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the use of ultrasound guidance in intrathecal pump refill Dear editor, the placement and management of the intrathecal pump (iP) used for the delivery of drugs into the cere-Figure 1.-this picture shows the injection port of intrathecal pump reservoir. You can see the titanium pump surface as well as the refill port membrane.

Introduction: Low and medium income countries face challenges in access to, and delivery of, surgical care, resulting in a high number of deaths and disabled individuals. Objective: To estimate the capacity to provide surgical and trauma patients care in public hospitals in the Piura region,   Perú, a middle income country. Methods: A survey was administered in public hospitals in the Peruvian region of Piura, which combined the Spanish versions of the PIPES and INTACT surveys, and the WHO situational analysis tool. The extent of the event was assessed based in the absolute differences between the medians of the scores estimated, and the Mann-Whitney bilateral tests, according to the geographical location and the level of hospital complexity. Results: Seven public hospitals that perform surgeries in the Piura region were assessed. Three provinces (3/8) did not have any complexity healthcare institutions. The average hospital in the peripheral provinces tended to be smaller than in the capital province in INTACT (8.25 vs. 9.5, p = 0.04). Additionally, water supply issues were identified (2/7), lack of incinerator (3/7), lack of uninterrupted availability of a CT-scanner (5/7) and blood bank working hours (2/7); in other words, the blood banks in two hospitals were not open 24 hours. Conclusions: There is a significant inequality among the provinces in the region in terms of their trauma care capacities and several shortfalls in the public sector healthcare infrastructure. This information is required to conduct future research on capacity measurements in every public and private institution in Perú.