Published: 2021-08-04

In memory of colleagues who have died due to COVID-19

Authors:
Editorial Revista Médica
Pages:
99-100
Abstract:
COLMEDEGUA is honored to pay tribute to health professionals who have died from COVID-19, in the line of duty.

Vector-borne diseases in children in Guatemala

Dengue, Zika, Chikungunya, Malaria, Chagas

Authors:
David Gallo-Chuy, Carlos Chúa, Lesly Alvizures, Alvaro De-León, Jeny Díaz, Cristyn Escobar, María Guillén, María Guerra, Leidy Mux, Melany Sierra
Pages:
101-107
Abstract:
Objective: to determine the epidemiological behavior of vector-borne diseases in Guatemalan children between the years 2015-2019. Material and methods: descriptive, cross-sectional, retrospective study with data from the Epidemiological Registry of the Gerencial Health Information System (SIGSA), of the Ministry of Health and Social Asistance (MSPAS). The geographical distribution, the age ranges with the highest number of cases and the vector-borne disease with the highest number of cases in the country, were determined. Results : of the total reported cases of vector-borne diseases, children 5 to 9 years of age represented 37%. Dengue was the most frequent disease, 68% of cases. Conclusions: The most frequently affected age group was 5 to 9 years, with 37%.  Of the cases reported of frequent vector-borne diseases from 2015-2019, 68% corresponded to dengue. The department of Guatemala has the highest proportion of cases in three vector-borne diseases.  

Homicides in guatemalans under fifteen years of age during the years 2009 to 2020

Authors:
Esio Culajay
Pages:
108-114
Abstract:
Objective : to describe the characteristics of the homicide, which occurred in Guatemalans under fifteen years of age, during the years 2009 to 2020. Material and methods : retrospective descriptive study that characterized the variables in 1187 homicide cases registered in the INACIF computer system. Results : the homicide rate per one hundred thousand inhabitants in both sexes presented a normal distribution (p-value of 0.7868, Kolmogorov test) and a variation from 0.78 to 2.41, with a higher magnitude in men (0.89 to 3.79) than in women (0.67 to 1.83). The median age in both sexes was 13 years (Q1: 8 years and Q3: 14 years). Conclusion : there were statistically significant differences (Z value greater than -1.96 and 1.96) for the higher homicide rate in men compared to lower homicide rate in women during the years 2009 to 2019. The highest seasonality indexes occurred in the months of January (1.51), November (0.84) and July (0.76). Keywords : homicide rate, normal distribution, variation.

Characteristics of personnel occupationally exposed to Ionizing radiation in Guatemala

Authors:
José Morales, Juan Fernández, Kevin González, Allan Godínez, Luis Chocón, Eduardo Gálvez, Edi Rodríguez, Lucía Terrón, María Vásquez
Pages:
115-119
Abstract:
Objective: to characterize the personnel occupationally exposed to ionizing radiation in the main radiology departments of public hospitals and of the Instituto Guatemalteco de Seguridad Social, Guatemala . Material and methods: survey carried out on 104 people. Univariate statistical analysis was applied. Results: the mean age was 37.65 years; 60.5% were male, 54.81% worked on X-rays; 81.73% were technicians and 90.58% had a valid operating license. 97.12% used physical protection measures. Conclusions: of 10 occupationally exposed workers, 6 are men, 7 use the dosimeter, 8 are technicians and 9 have a valid operating license. Most receive a permitted level of ionizing radiation.

Analysis of acute scrotum cases at the Hospital Regional de Occidente, Quetzaltenango, Guatemala

Authors:
Guillermo Ixquiac
Pages:
120-123
Abstract:
Objective: to establish the incidence of orchiectomy for acute scrotum in patients admitted to the Hospital Regional de Occidente, Quetzaltenango, Guatemala. Introduction: the acute scrotum represents a diagnostic challenge. The current results are far from optimal. Material and methods: the clinical records of patients admitted for acute scrotum to Hospital Regional de Occidente, from January 2014 to December 2018 were reviewed. The epidemiological, clinical and cabinet characteristics necessary for the study were collected. Results: orchiectomy was performed in 41 cases. The most affected age group was 11-20 years old. The three main causes of acute scrotum were; testicular torsion, trauma and testicular tumors. The most frequent clinical finding was testicular pain. The most common ultrasound finding was decrease or loss of vascularity. Discussion: the incidence of orchiectomies for acute scrotum was determined; as well as the clinical, epidemiological and ultrasound characteristics of the entity. The knowledge of these data will allow a better diagnosis, management and follow-up of patients at our institution.

