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INTRODUCTION: Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm-FINGERS) is the first non-pharmacological multicenter randomized clinical trial (RCT) to prevent cognitive impairment in Latin America (LA). Our aim is to present the study design and discuss the strategies used for multicultural harmonization. METHODS: This 1-year RCT (working on a 1-year extension) investigates the feasibility of a multi-domain lifestyle intervention in LA and the efficacy of the intervention, primarily on cognitive function. An external harmonization process was carried out to follow the FINGER model, and an internal harmonization was performed to ensure this study was feasible and comparable across the 12 participating LA countries. RESULTS: Currently, 1549 participants have been screened, and 815 randomized. Participants are ethnically diverse (56% are Nestizo) and have high cardiovascular risk (39% have metabolic syndrome). DISCUSSION: LatAm-FINGERS overcame a significant challenge to combine the region's diversity into a multi-domain risk reduction intervention feasible across LA while preserving the original FINGER design.
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Disfunção Cognitiva , Humanos , América Latina , Disfunção Cognitiva/prevenção & controle , Estilo de Vida , Cognição , Projetos de PesquisaRESUMO
Introduction: Stroke is one of the leading causes of death in Latin America, a region with countless gaps to be addressed to decrease its burden. In 2018, at the first Latin American Stroke Ministerial Meeting, stroke physician and healthcare manager representatives from 13 countries signed the Declaration of Gramado with the priorities to improve the region, with the commitment to implement all evidence-based strategies for stroke care. The second meeting in March 2020 reviewed the achievements in 2 years and discussed new objectives. This paper will review the 2-year advances and future plans of the Latin American alliance for stroke. Method: In March 2020, a survey based on the Declaration of Gramado items was sent to the neurologists participants of the Stroke Ministerial Meetings. The results were confirmed with representatives of the Ministries of Health and leaders from the countries at the second Latin American Stroke Ministerial Meeting. Results: In 2 years, public stroke awareness initiatives increased from 25 to 75% of countries. All countries have started programs to encourage physical activity, and there has been an increase in the number of countries that implement, at least partially, strategies to identify and treat hypertension, diabetes, and lifestyle risk factors. Programs to identify and treat dyslipidemia and atrial fibrillation still remained poor. The number of stroke centers increased from 322 to 448, all of them providing intravenous thrombolysis, with an increase in countries with stroke units. All countries have mechanical thrombectomy, but mostly restricted to a few private hospitals. Pre-hospital organization remains limited. The utilization of telemedicine has increased but is restricted to a few hospitals and is not widely available throughout the country. Patients have late, if any, access to rehabilitation after hospital discharge. Conclusion: The initiative to collaborate, exchange experiences, and unite societies and governments to improve stroke care in Latin America has yielded good results. Important advances have been made in the region in terms of increasing the number of acute stroke care services, implementing reperfusion treatments and creating programs for the detection and treatment of risk factors. We hope that this approach can reduce inequalities in stroke care in Latin America and serves as a model for other under-resourced environments.
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The large and increasing burden of stroke in Latin American countries, and the need to meet the UN and WHO requirements for reducing the burden from non-communicable disorders (including stroke), brought together stroke experts and representatives of the Ministries of Health of 13 Latin American countries for the 1st Latin American Stroke Ministerial meeting in Gramado, Brazil, to discuss the problem and identify ways of cooperating to reduce the burden of stroke in the region. Discussions were focused on the regional and country-specific activities associated with stroke prevention and treatment, including public stroke awareness, prevention strategies, delivery and organisation of care, clinical practice gaps, and unmet needs. The meeting culminated with the adoption of the special Gramado Declaration, signed by all Ministerial officials who attended the meeting. With agreed priorities for stroke prevention, treatment, and research, an opportunity now exists to translate this Declaration into an action plan to reduce the burden of stroke.
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Efeitos Psicossociais da Doença , Política de Saúde , Acidente Vascular Cerebral/epidemiologia , Humanos , Incidência , América Latina/epidemiologia , Prevalência , Acidente Vascular Cerebral/mortalidadeRESUMO
Biological drugs and nonbiological complex drugs with expired patents are followed by biosimilars and follow-on drugs that are supposedly similar and comparable with the reference product in terms of quality, safety and efficacy. Unlike simple molecules that can be copied and reproduced, biosimilars and follow-on complex drugs are heterogeneous and need specific regulations from health and pharmacovigilance agencies. A panel of 14 Latin American experts on multiple sclerosis from nine different countries met to discuss the recommendations regarding biosimilars and follow-on complex drugs for treating multiple sclerosis. Specific measures relating to manufacturing, therapeutic equivalence assessment and pharmacovigilance reports need to be implemented before commercialization. Physical, chemical, biological and immunogenic characterizations of the new product need to be available before clinical trials start. The new product must maintain the same immunogenicity as the original. Automatic substitution of biological and complex drugs poses unacceptable risks to the patient.
