biophysical Reviews on the Latin American Federation of Biophysical Societies (LAFeBS). It details the reason for the SI, the SI Editors contact information and the relevant submission details for those wishing to contribute.

Who is a legitimate actor under international human rights law? A story about women’s mobilization against enforced disappearances

This article inquires about who is deemed a legitimate actor by international human rights law. It offers an analysis of the role of the Latin American Federation of Associations of Relatives of Disappeared Detainees (FEDEFAM) as a women-led leading organization in creating the International Convention for the Protection of All Persons from Enforced Disappearances (CED) in 2007. The article shows that the wives and daughters of the disappeared played a determinant role in their struggle against enforced disappearances, undermining the view of the Working Group on Enforced Disappearances (WGEID), which did not recognize their struggle in its early reports. The article also critiques how international human rights law uses colonial and patriarchal power to produce and exclude subjects. Finally, it concludes by offering an analysis of the affective dimensions of FEDEFAM’s struggle as an opportunity to rethink human rights grassroots women-led mobilizations as a place for resistance against dominant narratives in international human rights law.

Clinical nutrition and human rights: an international position paper

Worldwide Societies for Clinical Nutrition have launched a promotional campaign that advocates for all patients to have access to food and evidence-based artificially administered nutrition and hydration (AANH). The campaign is supported by the simultaneous publication of a major position paper in, Clinical Nutrition and Nutrition in Clinical Practice, the official journals of the European and North American professional societies. The working group of experts in human rights and clinical nutrition, includes representatives of the American Society for Enteral and Parenteral Nutrition (ASPEN), The European Society for Clinical Nutrition and Metabolism (ESPEN), Latin American Federation of Nutritional Therapy, Clinical Nutrition and Metabolism (FELANPE), Parenteral and Enteral Nutrition Society of Asia (PENSA) and the West African Society of Parenteral and Enteral Nutrition (WASPEN).

In Memoriam: Jorge Cervantes Castro, MD, Honorary FACS (1938–2021)

Jorge Cervantes Castro, MD, FACS (Hon.2006) passed away on May 28, 2021, at the age of 83years. He graduated from medical school at the National Autonomous Mexican University (UNAM) and did his residency in general and vascular surgery at Georgetown University in Washington D.C. After completing his surgical training, he returned to Mexico City and established his practice at the American British Cowdray Medical Center (ABC Hospital). He was a professor of surgery for hundreds of surgical residents for over 50 years, author of over 240 surgical papers and 52 book chapters, and member of the editorial board of seven medical journals. He is the author of four surgical training books, one on "Iatrogenia in surgery" and the others on vanguard techniques for laparoscopic surgery. For his Juris Doctor degree obtained from UNAM in 2016, his thesis was on the "Legal implications of the professional title of medical surgeon" in which he emphasizes the legal need to change the professional degree conferred to Mexican medical graduates. A global ambassador of surgery, he was an active member of over 30 surgical societies, including the American College of Surgeons (ACS), the International Federation of Societies of Endoscopic Surgeons (IFSES), the International Society of Surgery (ISS; Hon.2009), and president of the Mexican chapter of the Latin American Federation of Surgery (FELAC), of which he also became honorary fellow. Among other accomplishments, he was one of the founding members of the Mexican Society of General Surgery, president of the Mexican Board of Surgery, distinguished member of the Mexican Academy of Surgery, and member of the editorial board of the World Journal of Surgery (1995-2004). He is survived by his one true and lifelong love Lucero, his wife of 57+ years, and by his children Jorge, Lucero, Arturo, Ignacio, and Pablo, 13 grandchildren, and five great-grandchildren.

Position statement of the Latin American Federation of Endocrinology on osteoporosis

Position statement of the Latin American Federation of Endocrinology on osteoporosis

Editorial introductions.

Editorial introductions.

