Published: 2021-11-25

Editorial

In Memoriam: Dr. Raúl Cruz Molina

Authors:
Mauricio O’Connell-Juárez
Pages:
210-211
Abstract:
Dr. Raúl Cruz Molina, founder of the Cardiovascular Surgery Unit of Guatemala, passed away on Sunday, August 29 at the age of 90. The pioneer of Guatemalan cardiac surgery whose most important achievement was having led the institutional development of the surgical treatment of heart diseases in the Unit, initially located within Roosevelt Hospital and his conviction that its creation would do much good.
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Original Articles

Geospatial analysis of COVID-19 in Honduras after 18 months of pandemic

Authors:
Roger Bonilla-Carrión, Ester Zapata-Quintanilla
Pages:
212-223
Abstract:
Introduction: the coronavirus disease COVID-19 poses many challenges in public health. For the proper design of prevention and control policies, it is very important to know the epidemiology of COVID-19. Objective: to detect the geospatial clusters of morbidity of COVID-19 in Honduras during the first 18 months of the pandemic. Methods: The morbidity rate of COVID-19 between March 6, 2020 and September 3, 2021 (18 months) was analyzed and it was mapped for the 298 municipalities of Honduras. A space scan was performed to detect clusters of COVID-19, assuming the Poisson distribution. Results: the space scan identified 14 clusters of high COVID-19 morbidity rates in Honduras. Conclusion: in the first 18 months of the COVID-19 pandemic in Honduras, the rate was not evenly distributed throughout the territory because clusters of high COVID-19 morbidity rates were detected. The geospatial heterogeneity of COVID-19 rates should be a guide for the government and public health organizations to implement measures in those geographic areas and raise awareness to prevent community transmission of COVID-19.
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Clinical, morphological and immunohistochemical characterization of breast cancer in Guatemala

Authors:
Elisa Hernandez-López, Jorge Pellecer, Rubin Güity, Carlos Ramírez, Amílcar Sosa, Ronald Morales, Nimzy Letona, Nimsi Barrios, Kevin Barrios, Orlando Rodas-Pernillo
Pages:
224-230
Abstract:
Breast cancer is one of the most common neoplasms in women. Objective: to characterize clinically, morphologically and immunohistochemically the breast cancer of patients from the following institutions: Roosevelt Hospital, San Juan de Dios General Hospital, Cancer Institute and Guatemalan Social Security Institute (IGSS), during the years 2013-2017. Material and methods: retrospective, descriptive and cross-sectional study in which a review of the clinical records of a sample of 397 records was carried out. The data was collected with a digital ballot using the Epi info 7.2 program. Results: the mean age was 54 years. The most frequent reason for consultation was breast mass, 72.29% (n = 287). The clinical findings were breast mass 92.95% (n = 369), lymphadenopathy 45.34% (n = 180) and nipple retraction 16.37% (n = 65). The gynecological and obstetric antecedents were late menopause, smoking and family history of cancer. The histological subtypes were Ductal Adenocarcinoma 89.4% (n = 355), Lobular Adenocarcinoma 5.5% (n = 22) and Mucinous Adenocarcinoma 1.7% (n = 7). The most immunophenotypes were: Luminal A in 41%, Triple negative in 23%, Her2 / Neu carcinoma positive in 17%, Luminal B 19%). Conclusions: The mean age of diagnosis was 54 years. The most frequent reason for consultation and clinical finding was breast mass. The predominant histological type was invasive ductal adenocarcinoma and the most frequent immunophenotype was luminal A.
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Prevalence of Triple-Negative breast carcinoma at the Instituto Guatemalteco de Seguridad Social

Authors:
Ana Orantes-Areano, Carolina Camey, Marisol Gramajo
Pages:
231-236
Abstract:
Triple negative mammary adenocarcinoma lacks immunohistochemical expression of hormone receptors (estrogens and progesterone) as well as of Her 2 Neu receptors. This phenotype corresponds to 15-20% of all breast carcinomas. It is characterized by poor prognosis, high rates of cell proliferation and metastasis. There is currently no specific targeted therapy for this neoplasm. In the present study, cases of triple negative breast adenocarcinoma diagnosed at the Hospital General de Enfermedades, Instituto Guatemalteco de Seguridad Social, were identified in the period 2012-2018. 195 cases out of 1590 cases of breast cancer were found. 69.60% diagnosed in menopausal patients. 76.80% corresponded to neoplasms with histological grade III, with a positive Ki67 in more than 20% in 86.40% of the cases.
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Prevalence of glomerular disease at the Hospital General San Juan de Dios, Guatemala.

Authors:
Alexa Benavides, Cristina Rodríguez, Dorian Toledo, Edward Girón, Elioenai Pérez, Marsha Pineda, Manuel Toledo, Pebbles Medina, Roberto Orozco, Werner De-León
Pages:
237-241
Abstract:
Objectives: to determine the prevalence of glomerulopathies in the department of nephrology and transplantation in adults of Hospital General San Juan de Dios. Stratify glomerulopathies. Material and methods: descriptive, retrospective, cross-sectional study carried out in 190 adult patients who underwent percutaneous renal biopsy (PRB) of native kidney from January 2017 to July 2021, in the department of nephrology and adult transplantation of the Hospital General San Juan de Dios, demographic characteristics and diagnoses of primary and secondary glomerulopathies were determined, obtained from the biopsy records of the nephrology and pathology departments. Results: of the total number of patients, 28.9% presented focal segmental glomerulosclerosis (FSGEF), being the most common glomerulopathy in this center, followed by lupus nephritis (LN) with 16.9% of which class IV LN is the most frequent with 56.2%; the third most common is minimal change disease (MCD) with 14.7%, assuming all three 60.5% of all diagnosed glomerulopathies. The predominant gender was female with 62.1% and the age range where the majority of glomerulopathies occurred was under 30 years of age, with 52.6%. Conclusions: FSGS was the most frequent glomerulopathy. The demographic characteristics that prevailed in the patients were: female sex and age range less than 30 years. Key Words: glomerular disease, prevalence, adults, kidney biopsy, Guatemala.
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Pulmonary function in construction workers of Chiquimula

Authors:
Simón Escoto, Rory Vides, Carlos Arriola, Ángel Chitay, Ronaldo Retana, Maynor Palma
Pages:
242-246
Abstract:
Introduction : occupational exposure to construction materials containing silica are part of the risk factors for the development of respiratory diseases that create pulmonary functional disability. Objective: to describe the pulmonary function by spirometry in construction workers exposed to silica dioxide in a company of construction from the department of Chiquimula in 2020. Materials and methods: descriptive, cross-sectional study, during the period from May 1 to June 30, 2020, carried out in 56 workers exposed to silica dust. An interview, physical examination and spirometry were carried out with the Spirobank II Smart ™ spirometer (Medical International Research) using international standards for their interpretation. Results: 100% (n = 56) were men, 62% (n = 38) aged between 18 to 34 years, 73% (n = 41) had 14 years or less of exposure to silica dioxide and 77% (n = 43) a grade of primary level schooling. Pulmonary function by spirometry was normal in 96% (n = 54), 2% (n = 1) showed a mild obstructive pattern and 2% (n = 1) suggestive of restriction. Conclusions: lung function in the majority of construction workers exposed to silica dust in the company Ingenieros Desarrolladores S.A. measured by spirometry, it is normal and the frequency of an obstructive or suggestive pattern of restriction is low.
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Relationship between serum procalcitonin values and evolution of patients diagnosed with neonatal sepsis

Authors:
Oscar López-Rodas
Pages:
247-249
Abstract:
Introduction: procalcitonin is considered one of the markers of bacterial infections in critically ill patients, in addition to being a diagnostic and prognostic aid in severe sepsis. Neonatal sepsis is one of the leading causes of mortality in newborns worldwide. Objective: to relate serum procalcitonin values ​​and factors such as sex, use of vasoactive drugs, use of glucocorticoids at supraphysiological doses, and clinical evolution in neonates diagnosed with sepsis. Material and methods: descriptive, retro-prospective study in patients admitted to the neonatal intensive care unit, Hospital Regional de Huehuetenango, Guatemala, in the period between October 2018 and January 2019. Results: a direct relationship between serum procalcitonin values ​​was demonstrated > 2 ng / ml, the use of both vasoactive drugs and steroids, with high mortality among the patients studied. Conclusions: Both the male sex and the use of the reviewed drugs significantly increase mortality by presenting procalcitonin values> 10 ng/ml. An early diagnosis added to a comprehensive treatment, provides a better prognosis in newborns who presented sepsis in the neonatal period.
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Knowledge of hospital staff on preventive measures for COVID-19, at the Hospital Regional de Zacapa