Prevalence of triple-positive breast carcinoma at the Instituto Guatemalteco de Seguridad Social

Authors:
Marisol Gramajo, Ana Orantes-Areano, Carolina Camey
Pages:
124-128
Abstract:
Triple-positive breast adenocarcinoma is one that is positive for estrogen, progesterone, and Her 2 Neu receptors. More aggressive behavior has been described. In this study, cases of triple positive adenocarcinoma were identified between the years 2012-2018, diagnosed at the pathology service of the Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social, Guatemala. In the study period, there were 1590 cases of breast carcinoma, and 77 triple-positive cases were found, with a higher prevalence between 50 and 59 years of age. The most frequent histological type not otherwise specified (96.1%). The histological grade II was the most frequent. Ki 67 was positive in 79.2% and P53 in 42.9% of the cases.

Molecular types of breast cancer at Hospital Roosevelt, Guatemala

Authors:
Mirza Ramírez, Juan de-León
Pages:
129-132
Abstract:
Introduction: breast cancer is one of the major causes of morbidity and mortality in the world. It often shows a different biological behavior than expected, so achieving a correct diagnosis could allow choosing a personalized therapy. Through molecular classification, this objective is becoming possible. Objective: to determine the molecular types of breast cancer at the Hospital Roosevelt, from 2015-2019. Material and methods: retrospective study on 180 patients who met the inclusion criteria. Results: the most frequent age group was between 51 and 60 years old. The most common histological type was invasive ductal carcinoma. 63.3% corresponded to a histological grade II. In the molecular classification, there was a predominance of the Luminal A subtype, followed by the triple negative. A small population of triple positives was found (7.2%). Conclusion: the Luminal A subtype was the most frequent, followed by the triple negatives cases.

Analysis of two age groups with Covid-19 to assess survival using the Kaplan-Meier tests

Authors:
Edmundo Velásquez-García
Pages:
133-139
Abstract:
It is intended with this article, to collaborate with the clinician of the Guatemalan Social Security Institute (IGSS), for the study of their cases in chronic diseases such as diabetes, hypertension and cardiovascular diseases, kidney problems, etc. but mainly in this Covid-19 emergency where the treatments carried out are evaluated according to mortality. Survival analysis is also used in Actuarial, so this technique could be applied to large data handled by the IGSS, in relation to the survival trends of its members. In the present investigation, the selected groups were two, one aged 20-30 years (n = 1903) and the second aged 50-60 years (n = 1244). Each group was ordered by days of hospital stay and the frequency of survivors and deaths in each category was compared. In the group of elderly people, the shortest hospital stay was less than 24 hours and the longest was 94 days, the losses observed were 210. Of the 1903 patients in the range between 20 and 30 years, 14 died, the shortest hospital stay was less 24 hours and the longest was 119 days. The non-parametric treatment of the data for the losses reported in the group of older people is 19.51, while in those under 11.48. The survival of each patient was obtained. Survival curves (not shown) and log-rank analyzes (Table 1) were performed. The data from both groups were then treated with the Chi-square test to evaluate the null hypothesis of belonging to a single group or accept the alternative hypothesis that significantly demonstrated the difference between one group and another. The groups generated, in turn, allowed a risk estimate (OR) to be made. Patients aged between 20 and 30 years survive 8.83 times longer than patients aged between 50 and 60 years.