P–471 Preconception and infertility care across South America: availability of policy, guidelines, recommendations and services

Abstract Study question What are the available preconception care policies, guidelines, recommendations and services as well as infertility care in South America ? Summary answer Preconception recommendations offered by both governament and medical societies in South America were fragmented and inconsistent and public fertility care is available in seven countries. What is known already Promoting preconception health can potentially improve women’s health and pregnancy outcomes. Evidence-based interventions exist to reduce many maternal behaviors and chronic conditions that are associated with adverse pregnancy outcomes such as tobacco use, alcohol use, inadequate folic acid intake, obesity, hypertension, and diabetes. Paternal factors are also influence pregnancy outcomes but male preconcepction health has received little attention so far and he focus remains on women. Study design, size, duration Cross-sectional evaluation including ann electronic search and investigation of preconception policy, guidelines, recommendations and services available to healthcare professionals and the general public in south America (N = 11 countries): Argentina, Bolívia, Brasil, Chile, Colômbia, Ecuador, , Paraguay, Peru, Suriname, Uruguay and Venezuela) that took place in June 2020. No ethical approval was obtained as we used only public avalialble online information. Participants/materials, setting, methods Eleven South American countries) were included Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, , Paraguay, Peru, Suriname, Uruguay and Venezuela.we searched Google using advanced search setup for each country with the following words: Preconception care; Pre-pregnancy care; Before pregnancy; Conception; Pregnancy planning; Preconceptual and variations and Policy; Guidelines, Recommendations and services. Data from the Latin American Registry (REDLARA, 2017) and the Latin American Federation of Societies of Obstetrics and Gynecology (FLASOG) was also obtained . Main results and the role of chance Government preconcepction care recommendations were available in 10 countries and 11 had family planning guidelines. Seven countries offered either public clinics or financial aid for infertile couples. According to REDLARA 2017 report there are 122 registered centers in South America but the region host much more. The Brazilian registry shows 154 IVF clinics in 2018. Although most countries offered guidance on major issues including folic acid supplementation (n = 10), nutrition (n = 10), Vaccination (n = 11), alcohol consumption (n = 11), smoking (n = 10), relevant health topics such physical activity (n = 7) and obesity (n = 7) were left out in 58,3% of the countries. Medical societies provided guidelines on preconcpection care in 7 countries and for other health issues: folic acid supplementation (n = 5), nutrition (n = 5), Vaccination (n = 6), alcohol consumption (n = 4), smoking (n = 4), physical activity (n = 4)and obesity (n = 2). When male preconception care was considered, only two countries have public guidelines whereas no medical society provided specific recommendations for men. Sexually transmitted diseases (STD) was another topic of interest for both public (n = 10) and medical societies (n = 4). STD guidelines were heterogenous and focused more on treatment rather than prevention. FLASOG however displayed guidelines for peconception care and STD prevention. Limitations, reasons for caution The search was performed only in Google as it is the most opular search engine. We did not include other search pages asuch as Yahoo and limited our search to the first 3 pages for each search term as people rarely examine more thatn the first there pages. Wider implications of the findings: Current reccomendations are heterogeneous, fragmented and inconsitent and there is a lack of interest on male reproductive health y. Public fertility care is only available in 7 countries. Collaborative research among countries is necessary so as to develop evidence-based guidelines for preconcepction and fertility care for both men and women. Trial registration number not-applicable

Diagnostic performance of two different maternal near-miss approaches in a High Obstetric Risk Unit

ABSTRACT Maternal near-miss (MNM) is a maternal quality care indicator. The World Health Organization (WHO) defines it as a state in which a woman nearly dies but survives due to a complication during pregnancy, birth, or puerperium. The Latin American Federation of Obstetrics and Gynecology (FLASOG) and the Colombian National Health Institute (INS) established recommendations for the event’s epidemiological surveillance; nonetheless, the operational definitions of the cases are different. This retrospective study examined the approaches of FLASOG and INS versus the WHO approach (gold standard) for the assessment of MNM in a high obstetric risk unit. Patients admitted with at least one criterion of the WHO, FLASOG, or INS approach for the definition of MNM from March 2016 to March 2017 were included. Sensitivity, specificity, positive and negative predictive value (PPV, NPV) were evaluated, as well as the Receiver Operating Characteristics (ROC) curve of the FLASOG and INS. MNM classification compared to WHO system as reference. The results highlight that the WHO classification establishes very high boundaries for some of the diagnostic criteria and the lack of standardization of the MNM criteria among the different proposals in Latin America hinders the applicability in Colombia and other countries with a similar situation.

Diagnostic, treatment, and follow-up of osteoporosis-position statement of the Latin American Federation of Endocrinology.

