Persistent inequities in maternal mortality in Latin America and the Caribbean, 1990-2019.

BACKGROUND: Despite the resources and personnel mobilized in Latin America and the Caribbean to reduce the maternal mortality ratio (MMR, maternal deaths per 100 000 live births) in women aged 10-54 years by 75% between 2000 and 2015, the region failed to meet the Millenium Development Goals (MDGs) due to persistent barriers to access quality reproductive, maternal, and neonatal health services. METHODS: Using 1990-2019 data from the Global Burden of Disease project, we carried out a two-stepwise analysis to (a) identify the differences in the MMR temporal patterns and (b) assess its relationship with selected indicators: government health expenditure (GHE), the GHE as percentage of gross domestic product (GDP), the availability of human resources for health (HRH), the coverage of effective interventions to reduce maternal mortality, and the level of economic development of each country. FINDINGS: In the descriptive analysis, we observed a heterogeneous overall reduction of MMR in the region between 1990 and 2019 and heterogeneous overall increases in the GHE, GHE/GDP, and HRH availability. The correlation analysis showed a close, negative, and dependent association of the economic development level between the MMR and GHE per capita, the percentage of GHE to GDP, the availability of HRH, and the coverage of SBA. We observed the lowest MMRs when GHE as a percentage of GDP was close to 3% or about US$400 GHE per capita, HRH availability of 6 doctors, nurses, and midwives per 1,000 inhabitants, and skilled birth attendance levels above 90%. CONCLUSIONS: Within the framework of the Sustainable Development Goals (SDGs) agenda, health policies aimed at the effective reduction of maternal mortality should consider allocating more resources as a necessary but not sufficient condition to achieve the goals and should prioritize the implementation of new forms of care with a gender and rights approach, as well as strengthening actions focused on vulnerable groups.

COVID-19 Response in Latin America.

Effective management of a pandemic due to a respiratory virus requires public health capacity for a coordinated response for mandatory restrictions, large-scale testing to identify infected individuals, capacity to isolate infected cases and track and test contacts, and health services for those infected who require hospitalization. Because of contextual and socioeconomic factors, it has been hard for Latin America to confront this epidemic. In this article, we discuss the context and the initial responses of eight selected Latin American countries, including similarities and differences in public health, economic, and fiscal measures, and provide reflections on what worked and what did not work and what to expect moving forward.

Amplificación de los oncogenes ErbB-1 y ErbB-2 en cancer de mama, su asociación con variables clínicas y evidencia de heterogeneidad intratumoral mediante hibridación in situ / Amplification of ErbB-1 and ErbB-2 oncogene in breast cancer, its asociation with clinical variables and evidence of intratumoral heterogenicity through in situ hybridization", "_i": "

Se realizó un estudio de tipo descriptivo, retrospectivo con el objetivo de evaluar el estado de amplificación de los oncogenes ErbB-1 y ErbB-2 mediante la técnica de FISH en un grupo de casos de cáncer de mama del Instituto Nacional de Cancerología. Se incluyeron 50 casos y las muestras empleadas fueron bloques de tejido incluidos en parafina, pertenecientes a biopsias de diagnóstico o mastectomías de las pacientes después de haber recibido o no quimioterapia coadyuvante. Se encontró un 18% de casos positivos para la amplificación de ErbB-2 y ningún caso amplificado para ErbB-1. Se observó una asociación altamente significativa entre la amplificación de ErbB-2 con el compromiso ganglionar (p=0.006), y una tendencia de los casos amplificados a la negatividad en los receptores de estrógeno y progesterona (p=0.06). En los casos no amplificados para ErbB-1 y ErbB-2 se evaluó la presencia de heterogeneidad genética intratumoral, detectando además de la amplificación diferentes poblaciones celulares disómicas y monosómicas

It was a retrospective and descriptive study, the aim of this was to evaluate the status of the ERbB1 and ErbB2 oncogenes by FISH in a group of cases in breast cancer of the Institute National of Cancer of Colombia. There were fifty cases with samples of the paraffin blocks of biopsies and specimens of mastectomies with diagnosis of breast cancer of patients with or without chemotherapy adjuvant. In this study was found 18% positive cases to the ErbB2 amplification and none case showed ErbB1 amplification. The association between the ErbB2 amplification and lymph node compromised was a high significative statistic level (p= 0.06) with tend to estrogenic and progesterone receptors negatives (p=0.06). In the cases without ErbB1 and erbB2 amplification were evaluated for the presence of the intratumoral heterozigocity found population cellular different disomic and monosomic