Glycogenosis in liver biopsies

Authors:
Emerson De-la-Rosa, Julia Ovalle
Pages:
140-143
Abstract:
Glycogenesis comprise a set of innate errors in glycogen metabolism due to various enzymatic deficiencies. One case occurs for every 20,000 to 40,000 live newborns of any ethnic group. Due to the complexity of the approach and diagnosis of these entities, we present eight cases of pediatric patients with histopathological diagnosis of glycogenosis by liver biopsy.

Rhinocerebral Mucormycosis at the Hospital General San Juan de Dios, Guatemala

Authors:
Clara Sáenz, Paulina Solares, Pebbles Medina, Victor Argueta, Roberto Orozco
Pages:
144-147
Abstract:
Mucormycosis is caused by Mucormycetes, a ubiquitous saprophytic fungus that affects immunocompromised patients. The frequency with which this disease occurred before and during the COVID-19 pandemic is unknown. We present a series of 8 cases diagnosed histopathologically at the San Juan de Dios General Hospital in Guatemala.

Descending necrotizing mediastinitis in a child

Authors:
Jaime Dionisio-Rivera, Kenneth Escobar-Pérez
Pages:
148-151
Abstract:
Descending necrotizing mediastinitis is a rare disease with a high fatality rate. Few cases have been described in adults and fewer in children. We present the case of a child with this entity, who underwent deep surgical drainage of a retropharyngeal abscess and intravenous antibiotics directed against the isolated germ, Staphylococcus aureus, and against anaerobes typical of the oral flora. His outcome was satisfactory.

Recurrent acute pancreatitis secondary to superior mesenteric artery syndrome

Authors:
Kevin Molina
Pages:
152-154
Abstract:
Superior mesenteric artery syndrome is characterized by compression of the third part of the duodenum by the superior mesenteric artery. The most common causes are congenital abnormalities and loss of intra-abdominal adipose tissue. In healthy individuals, this adipose tissue displaces the superior mesenteric artery toward the aorta, thus avoiding compression of the duodenum. The cause of pancreatitis is due to an obstructive post-papillary syndrome, with retrograde reflux of bile into the pancreatic duct, which activates the inflammatory phenomena of pancreatitis. We present the case of an 18-year-old woman diagnosed with recurrent pancreatitis due to superior mesenteric artery syndrome.

Dystrophic calcinosis cutis in a patient with classic dermatomyositis

Authors:
Nancy Vargas, Alexis Monroy, Diego Cruz, Renato Meléndez
Pages:
155-157
Abstract:
A 41-year-old woman with past medical history of dermatomyositis diagnosed 6 years earlier, on treatment with prednisone and hydroxychloroquine. She had been well until 3 months before her admission, when she began with multiple and painful skin lesions, with white chalk-like discharge, in the axillary region and dorsal side of both hands. Calcinosis cutis was diagnosed. This is an extremely unusual finding in patients with classic dermatomyositis.

Reversible cerebral vasoconstriction syndrome in the elderly

Authors:
Juan Raymundo, José Agurcia, Luis Joj
Pages:
158-160
Abstract:
A 77-year-old female, long-term hypertensive and diabetic, with severe headache followed by acute confusional state. Normal laboratory studies and brain tomography. Cerebral angio-resonance revealed a multifocal decrease in the loops of cerebral arterial vessels of the left and right carotid artery, posterior and anterior circuit. She was treated with steroids and nimodipine, obtaining clinical improvement.

Use of liver-specific contrast in biliary leak secondary to laparoscopic cholecystectomy

Authors:
Juan Paz, Sven Kuestermann
Pages:
161-163
Abstract:
A 23-year-old patient presents with abdominal pain and distention with multiple episodes of vomiting 4 days prior to a laparoscopic cholecystectomy due to acute cholecystitis. Ultrasound and computer tomography of the abdomen reveals intra-abdominal free fluid. A MRI of the upper abdomen with administration of liver specific contrast, gadoxetic acid, is performed and it reported pooling of contrast in the gallbladder fossa 20 minutes after the injection. ERCP is then performed, with placement of biliary stent for treatment with subsequent resolution of the symptoms.

