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Las leyes bolivianas se aplican a todas las personas, naturales o jurídicas, bolivianas o extranjeras, en el territorio boliviano. Las extranjeras y los extranjeros en el territorio boliviano tienen los derechos y deben cumplir los deberes establecidos en la Constitución, salvo las restricciones que ésta contenga. Las bolivianas y los bolivianos tienen los siguientes derechos: A la libertad de residencia, permanencia y circulación en todo el territorio boliviano, que incluye la salida e ingreso del país.

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La nacionalidad boliviana se adquiere por nacimiento o por naturalización. Que tengan cónyuge boliviana o boliviano, hijas bolivianas o hijos bolivianos o padres sustitutos bolivianos. Que presten el servicio militar en Bolivia a la edad requerida y de acuerdo con la ley. Prenatal care in 27 women The child arrived after 24 hours of birth Lumbosacral lesion Of those Three children were not operated because they had complex and severe malformations associated to the MMCL.

The most common surgical complications were; wound dehiscence or infection Mortality and specifically postoperative mortality were 7. Nine patients who had long term follow up presented with tethered cord.

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A characteristic, delayed referral. No gender predominance. Majority of cases were lumbar or lumbar sacral. Mortality similar to what is reported in the literature. Few patients came for follow up.


MMCL is a pathology that requires concentrated attention by the national authorities. A multi center and multi national study will improve our management of these patients. In the world between There is a difference in treatment criteria according to the economic status of the countries were the children are born.

For long a passive approach was accepted. Haimburger and Haimburger[ 7 ] have documented this trend. After the studies by Chambers and Hamburger[ 4 , 6 ] the wave was to favor early intervention. Almost 30 years ago Ausman[ 1 ] pointed out that the treatment of MMCL was not a matter of surgical technique but depended of a series of cultural and social factors. South America occupies a surface of almost This program studies the risk factors for developing congenital malformations in Latin America[ 3 ].

It began its activities in , limited to Buenos Aires, then gradually expanded to include 10 countries and Costa Rica and the Dominican Republic. The hospital network attends at All the malformations diagnosed in children with a weight above grams are registered according to protocol. Between there were 2,, live births in the participating countries, 2. Boliva had an incidence of 2. Between there was a significant reduction of anencephaly and spina bifida in Argentina and Chile.

In the other countries there was an increase in cases. Geographical breakdown of total births, live births, stillbirths, total malformed malformed living, malformed stillbirths. Rates per [ 13 ]. This is an initiative that is worth praising. The objective is to determine the impact of early intervention on clinical evolution of the patients when diagnosed after birth and when presenting symptoms of tethered cord. An web centered data base was created for the paricipitants to download their cases.

Supplementing flour with folic acid became a relity in It is considered an important factor in the reduction of spina bifida cases. The data for Argentina, Brasil and Chile are summarized there. Birth prevalence rates of neural tube defects isolated and total in pre- and post-fortification of flour with folic acid in 3 South American countries periods[ 13 ]. Recommended the governments of the region to support plans prevention before conception.

Recommended considering environmental factors that could be responsible for NTD such as soil fertilizers. Today other countries of Latin America and the Caribbean have adhered to this plan and there are national regulations mandating the fortification of flour with micronutrients as recommended by the WHO.

The mothers were from a low and middle economic level. Age at admission at HUJ: Mortality within 30 days: Time delay since birth till surgery: Less than 24 hours: Five layers arachnoid, dura, fascia, subcutaneous tissue and skin: Complications within 30 days of surgery: Wound infection or dehiscence 10 Our data was similar that to that of La Paz. Santa Cruz is at feet above the sea level and La Paz at 11, feet. The parameters compared in Table 4 are: Prenatal control. Admission at less than 24 hours. Admission older than 24 hours. General mortality 30 days. Postoperative mortality.

One in Mother, 26 years.

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Defect, L5-S1 at 26 weeks. Delivery at 33 weeks. Excellent wound healing. Lower muscle tone in lower limbs. Adequate sensory response [ Figure 1 ]. Parents are informed that the surgery will not correct the deficit. They have ample opportunities for asking questions. We explain that we choose not to treat children who have associated conditions that endanger their lives. This considering that little can be done regarding the already present sensory and motor deficit.

If there are signs of infection we treat it accordingly. We first treat the MMCL and then the hydrocephalus.

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We shunt with a medium pressure valve donated by an NGO Fundacion Sonrisa Feliz because they are not covered by insurance. If the child does not have hydrocephalus at the moment of discharge we schedule appointments for 3, 6 and 12 months after. In our experience Hydrocephalus manifest within 1 year. If this does not help we consider cervical laminectomy and or occipital craniectomy. In Bolivia as in the rest of Latin America socio economical factors weight on the prevention and treatment of MMCL We do not have statistical data but it seems that in Bolivia we have a lower incidence of NTD than in Nicaragua and Guatemala where they see cases per month in Nicaragua and in Guatemala[ 12 ].

Preventive use of folic acid is not fully complied in Bolivia. In South America in a study of women it was observed that only Lack of adequate equipment and personnel is a factor but also the program is not widely advertised in rural areas. The referral system to tertiary care hospital is deficient.

The number of home deliveries is high Due to lack of advanced imaging there is no adequate assessment of long-term consequences of MMCL such as Chiari II, syringomyelia and tethered cord.

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MRI was requested in those who tethered cord was suspected motor weakness, sphincter dysfunction, pain, scoliosis. Parents and Neurosurgeons and the health care team, physicians, nurses, physical therapists, are fully aware about the phenomenal challenges represented by each one of the children born with Myelomeningocele. Anualmente nacen en el mundo entre Del mismo modo, la evolución de estos enfermos varía notoriamente de acuerdo al país donde nacen.

América del Sur ocupa una superficie de casi Es un programa de investigación clínica y epidemiológica sobre los factores de riesgo en defectos congénitos detectados en una red de hospitales de América Latina. En el período hubo 2. En el período , hubo una reducción significativa en las tasas de anencefalia y la espina bífida en Chile y Argentina. Sin embargo, en el resto de los países, las tasas globales de malformaciones aumentaron. Distribución por país del total de nacimientos, nacidos vivos, mortinatos, total de malformados, malformados vivos, malformados mortinatos.

Tasas por Para ello, 12 hospitales elegidos en estos países incluyeron en un banco de datos a todos los pacientes con espina bífida y médula anclada entre 0 y 15 años, y que tuvieron un seguimiento médico anual, por un periodo de 5 años. Actualmente, los países firmantes de esta declaración así como otros países de América Latina y el Caribe, han dictado regulaciones nacionales para enriquecer las harinas de trigo y maíz con los micronutrientes recomendados por la OMS.

Se recopilaron los datos de 70 pacientes con diagnóstico de MMC atendidos entre y por un equipo multidisciplinario obstetra, pediatra, neurocirujano, urólogo, ortopedista, radiólogo, psicólogo y fisiatra del Hospital Universitario Japonés HUJ. Edad de las madres: Menor a 18 años: Mayor de 35 años: Edad gestacional: Control prenatal: Diagnóstico de disrafia espinal: Localización del MMC: Cuadro clínico: Mortalidad general a los 30 días: De los 70 MMC, tres 4.

Sobre un total de 60 pacientes operados, observamos:. Tiempo medio de reparación del MMC desde su nacimiento hasta la cirugía: Menos de 24 horas: Modalidad de cierre: Días de estadía en el hospital: Infección o dehiscencia de la sutura: