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Abstract Aim This study aims to investigate experiences of frontline nurses about human caring during COVID‐19 pandemic based on the Ten Caritas Processes® of Watson's Human Caring Theory. Design A directed content analysis was performed. Methods A total of 15 frontline nurses were recruited by purposive sampling from Razi hospital (north of Iran), in 2020 and semi‐structured interviews were conducted. Results Extracted categories based on Ten Caritas Processes® included feeling satisfied in providing care to patients, effective presence with patients, moving towards self‐actualization (moving towards transcendence), care with trust and compassion, experience positive and negative emotions, creativity in providing care, self‐directing learning experience in the field of care, unfavourable environment for providing care, feeling acceptance and worth, uncertainty (facing the unknown). This study showed that communication skills, self‐sensitivity, patient dignity, teaching‐learning and problem‐solving skills, holistic attention to the patient, and the provision of a healing environment are necessary for patient care.

At a time when national education professionals are being asked to take "trans" students into account in the school environment, scientific papers on adults within the school is timidly emerging in the field of trans studies in education. As heuristic as these studies may be, it must be noted that this research very often considers academic actors as a monolithic entity, depriving the reader of a finer understanding of the difficulties they face. In PE, an eminently gendered discipline where norms are (de)constructed in action, are teachers true "out-of-peer" educators when it comes to welcoming a "trans" student? This article suggests investigating the place and role of teachers in this discipline in the light of the "trans issue" by placing their practices in perspective with those of their colleagues in the French national education system.

Aim:The present study surveys the available evidence regarding the role and scope of nursing leadership in disaster and emergencies.Materials and Methods:This scoping review was carried out between 2010 and 2020 through a series of databases including Embase, Scopus, CINHAL, Web of Science, Cochrane Library, PubMed, ProQuest, and Google Scholar with keywords of “leadership,” “nursing,” “competency,” “disaster,” and “emergency”.Results:Seven articles met the inclusion criteria of the scoping review. Three main research questions were addressed, relating to the role of nursing leadership in times of disaster, the skills required of a nursing leader, and the strategies recommended for promoting nursing leadership during a disaster or pandemic.Conclusion:This study shows that nurses are a vital part of the healthcare system in times of disaster and that nursing leaders provide valuable services for maintaining individual and community health. Given that there is no agreement in the existing research as to which competencies are required of nursing leaders in times of disaster, more researches must be developed to enhance the effectiveness of nursing leaders in future disasters and pandemics.

Introduction: Standard cardiopulmonary resuscitation (STD-CPR) is successful in only 10-15% of cases in emergency department (ED). This study aimed to determine the effect of interposed abdominal compression (IAC) during resuscitation on outcomes of ED cardiac arrests. Methods: In this randomized clinical trial study, non-trauma patients aged 18-85 years, patients with in-hospital cardiac arrest hospitalized in the ED were randomly assigned into two either STD-CPR or IAC-CPR group on a 1:1 basis and using computer-generated random numbers. Participants in the intervention group, received abdominal compression during the diastole phase of STD-CPR. The rate of return of spontaneous circulation (ROSC), heart rate (HR), respiratory rate (RR), arterial blood gas (ABG) indicators, and survival rate were compared between the two groups. Results: Ninety patients were enrolled (45 in each group). There were no differences between the two groups regarding age (p = 0.76), sex (p = 0.39), employment status (p = 0.62) and Charlson comorbidity scale (p = 0.46). Abdominal compression had a positive effect on heart rate (p < 0.001), mean arterial pressure (p = 0.003), arterial blood oxygen pressure (p = 0.001), and arterial blood carbon dioxide pressure (p = 0.001) as well as a negative effect on arterial blood oxygen saturation (p = 0.029) 30 minutes after resuscitation. Out of the 90 CPR cases, 8 (17.7%) cases in intervention group and 8 (17.7%) cases in control group were successful, among which all of the 8 patients in the intervention group and 5 of the patients in the control group had been discharged from hospital without any complications. Conclusion: The results showed that abdominal compression during CPR can improve resuscitation outcomes in patients with cardiac arrest. Therefore, in order to use this technique, further research is recommended.

El cáncer gástrico es la quinta neoplasia maligna más frecuente a nivel mundial y en nuestro país, y la cuarta causa de mortalidad por cáncer. La tasa de supervivencia continúa siendo baja, dado que su diagnóstico suele ser tardío y en etapas avanzadas. En países con alta incidencia se realiza screening endoscópico, realizándose el diagnóstico en etapas precoces, con un mejor pronóstico. En estos pacientes existe menor riesgo de diseminación regional o distancia, y se pueden plantear tratamientos a medida, evitando resecciones amplias.

Background and purpose: Hypotension is the most common serious complication during hemodialysis. The aim of this study was to evaluate the effect of cold dialysate on hemodynamic status of patients undergoing hemodialysis. Materials and methods: A before/after study using a quasi-experimental design was carried out in 99 patients undergoing hemodialysis attending Rasht Razi Hospital, 2019. All patients received hemodialysis using a dialysate at 37°C for three consecutive sessions and the next three sessions were performed using a cool temperature dialysate (35.5°C). Blood pressure and pulse rate were monitored in all sessions. Data were analyzed in SPSS V16 using independent t-test and paired t-test. Results: Systolic and diastolic blood pressure changes were significantly different between the two dialysate temperatures (P

La tasa de recidiva radiológica luego de la cirugía de las hernias hiatales grandes tipo IV es cercana al 50%. La mayoría de las veces la recidiva supone un ascenso parcial de la funduplicatura al tórax (telescopaje), y si no tiene expresión clínica puede optarse por un manejo conservador (solo 3-6% requieren cirugía de revisión). Sin embargo, en ocasiones hay otro tipo de recidivas (paraesofágicas) que deben valorarse mediante estudios funcionales, endoscópicos y radiológicos, que dan disfagia con mayor frecuencia. Un tránsito contrastado digestivo superior permite en este caso identificar el tipo de recidiva herniaria, con migración parcial del fundus gástrico hacia el tórax paraesofágico izquierdo, y una funduplicatura continente pero realizada técnicamente en por debajo de lo deseable (cuerpo alto) (figura). La resolución del cuadro implica la reducción de la hernia a la cavidad abdominal, con cierre del defecto diafragmático, desmontar la funduplicatura anterior anatomizando la zona y la reconfección de una nueva funduplicatura.

Introducción: la equinococosis quística músculo-esque­lética es poco frecuente, pudiendo determinar retrasos diagnósticos y errores terapéuticos. Reporte de caso: presentamos el caso de un paciente con un quiste hidático primario único a nivel de la región femoral posterior derecha, infectado. Discusión: se realizó una revisión en las bases de datos PubMed y LILACS sobre el diagnóstico y manejo terapéutico de los quistes hidáticos músculo-esqueléticos primarios. Conclusiones: la equinococosis quística músculo-esquelética debe ser tenida en cuenta dentro de los diagnósticos diferenciales de tumoraciones de partes blandas en pacientes provenientes de zonas endémicas. La tomografía computada y/o resonancia magnética cumplen un rol diagnóstico y de planificación terapéutica. El tratamiento es quirúrgico, a medida del paciente y del quiste, en función de su topografía, tamaño y fundamentalmente relaciones vasculo nerviosas y musculares. Otros factores a tener en cuenta son las futuras secuelas funcionales y resultados estéticos.

Introducción: a nivel mundial, la pandemia COVID-19 determinó una disminución significativa en el volumen de cirugía electiva. Existe preocupación por parte de generaciones de residentes quirúrgicos debido a las consecuencias en su formación. Si bien la formación alcanza otros aspectos que exceden a la práctica quirúrgica, ésta no deja de ser un pilar fundamental. Objetivo: cuantificar el impacto de la pandemia COVID-19 en el volumen asistencial de los residentes de cirugía general en un servicio universitario. Método: es un estudio observacional, retrospectivo y analítico. Se comparó el volumen quirúrgico y asistencial de los residentes de cirugía general durante el período entre el 13/03/2020 y el 13/12/2020, posterior al inicio de la pandemia COVID-19, con el volumen registrado en el mismo período previo al inicio de la pandemia. Resultados: todos los residentes participaron en un menor número de cirugías. El mayor impacto fue en la participación de cirugías de coordinación, siendo menores las diferencias en la cirugía de urgencia. El mayor impacto en cuanto a volumen de pacientes operados fue para el residente de primer año. Discusión y conclusiones: a nivel mundial, la pandemia determinó una notoria disminución en el volumen de cirugías electivas. Este trabajo demostró una disminución significativa en el volumen quirúrgico asistencial del residente de cirugía general, por lo que, de prolongarse las medidas sanitarias, sería sustancial evaluar la necesidad de proyectar objetivos e instancias alternativas de aprendizaje.

Introducción: la vena porta origina clásicamente de la confluencia de las venas mesentérica superior y tronco espleno mesentérico, conformado por las venas esplénica y mesentérica inferior. Su conformación y principales afluentes no escapa de presentar variaciones anatómicas, las cuales el cirujano debe conocer y anticipar, al momento del abordaje del macizo duodeno pancreático en vistas a evitar consecuencias catastróficas. El objetivo es el estudio de la conformación, dimensiones y disposición espacial de la vena porta en su origen, y sus principales afluentes. Materiales y método: se utilizaron 50 cadáveres formolados. Se registró origen de la vena porta, calibre de la misma y sus afluentes. ángulos de abocamiento y nivel vertebral de proyección. Resultados: se distinguieron tres tipos de origen. Se registró el tipo I en el 78% de los casos, tipo II en el 18% y tipo III en el 4%. Los calibres fueron: vena porta 16,12 mm, mesentérica superior 11,77 mm, esplénica 9,34 mm, mesentérica inferior 5,03 mm y tronco esplenomesaraico de 10,44 mm. Este último, alcanzó una longitud de 20,26 mm. Los ángulos fueron: ángulo porta - tronco esplenomesenterico 124,18°, ángulo mesentérica superior - tronco esplenomesenterico 101,92° y ángulo mesentérica inferior - esplénica 75,4°. En el 75% de los casos el nivel de proyección vertebral fue el tercio superior de L2. Conclusiones: El origen mas frecuente fue el clásicamente descrito. De sus variantes, es mas constante la reunión de la vena mesentérica superior con la vena esplénica, y mas variable la desembocadura de la vena mesentérica inferior.

Many people are experiencing serious health-related suffering that would benefit from palliative care. However, this service is inaccessible or underdeveloped in many parts of the world. One of the main starting points for introducing or developing palliative care services is improving awareness and participation in palliative care in the community. A group of clinicians from diverse backgrounds discussed how to implement this and this paper is a culmination of ideas arising from these conversations. For awareness building, social media campaigns, awareness at food festivals, national palliative care day programs, sharing stories and testimonials to stimulate conversations regarding palliative care and a "human library" project were described. For improving community participation, community volunteer development programs, the "adopt a grandma" initiative, medical student palliative care project, workshops and training for non-communicable diseases and community nursing cross-specialty collaborations are suggested. It is hoped that these proposals will stimulate further ideas and support the implementation of palliative care in different settings. [ABSTRACT FROM AUTHOR]

Minimally invasive surgery reduces perioperative pain and morbidity, facilitating rapid recovery. However, the field of kidney transplantation has lagged in this regard, its customary open surgical techniques going nearly unchanged until recently. Robotic kidney transplantation (RKT) is a novel and welcomed innovation yielding good surgical outcomes. In Korea, the first RKT performed (November 2019) involved a 30-year-old man (body mass index, 22 kg/m2) with end-stage hypertensive nephrosclerosis. A left donor kidney from his 28-year-old sister was successfully transplanted using the daVinci Robotic Surgical System. Transperitoneal regional hypothermia (Vattikuti Urology Institute-Medanta technique) was also implemented across the main periumbilical incision (up to 6 cm). Total operative time was 260 minutes (cold ischemia, 34 minutes; rewarming, 54 minutes), with 50 mL of blood loss. There was immediate graft function, unencumbered by surgical complications (e.g., postoperative bleeding, leakage, or lymphocele). The patient was discharged on postoperative day 8, with serum creatinine at 1.27 mg/dL. RKT with regional hypothermia may be a viable, minimally invasive intervention that is safe and effective in select patients, showing good surgical results.

Introducción: la colecistectomía laparoscópica (CL) es la cirugía más frecuente del tracto digestivo. A pesar de considerarse un procedimiento seguro, la morbilidad se reporta hasta en un 10%, no existiendo registro a nivel nacional. Objetivo: describir la incidencia de complicaciones y morbimortalidad de la CL electiva en una población no seleccionada de un servicio universitario. Método: se realizó un estudio retrospectivo observacional de los pacientes intervenidos en forma electiva de CL, entre el 1/1/2010 y el 31/12/2019 en la Clínica Quirúrgica B del Hospital de Clínicas y en la Unidad Docente Asistencial de Cirugía del Hospital Español. Las variables incluidas fueron demográficas, diagnóstico operatorio, conversión, morbimortalidad, reintervenciones y readmisiones. Resultados: se reclutó un total de 1.499 CL electivas, edad promedio 49 años (15-87), 79% sexo femenino, incidencia de litiasis de vía biliar principal (LVBP) en 210 (17%) casos; 25 conversiones (1,7%). Hubo un total de 64 complicaciones (4,3%) con una incidencia significativamente mayor en pacientes con LVBP (2,8% vs 7,6%, p 0,01). Hubo dos lesiones del hepato-colédoco (0,13%) (tipo Hannover D y C), ambas detectadas y reparadas en la misma cirugía y tres lesiones viscerales (0,20%). Hubo 16 readmisiones (1,07%) y 9 reintervenciones (0,6%). Dos pacientes fallecieron (0,13%) en el posoperatorio (insuficiencia hepatocítica crónica descompensada y pancreatitis grave pos-CPRE posoperatoria). Conclusiones: la CL en la población no seleccionada del servicio universitario analizado en este trabajo demuestra ser un procedimiento seguro, con tasas de complicaciones, reintervenciones y readmisiones que en este estudio se comparan favorablemente con las reportadas en la literatura. La presencia de litiasis en la vía biliar principal se asoció a una incidencia significativamente mayor de complicaciones posoperatorias y de mayor severidad.

OBJECTIVES Medication errors (MEs) made by nurses are the most common errors in emergency departments (EDs). Identifying the factors responsible for MEs is crucial in designing optimal strategies for reducing such occurrences. The present study aimed to review the literature describing the prevalence and factors affecting MEs among emergency ward nurses in Iran. METHODS We searched electronic databases, including the Scientific Information Database, PubMed, Cochrane Library, Web of Science, Scopus, and Google Scholar, for scientific studies conducted among emergency ward nurses in Iran. The studies were restricted to full-text, peer-reviewed studies published from inception to December 2019, in the Persian and English languages, that evaluated MEs among emergency ward nurses in Iran. RESULTS Eight studies met the inclusion criteria. Most of the nurses (58.9%) had committed MEs only once. The overall mean rate of MEs was 46.2%, and errors made during drug administration accounted for 41.7% of MEs. The most common type of administration error was drug omission (17.8%), followed by administering drugs at the wrong time (17.5%) and at an incorrect dosage (10.6%). The lack of an adequate nursing workforce during shifts and improper nurse-patient ratios were the most critical factors affecting the occurrence of MEs by nurses. CONCLUSIONS Despite the increased attention on patient safety in Iran, MEs by nurses remain a significant concern in EDs. Therefore, nurse managers and policy-makers must take adequate measures to reduce the incidence of MEs and their potential negative consequences.

Introduction: World Health Organization has declared COVID-19 a pandemic and a global health emergency. Thus, it is necessary to clearly characterize clinical manifestations and management of COVID-19 infection in children to provide accurate information for healthcare workers. Accordingly, the present study was designed to review articles published on clinical manifestations and characteristics of children and infants with COVID-19. Methods: In this systematic review, medical databases including Cochrane Library, Web of Science, Embase, Scopus, SID, Medline, WHO and LitCovid were searched using English and Persian keywords including COVID-19, Pediatrics, Newborn, Coronavirus 2019, 2019-nCoV, SARS-CoV-2. Finally, data of 14 related articles were included in the study. Results: A total of 2228 children, newborns and infants were studied. Clinical manifestation in children may be mild (72%), moderate (22%) or severe (6%), and the most common symptoms include dry cough (91%) and fever (96%). According to the included articles, two children had died, one of which was a 14-year-old boy and his exposure history and underlying disease were unclear, and the other was a male newborn with gestational age of 35 weeks and 5 days, birth weight of 2200, Apgar score of 8, 8 (1 min and 5 min) and his first symptom was increased heart rate. No differences were found between male and female children regarding infection with COVID-19. Conclusion: Most pediatrics were infected with COVID-19 due to family cluster or history of close contact. Infected children have relatively milder clinical symptoms compared to infected adults. We should pay special attention to early diagnosis and early treatment in children infected with COVID-19.

El compromiso ganglionar es crítico en la estadificación del cáncer de colon como factor pronóstico y como determinante de tratamiento adyuvante. Se sigue discutiendo el número de ganglios adecuados a resecar, cuáles son los factores que inciden en la cosecha ganglionar y el significado biológico de ésta. Se revisan las variables clínicas y de la propia biología tumoral que hacen que la definición de un número determinado de ganglios, como gold standard de cosecha ganglionar adecuada, sea controversial. El número 12 no necesariamente es un número “mágico” marcador de calidad. Extender la resección para aumentar la cosecha ganglionar no mejora la estadificación, expone al paciente a riesgos innecesarios, sin efecto terapéutico comprobado. La “magia” sigue siendo realizar resecciones regladas, que incluyan el pedículo vascular y el meso satélite al tumor, ajustando la resección a las características del paciente. Menos no es más, pero más no es necesariamente mejor.

Introduction: The outbreak of the new Coronavirus in China in December 2019 and subsequently in various countries around the world has raised concerns about the possibility of vertical transmission of the virus from mother to fetus. The present study aimed to review published literature in this regard. Methods: In this narrative review, were searched for all articles published in various databases including PubMed, Scopus, Embase, Science Direct, and Web of Science using MeSH-compliant keywords including COVID-19, Pregnancy, Vertical transmission, Coronavirus 2019, SARS-CoV-2 and 2019-nCoV from December 2019 to March 18, 2020 and reviewed them. All type of articles published about COVID-19 and vertical transmission in pregnancy were included. Results: A review of 13 final articles published in this area revealed that COVID-19 can cause fetal distress, miscarriage, respiratory distress and preterm delivery in pregnant women but does not infect newborns. There has been no report of vertical transmission in pregnancy, and it has been found that clinical symptoms of COVID-19 in pregnant women are not different from those of non-pregnant women. Conclusion: Overall, due to lack of appropriate data about the effect of COVID-19 on pregnancy, it is necessary to monitor suspected pregnant women before and after delivery. For confirmed cases both the mother and the newborn child should be followed up comprehensively.