Authors:
Inés Lemus, Omar Estrada
Pages:
250-255
Abstract:
The Hospital Regional de Zacapa, is one of the reference, diagnosis and treatment centers of the country, Objective : describe the knowledge of hospital staff on preventive measures for COVID-19. Material and methods : cross-sectional descriptive study by electronic survey, with a non-probabilistic convenience sampling to assess the knowledge of hospital staff. Results : 54 responses were obtained, 63% recognized hand hygiene as the most important procedure, as well as its 5 moments according to the WHO. Only 42% know the time necessary for the correct technique with soap and water, and 20% with alcohol. 81% know how to use a mask, only 25% knew when to dispose it and 28%, the types that can be used within the hospital. Conclusion : The knowledge that the staff has is incomplete, and they consider that the information providaded is not enough.
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Case Report

Acute Silicoproteinosis

Authors:
Maynor Palma, Carlos Morales, Edgar Contreras, Juan de-León
Pages:
256-259
Abstract:
Lung silicosis is produced by the continuous inhalation of silica, one of the most abundant chemical compounds in the earth and rocks. This disease is common in people who work in mines and with construction materials. Currently, it has taken a boom due to the acute and accelerated forms that give a poor prognosis due to the important pulmonary involvement that they cause. We present the case of a man with acute pulmonary silicosis.
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Post-COVID-19 mucormycosis

Authors:
Blandina Mogollón-Gil, Daniela Díaz-Carbajal, José Echeverría, Mary Cotí
Pages:
260-262
Abstract:
Mucormycosis is a rare and opportunistic mycosis, produced by Zygomycetes fungi of the Mucorales order, associated with immunosuppression and with an aggressive course. It can be divided into several types, rhinocerebral, cutaneous and pulmonary. Generally, it is acquired through the respiratory route. Mucormycosis is characterized by infarction and necrosis of host tissues. It can be described as “black fungus, because the infected tissues turn black. The fatality rate is estimated at 40-80%.
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Jellyfish sting complicated with abscesses

Authors:
Ever Morataya-López, Diana Maribel Paz-Huox
Pages:
263-265
Abstract:
The stings from jellyfish are produced through nematocysts. The difference in pressure changes produced by contact with the human skin, allows the inoculation of the venom by the jellyfish. Anaphylactic reactions and secondary infections are rare, but serious. We present de case of a 10 year-old patient with jellyfish sting and soft tissues infection.
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Neural tube defect: nasofrontal encephalocele

Authors:
Hasel Nájera, Delia Mannucci, Williams González
Pages:
266-269
Abstract:
Neural tube defects (NTDs) are congenital malformations caused by incomplete closure of the neural tube during embryogenesis. These are divided into anencephaly, occult or cystic spina bifida, meningocele, myelomeningocele, myeloschisis, craniorachischisis, and encephalocele. The prevention of these anomalies through the consumption of folic acid (FA) must begin at least three month prior to conception and during the gestation. The following is a case of a patient with nasofrontal encephalocele.
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Tuberculous pericarditis in an infant

Authors:
Diana Paz-Huox, Julio Juárez-Lorenzana, Nancy Gálvez-Rafael
Pages:
270-273
Abstract:
Tuberculosis in children can present from the most common pulmonary to extrapulmonary forms, which, because they are paucibacillary, bacteriological confirmation of the disease can be a challenge. Tuberculous pericarditis is rare, however, it represents the first cause of pericarditis in areas of high prevalence of tuberculosis. We present the case of a 5 month-old patient with tuberculous pericarditis.
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Granule Cell Tumor of the esophagus