There is a gap in the understanding of osteoporosis in Latin America. The objective of this work is to state the position of the Latin American Federation of Endocrinology on osteoporosis care in postmenopausal women to better bridge this gap. An experts' panel was formed comprising of 11 endocrinologists from 9 countries. A data search was conducted with a conceptual approach and data selection was based on the hierarchy of the EBHC pyramid. Unpublished data was considered for local epidemiological data and expert opinion for the identification of barriers to healthcare. An expert consensus based on the Delphi methodology was carried out. Experts were asked to respond on a 5-point Likert Scale to two provided answers to guiding questions. Consensus was agreed on the answer for the questions with the higher median on the Likert scale and synthetized on 16 statements covering the definition of osteoporosis, diagnostic approach, treatment options, and follow-up. Besides clinical topics, unmet needs in osteoporosis were identified in relation to local epidemiological data, barriers to treatment, and misclassification of programs within health systems. Through a process based on recognized methodological tools, FELAEN's position on osteoporosis was developed. This made it possible to state an optimum scenario for the care of the disease and helped to identify knowledge gaps. There is great variability in the approach to osteoporosis in Latin America and barriers in all the stages of healthcare persist.

Analysis of Extreme Maternal Morbidity at the Women´s Hospital of Aguascalientes.

BackgroundExtreme maternal morbidity is defined as "events that potentially threaten the life of a pregnant woman during pregnancy, childbirth or the puerperium, but that due to a medical intervention the patient does not die", and this is an indicator of health quality at the hospital and demographic level.ObjectiveThe aim of this study was to determine the prevalence of extreme maternal morbidity in the Women´s Hospital of Aguascalientes, Mexico.Material and methodsA retrospective cross-sectional study was conducted under the criteria of the World Health Organization and the Latin American Federation of Obstetrics and Gynecology Societies for the definition of extreme maternal morbidity to determine the prevalence of near miss morbidity, between January 1 and December 31, 2016.ResultsWe found 165 cases of extreme maternal morbidity; no maternal death was registered during the study year. The extreme maternal morbidity rate was 0.016 and 16.69 per 1000 live births; the ratio of extreme maternal morbidity cases / obstetric admissions was 11.07. The prevalence of extreme maternal morbidity was 1.6%. The main causes of extreme maternal morbidity were hypertensive disorders (57%), obstetric hemorrhage (29%), sepsis (1%) and other (13%).ConclusionExtreme maternal morbidity in our institution had a similar prevalence to that reported in other countries and was mainly caused by hypertensive disorders.

Postural ergonomics and work-related musculoskeletal disorders in neurosurgery: lessons from an international survey

BackgroundWork-related musculoskeletal disorders (WMSDs) affect a significant percentage of the neurosurgical workforce. The aim of the current questionnaire-based study was to examine the prevalence of WMSDs amongst neurosurgeons, identify risk factors, and study the views of neurosurgeons regarding ergonomics.MethodsFrom June to August 2020, members of the “European Association of Neurosurgical Societies,” the “Neurosurgery Research Listserv,” and the “Latin American Federation of Neurosurgical Societies” were asked to complete an electronic questionnaire on the topics of WMSDs and ergonomics.ResultsA total of 409 neurosurgeons responded to the survey, with a 4.7 male to female ratio. Most of the surgeons worked in Europe (76.9%) in academic public hospitals. The vast majority of the participants (87.9%) had experienced WMSDs, mainly affecting the shoulder, neck, and back muscles. The most common operations performed by the participants were “Craniotomy for convexity/intrinsic tumors” (24.1%) and “Open lumbar basic spine” (24.1%). Neurosurgeons agreed that ergonomics is an underexposed area in the neurosurgical field (84.8%) and that more resources should be spend (87.3%) and training curricula changes should be made (78.3%) in order to alleviate the burden of WMSDs on neurosurgeons. Univariate analysis did not reveal any associations between the development of WMSDs and age, gender, tenure, average duration of operation, operating time per week, type of operation, and surgical approach.ConclusionsThe problem of WMSDs ought to be more closely addressed and managed by the neurosurgical community. More studies ought to be designed to investigate specific ergonomic parameters in order to formulate practice recommendations.

Past, present, and future of sleep medicine research in Latin America.

Sleep medicine is a relatively young field with exponential growth in development and research in the last decades. Parallel to the advances in the United States, Latin America also had its beginnings in sleep medicine housed in neuroscience laboratories. Since the very first Latin American meeting in 1985, and the first sleep society in 1993, sleep research has undergone significant development in subsequent years. From contributions in animal research that allowed understanding of the activity of the brain during sleep to the studies that improved our knowledge of sleep disorders in humans, Latin America has become a scientific hub for expansion of sleep research. In this article, we present a historical account of the development of sleep medicine in Latin America, the current state of education and the achievements in research throughout history, and the latest advances in the trending areas of sleep science and medicine. These findings were presented during World Sleep Society meeting in Vancouver in 2019 and complement the work on sleep societies and training published by Vizcarra-Escobar et al in their article "Sleep societies and sleep training programs in Latin America" (J Clin Sleep Med. 2020;16(6):983-988).