Introducción: el tronco venoso gastrocólico, según lo descrito por Henle en 1868 se forma de la confluencia de las venas gastroepiploica derecha, cólica derecha y pancreático duodenal anteroinferior. Su localización y conocimiento anatómico es de importancia quirúrgica en la movilización duodeno pancreática y colo-epiploica. Material y métodos: se utilizaron 13 cadáveres formolados, adultos, de ambos sexos. Se registró: formación del tronco venoso gastrocólico, calibre de los afluentes y del tronco, distancias entre: cuello del páncreas y borde superior del duodeno III, vena mesentérica superior a duodeno II. Se topografió el tronco venoso en relación a las estructuras mencionadas. Se registró largo del tronco, distancia al borde superior del duodeno III y al borde inferior del cuello de Páncreas. Resultados: la conformación más frecuente fue por confluencia de las venas cólica derecha, gastroepiploica derecha y pancreático duodenal anteroinferior. El calibre medio del tronco venoso fue 5,65mm (3,3mm-10mm). La distancia media entre duodeno III y cuello de páncreas fue de 31,34mm (13,2mm-51mm). La distancia media entre vena mesentérica superior y duodeno II fue de 34,23mm (23,8mm-45,7mm). El largo medio del tronco venoso fue 9,43mm (3,2mm-16,3mm). Conclusión: se constató, en la mayoría de los casos, que la confluencia de formación del tronco venoso se daba según lo descrito clásicamente. Este se situó más frecuentemente de disposición oblicua hacia abajo y adentro, y en el cuadrante ínfero-interno respecto al cuadrilátero dado por una línea vertical desde cuello del páncreas a duodeno III y una horizontal desde duodeno II hasta la vena mesentérica superior.

Introducción: Las hernias lumbares, se desarrollan en el área comprendida entre la costilla XII y la cresta iliaca, lateral a los músculos erectores de la espina. Se producen a través de los puntos donde los pedículos vásculo-nerviosos atraviesan los planos músculo-aponeuróticos, siendo crucial la existencia de intersticios entre dichos planos. Se reconocen dos zonas anatómicamente débiles: el triángulo lumbar inferior y el cuadrilátero lumbar. Materiales y método: 24 cadáveres adultos, ambos sexos, formolados. Se disecó la pared posterior del abdomen por planos, registrando la existencia o no de áreas débiles, su forma, dimensiones y áreas. Resultados: Triángulo lumbar inferior; encontrado en 28 casos (58,3%), 13 derechos y 15 izquierdos. Se encontró un caso con forma de hendidura. Las dimensiones medias de los lados fueron 19,96mm la base, 33,62mm anterior y 27,42mm posterior. El área promedio de la zona débil fue de 25,66 mm2 (17,8 mm2-59,38 mm2). Cuadrilátero lumbar; encontrado en 29 casos (60,4%) 15 derechos y 14 izquierdos. Se encontraron 9 casos a forma de triángulo (18,7%), 4 derechos y 5 izquierdos. Se encontró un caso a forma de hendidura. La media de los lados fue 28,40mm posterosuperior, 24,19mm posteroinferior, 19,46mm anterosuperior y 31,52mm anteroinferior. . El área promedio del cuadrilátero lumbar fue de 55,6 mm2 (16,6 mm2-167,3 mm2). Conclusión: Es más constante la presencia, como área anatómicamente débil, el cuadrilátero lumbar y su variante triangular. El triángulo lumbar inferior predomina a izquierda mientras que el cuadrilátero lumbar y su variante triangular presentaron igual distribución a ambos lados. Introduction: Lumbar hernias develop in the area between the XII rib and the iliac crest, lateral to the erector muscles of the spine. They occur through the points where the neurovascular bundles cross the muscle planes, being crucial the existence of interstices between these planes. Two anatomically weak areas are recognized: the lower lumbar triangle and the lumbar quadrilateral. Materials and method: 24 adult cadavers, both sexes. The posterior wall of the abdomen was dissected by planes, recording the existence or not of weak areas, their shape, dimensions and areas. Results: Lower lumbar triangle; found in 28 cases (58.3%), 13 rights and 15 left. One case as slit shape was found. The average dimensions of the sides were 19.96mm the base, 33.62mm anterior and 27.42mm posterior. The average area of the weak zone was 25.66 mm2 (17.8 mm2-59.38 mm2). Lumbar quadrilateral; found in 29 cases (60.4%) 15 rights and 14 left. We found 9 cases with triangle shape (18.7%), 4 right and 5 left. One case as slit shape was found. The average of the sides was 28,40 mm posterior superior, 24,19 mm posterior inferior, 19,46 mm anterior superior and 31,52 mm anterior inferior. . The average area of the lumbar quadrilateral was 55.6 mm2 (16.6 mm2-167.3 mm2). Conclusion: The presence of the quadrilateral lumbar and its triangular variant is more constant, as an anatomically weak area. The lower lumbar triangle predominates on the left while the lumbar quadrilateral and its triangular variant presented the same distribution on both sides.