Severe trichuris trichiura infection

Authors:
Hector de-Paz, Lester Gutiérrez, Roberto Orozco, Victor Argueta
Pages:
164-166
Abstract:
Trichuris trichiura is a nematode of the order Trichurida, responsible for the parasitosis known as trichuriasis. It is the third most common intestinal soil-transmitted helminth in humans. The infection is usually asymptomatic. We present case of a 57-year-old male patient with acute abdomen due to trichuriasis trichiura.

Acute motor sensory axonal neuropathy

Authors:
Rosa León-Mansilla, Guillermo Ixquiac-Pineda
Pages:
167-169
Abstract:
Acute motor and sensory axonal neuropathy (AMSAN) is a recently described subtype of Guillain-Barré syndrome. It is characterized by acute onset of distal weakness, loss of deep tendon reflexes, and sensory symptoms. Electrophysiological studies show slightly reduced nerve conduction velocities and marked reduction in muscle action and sensory nerve action potentials. This case corresponds to an 8-year-old male patient, who presented with equine gait, spontaneous falls forward, without infectious or traumatic history, of 6 weeks of evolution.

Gastroesophageal reflux pneumopathy

Authors:
Beily Sapón-López, Kenneth Escobar-Pérez, Robin Alvarez-Gonzalez
Pages:
170-172
Abstract:
Persistent or recurrent pneumonia can occur in pediatric patients. They are an indication to carry out a diagnostic bronchoscopy, since sometimes the cause of the recurrent pathology may not be infectious. This is the case of a patient with recurrent respiratory symptoms, who was diagnosed with gastroesophageal reflux pneumopathy as a result of incompetence of the gastro-esophageal hiatus and his case was resolved with a Nissen fundus duplication.

Intestinal perforation related to tuberculosis

Authors:
Lourdes Herrera, Javier Morán, Osman Batz, Pebbles Medina
Pages:
173-175
Abstract:
Extrapulmonary tuberculosis has a nonspecific picture that makes it difficult to diagnose. We present the case of a 19-year-old patient with pregnancy of 30.6 weeks of gestation and history of colicky abdominal pain of one day of evolution. She underwent an exploratory laparotomy and intestinal resection. The histopathological study reported granolumatous enteritis with acid-fast bacilli consistent with intestinal tuberculosis.

Endoscopic retrograde cholangiopancreatography in residual choledocholithiasis

Authors:
Oscar Gonzalez
Pages:
176-178
Abstract:
The case of a 25-year-old female patient who underwent conventional cholecystectomy for acute lithiasic cholecystitis is presented. On the 5 th postoperative day, the patient presented generalize jaundice, vomiting and intense pain in the right upper quadrant. Endoscopic retrograde cholangiopancreatography was performed, showing residual choledocholithiasis.

Diagnosis of Angiostrongylus costaricensis in endoscopic biopsy of colon

Authors:
Brígida Hernández-Ros, Héctor de-Paz, Pebbles Medina, Pedro Chávez
Pages:
179-181
Abstract:
Angiostrongylus costaricensis is a nematode that affects humans, although this is not the definitive host, causing mainly gastrointestinal symptoms and severe non-specific eosinophilia. The case of a 53-year-old male patient is reported. He presented a clinical picture of difficult diagnosis, finally diagnosed as Angiostrongylus costaricensis parasitosis in endoscopic biopsy of colon.

Choroidal metastasis as the first sign of primary lung carcinoma

Authors:
Maria Zepeda, Patricia Uribe, Gustavo Méndez
Pages:
182-184
Abstract:
Choroidal metastasis is the most common intraocular tumor in adults. Autopsy studies suggest that approximately 10% of disseminated cancer patients have ocular metastasis, more frequently to the choroid. We present the case of a 37-year-old woman who came to the clinic due to decreased visual acuity as a result of choroidal metastasis.  