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Medicamentos Biossimilares/uso terapêutico , Controle de Medicamentos e Entorpecentes , Fatores Imunológicos/uso terapêutico , Esclerose Múltipla/tratamento farmacológico , Gestão de Riscos , Prova Pericial , Humanos , América Latina/epidemiologia , Esclerose Múltipla/epidemiologiaRESUMO
Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.
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Transtornos de Enxaqueca/terapia , Doença Crônica , Comorbidade , Humanos , América Latina , Transtornos de Enxaqueca/diagnóstico , Fatores de RiscoRESUMO
Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.
A migrânea crônica é uma condição com prevalência significativa ao redor do mundo e alto impacto socioeconômico, sendo que seu manuseio tem desafiado os neurologistas. Os avanços na compreensão de seus mecanismos e das condições a ela associadas, bem como nas novas terapêuticas, têm sido rápidos e importantes, fato que motivou as Sociedades Latino-americana e Brasileira de Cefaleia a elaborarem o presente consenso. O tratamento da migrânea crônica deve ser sempre precedido por uma revisão cuidadosa do diagnóstico, pela detecção de possíveis fatores de piora e das condições associadas, pela estratificação de gravidade/impossibilidade de se tratar e pelo monitoramento com um diário da dor. Este consenso apresenta abordagens farmacológicas e não-farmacológicas para tratar a migrânea crônica.
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Humanos , Transtornos de Enxaqueca/terapia , Doença Crônica , Comorbidade , América Latina , Transtornos de Enxaqueca/diagnóstico , Fatores de RiscoRESUMO
La colangiopancreatografía retrógrada endoscópica, produjo un dramático impacto en el abordaje diagnósticos de las enfermedades pancreáticas y biliares, pero fue la posibilidad de que el método tuviera una aplicación terapéutica lo que cambio por completo el estudio y resolución de las patologías bilio-pancreáticas. Los primeros reportes de esfinterectomías endoscópicas, realizados en forma independiente por Kawai y Classen y Deling, dieron esa nueva visión sobre la posibilidad de solucionar por vía endoscópica las enfermedades de las vías biliares.
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Doenças Biliares , História da Medicina , Academias e Institutos , Ductos Biliares/cirurgiaAssuntos
Humanos , Masculino , Feminino , Endoscopia , Vesícula Biliar/cirurgia , Vesícula Biliar/lesões , Medicina , VenezuelaRESUMO
Objetivos: Comparar los resultados del tratamiento de la mediatinitis en dos series sucesivas y homogéneas empleando dos modalidades terapéuticas diferentes y analizar su influencia sobre la morbimortalidad y los costos. Material y métodos: Treinta pacientes con diagnóstico de mediastinitis son comparados en este reporte. Dieciséis casos consecutivos fueron tratados con debridamiento, curas abiertas y plástica muscular diferida empleando ambos músculos pectorales (Serie A). Los siguientes 14 casos fueron tratados con debridamiento y deslizamiento miocutáneo pectoral bilateral simultáneo (Serie B). Resultados: La mortalidad hospitalaria fue del 31,2 por ciento para la Serie A y 0 por ciento para la Serie B. El promedio de internación desde el diagnóstico de mediastinitis hasta el alta fue de 47 días (rango: 20-66 días) para la Serie A y 15 días (rango: 7-32 días) para la Serie B. Requirieron hemodiálisis 25 por ciento de los pacientes de la Serie A y 7,1 por ciento de los pacientes en la Serie B. En los pacientes de la Serie A fueron necesarios al menos dos procedimientos quirúrgicos, mientras que los pacientes de la Serie B se resolvieron con un solo acto quirúrgico. Nosotros concluimos que, empleando el debridamiento y deslizamiento miocutáneo pectoral simultáneo, podemos reducir sensiblemente la morbimortalidad hospitalaria, los días de internación y los costos