Background: Palliative care is one of the primary rights of children with cancer and their families. Identifying the unmet needs of palliative care for these children is important in providing high-quality care. Objectives: The present study aimed at explaining the perception of formal and informal caregivers about the unmet palliative care needs of children with cancer and their families. Methods: This qualitative study was conducted from October 1, 2020, to May 15, 2021, in one of the children's hospitals in Rasht (Northern Iran). This study enrolled 25 caregivers (nurses, doctors, grandmothers, sisters, aunts, neighbors, and parents of children with cancer) and 5 children with cancer, who met the inclusion criteria by purposeful sampling to participate in in-depth and semi-structured interviews. The interviews continued until data saturation. A directed content analysis was performed according to the Elo and Kyngas proposed approach and based on the National Consensus Project (NCP) framework. The findings were managed byMAXQDA2020 software. Gubaand Lincoln criteria were used to ensure the trustworthiness of the data. Results: The average age of the participants was 32.40 ± 1.4 years, and 1,450 codes were extracted. The extracted theme was "the need for holistic care", which included 7 main categories such as "the structure and process of care", "physical aspects of care", "psychological aspects of care", "social aspects of care", "cultural aspects of care", "care of the patient nearing the end of life", and "spiritual, religious, and existential aspects of care", and 23 subcategories. Conclusions: Children with cancer and their families have many physical, psychological, spiritual, and social needs. To meet these needs, it is suggested to provide the necessary infrastructure for palliative care, strive for justice in access to palliative care services for children with cancer and their families, empower caregivers, form an interdisciplinary team, and promote cultural awareness regarding cancer and end-of-life care. [ABSTRACT FROM AUTHOR]

Se reporta la rara asociación de un aneurisma de arteria trigeminal persistente lateral derecha (Tipo II de Saltzman), aplasia del segmento pre-comunicante de ambas arterias cerebrales posteriores y la presencia de arterias cerebrales posteriores fetales en forma bilateral, en una mujer de 64 años que consultó de diplopía y parálisis del nervio abducens derecho, probablemente debida a compresión del nervio en el espacio latero-celar. Se realizó con éxito la embolización endovascular con coils, sin complicaciones inmediatas. Los hallazgos de CT, RM y angiografía son presentados. Aunque cada una de estas variaciones son infrecuentes en forma individual, la combinación de las mismas no ha sido reportada en la literatura hasta nuestro conocimiento, siendo de enorme importancia en el manejo diagnóstico y terapéutico de pacientes con stroke de mecanismo embolico, así como para la planificación de procedimientos endovasculares diagnósticos y terapéuticos. We report the rare association of an aneurysm of a lateral right persistent trigeminal artery (Saltzman type II), bilateral aplasia of the pre-communicating segment of both posterior cerebral arteries and bilateral fetal posterior cerebral arteries, in a 64 years old woman who suffered from progressive diplopia and right abducens nerve palsy, most likely due to nerve compression in the latero-cellar space. Successful endovascular coils embolization of the aneurysm was performed, with no immediate complications. CT, MR and angiographic findings are presented. Although infrequent as single variations, the association of these three arterial variations has not been reported in literature to our knowledge, having special importance in the diagnostic workup and therapeutic procedures in a patient with an embolic stroke, as well as in the planification of intracranial endovascular diagnostic and therapeutic procedures.