Sturge-Weber syndrome

Authors:
Maria Zepeda, Yadira Súchite, Gustavo Méndez
Pages:
185-187
Abstract:
Sturge-weber syndrome is a neuro-oculo-cutaneous lesion of unknown cause that appears at birth, it is characterized by a flat angioma that follows the ophthalmic branch of the trigeminal nerve, ipsilateral leptomeningeal capillary malformation, choroidal angioma, intracranial calcifications, seizures and mental retardation. This is the case of a 2-year-old girl with Sturge-Weber syndrome.

Idiopathic Cystic Lung Disease

Authors:
Kimberly Herwig, Maynor Palma, Servio Torres, Juan de-León
Pages:
188-190
Abstract:
Cystic Lung Diseases include a heterogeneous group of pathologies with multiple causes. The clinical presentation is variable and generally includes progressive dyspnea, cough, and chest tightness. The diagnosis is often challenging. The high-resolution chest tomography plays an essential role. The treatment will depend on the primary cause, however, in some cases, this cannot be determined. We present the case of a 45-year-old woman with idiopathic cystic lung disease.

Cutaneous leishmaniasis in upper extremity

Authors:
Patricia Chang, Rosmin Marroquín, Sara Barillas, Julia Ovalle, Tom Samayoa
Pages:
191-193
Abstract:
In Guatemala, leishmaniasis continues to be a public health problem, being endemic in the departments of Petén, Alta Verapaz, Izabal, Quiché, Huehuetenango and El Progreso. We present the case of a 38-year-old patient from Alta Verapaz, with an ulcerated leishmaniasis in the left upper limb.

Sebaceoma and Muir Torre Syndrome

Authors:
Ana Orantes, Marisol Gramajo
Pages:
194-196
Abstract:
Sebaceoma is a benign, papulonodular, yellowish neoplasm that usually appears on the face, scalp, or areas with abundant sebaceous glands. The association of sebaceous neoplasms with Muir Torre syndrome has been described in the literature. We present the case of a male patient with a history of colonic cancer and the presence of a single skin lesion on the chest, two years after the first diagnosis.

Guidelines on gynecological surgery enhanced recovery

Authors:
Lisbeth Godínez, Carmen Samayoa, Luisa Rodas, Sebastián Alvarado, Adriana Estrada, Nancy Hernández, Adriana Knoepffler, Angélica Blanco, Diego Rivas, Carmen González
Pages:
197-199
Abstract:
Enhanced Recovery After Surgery (ERAS) has been created for all surgical disciplines and for anesthesiologists, offering patients a faster and comfortable recovery, with fewer complications, with a rapid return to their daily activities. With the importance of the use of ERAS protocols, we present the following case, managed at the Hospital de Gineco-Obstetricia of the Instituto Guatemalteco de Seguridad Social (IGSS), of a female patient who underwent abdominal hysterectomy. The management is analyzed in accordance to the ERAS guidelines with the aim of an accelerated and optimal recovery of the patient.

Solitary angiokeratoma

Authors:
Ana Orantes, Ricardo Salvado, Marisol Gramajo
Pages:
200-201
Abstract:
Angiokeratoma is a rare benign skin lesion that can occur in children and adults. It has several clinical differential diagnoses.  We present the case of an 86-year-old man with a nodular lesion on the lower limb of unknown duration.

Generalized dermatophytosis by trichophyton rubrum

Authors:
Patricia Chang, Francia Madrid, Heidi Logemann
Pages:
202-204
Abstract:
We present the case of a 68-year-old female patient with a generalized trichophyton rubrum dermatophytosis of 1-year evolution and good response to treatment.

Primary rib osteosarcoma in adult

Authors:
Ana Orantes, Marisol Gramajo
Pages:
205-207
Abstract:
Osteosarcoma is a neoplasm characteristically of young patients, located mainly in long bones. Primary rib involvement occurs only in 1-3% of osteosarcomas. Next, the case of a 62-year-old man with a single bone lesion in the chest is presented.

Board of Directors and Editorial Boards

Authors:
Editorial Revista Médica
Pages:
208-209
Abstract:
Board of Directors of the College of COLMEDEGUA, 2020 - 2022 Commission of the Medical Journal of COLMEDEGUA