Why a New Journal on Regenerative Medicine?

Why a New Journal on Regenerative Medicine? “Strange times are these in which we live, when old and young are taught falsehoods in school. And the person that dares to tell the truth is called at once a lunatic and fool.” It sounds current, however, it was stated by Plato almost 2400 years ago. Obviously, the collision between old and new ideas, different points of view, and scientific approaches has always been conflictive. In our times this situation is exacerbated by the enormous generation of information and by the indiscriminate access to it. Educational offer includes scientific societies, universities, predatory editors, industry, and even beginners, who simply by having access to social media become opinion makers. The tenuous limits between scientific information, marketing, and entertainment have their maximum expression in the field of social media. What can we do? The answer also comes from the golden age of Greece: The scientific method. Its basis is the search for truth. The truth cannot be modified by biases. The findings of observation and experimentation should be disseminated. Despite isolated initiatives, there has not been a coordinated effort or an editorial forum dedicated to techniques such as the use of mechanical waves in non-invasive regenerative medicine. That is the reason of this publication. This Journal will also include information on minimally invasive, and invasive techniques as long as they are related to tissue regeneration. Any applied treatment has no value if it is not based on a precise diagnosis, so it will also be of interest to this Journal to include not only therapeutic concepts but also the discussion of the diagnostic criteria and the most commonly used complementary tests. The heart and soul of a publication are the authors. I will be eternally grateful to them for trusting in this project and enthusiastically joining this first issue. The circuit will be completed with readers, their opinion and contribution will be valued. We will develop a section dedicated to this. Interaction with the readers will surely give the publication more dynamics and enrich it. It would have been impossible to make this initiative a reality without the encouragement and trust of Dr. Ashok Shyham Pasi, the technical and scientific contribution of The Indian Orthopedic Research Group, the support of the Ibero Latin American Federation of Shockwaves and Tissue Engineering, and the editing input of Ms. Kajal Mandalia. If we manage to improve the practice of a colleague or benefit the quality of life of a patient anywhere in the world, our mission will be fulfilled. Dr. Daniel Moya, MD

Factors associated with producing a scientific publication during medical training: evidence from a cross-sectional study of 40 medical schools surveyed in Latin America

Background: Scientific publication during medical training is key to promote enduring cutting-edge knowledge. The promotion of science among medical students in Latin America is a multi-sphere issue hampered by the unawareness of governments to invest in national research, as well as a lack of support from local universities. This study aims to determine the factors associated with producing a scientific publication during medical training among Latin American medical students of local scientific societies. Methods: This is a secondary data analysis of a cross-sectional study initially conducted in 2016 to evaluate the use of information and communications technologies (TICs) among medical students of 40 local scientific societies of medical students affiliated to the Latin American Federation of Medical Students Scientific Societies (FELSOCEM, in Spanish). Teams in each local scientific society surveyed self-reported scientific publications and explored its association with socioeconomic, academic, and research training conditions. We included medical students enrolled in the 2016-I term and excluded medical interns. We implemented nested models to identify covariates associated with self-reported scientific publication until reaching a parsimonious mixed-effect multilevel model clustered by medical scientific society. Results: We surveyed 11,587 medical students. The prevalence of scientific publications increased in 36% among medical students affiliated to a Scientific Society of Medical Students [parsimonious prevalence ratio (PRp)=1.36, 95%CI=1.16-1.59], 51% among medical students with advanced English proficiency [PRp=1.51, 95%CI=1.21 - 1.87], 85% among medical students who attended a scientific writing skills course [PRp=1.85, 95%CI=1.59-2.15], 81% among medical students who use Sci-Hub [PRp=1.81, 95%CI=1.50-2.20], and 108% among medical students who have access to a pirated academic account [PRp=2.08, 95%CI=1.83-2.36]. Conclusions: Producing a scientific publication among medical students is associated with being affiliated to a Scientific Society of Medical Students, English proficiency, training in scientific writing, use of Sci-Hub, and pirated academic accounts.