Authors:
Walter Vásquez-Bonilla, Luis Guerra, Pebbles Medina, Víctor Argueta, Roberto Orozco
Pages:
274-277
Abstract:
Granular cell tumor of the esophagus is a rare soft tissue neoplasm. It originates from Schwann cells and its diagnosis is histopathological. Occurs most frequently in the skin, tongue, subcutaneous tissue and skeletal muscle. Its location in the digestive tract is rare and the esophagus is the most frequently affected organ. It presents after the fourth decade of life, it is generally benign, asymptomatic with masses smaller than 2 cm. We present the case of a 23-year-old patient, without antecedents, with a history of +/- 5 cm mass in the neck, at the level of the esophagus, of 3 years of evolution.
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Uveal melanoma in a patient with neurofibromatosis

Authors:
Susan Dominguez, José Dominguez
Pages:
278-281
Abstract:
The most common malignant primary intraocular tumor in adults is uveal melanoma, constituting 5% of all melanomas, with a mortality rate of 33%. Neurofibromatosis type 1 occurs in 0.03% of the general population and is associated with melanoma in up to 66% of cases. The case of a male patient with uveal melanoma and a history of neurofibromatosis is presented.
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Dupuytren’s disease in a 23 years old woman with polycystic ovary syndrome

Authors:
Mario López-Monzón, Julio Morales, Andrea Vivar
Pages:
282-285
Abstract:
Dupuytren’s disease is a benign fibromatosis, affecting the development of connective tissue in the hand, at the level of palmar and digital aponeurosis, which occurs mostly in men and a reported prevalence of 5% in Caucasians. We present the case of a 23-year-old patient with a history of polycystic ovary syndrome.
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Idiopathic pulmonary arterial hypertension

Authors:
Jorge Guardado, Maynor Palma, Edgar Contreras
Pages:
286-290
Abstract:
Pulmonary Hypertension (PH) is defined as an increase in mean pulmonary arterial pressure greater than 20 mmHg as measured by cardiac catheterization. It is currently classified according to etiological groups proposed in the 2013 Nice Consensus. Its approach and diagnosis requires a protocolized algorithm in which autoimmune, cardiac, pulmonary, thromboembolic and miscellaneous causes must be evaluated, however, in a percentage of patients the cause cannot be clarify, being categorized as “idiopathic”. Treatment includes multiple drugs with various mechanisms of action and with adequate tolerance. We present a series of 4 cases of idiopathic pulmonary arterial hypertension.
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A Dismembered ureteropyeloplasty as a treatment for pyeloureteral obstruction

Authors:
Jéshua Dos-santos, Javier Bolaños-Bendfeldt
Pages:
291-294
Abstract:
Urinary obstruction is any restriction to the urinary flow that, by means of an increase of retrograde pressure, initiates a complex sequence of processes that can cause an alteration of renal function, although when it happens during fetal period, its effects can be more important. We present the case of a 10 month old male patient with diagnosis of grade IV hydronephrosis due to ureteropyelic obstruction.
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Scrotal reconstruction post Fournier's gangrene

Authors:
Jéshua Dos-santos, Ángel Longo-Calderón
Pages:
295-297
Abstract:
Scrotal reconstruction is a procedure performed on patients with areas of loss of tissue from the genital, perineal, or perianal region. The cause of the formation of these areas, in most cases, is due to Fournier syndrome, a disease of unknown etiology, although it has its risk groups such as diabetic patients, immunosuppressed patients, colorectal pathology or alcoholism. Fournier's gangrene is a urological emergency whose final objective is scrotal reconstruction, which was carried out in the present case.
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Primary squamous cell carcinoma of the endometrium

Authors:
Gabriela Aqueche, Marisol Gramajo
Pages:
298-300
Abstract:
Primary squamous cell carcinoma of the endometrium is a rare entity, first described in 1982 by Gebhard, which to be considered primary must meet the Fluhmann criteria of 1928: 1) simultaneous absence of adenocarcinoma, 2) that there is no continuity between the endometrial tumor and the squamous epithelium of the neck and 3) check that there is no proliferation of a primary squamous cell carcinoma of the neck. We present the case of 80-year-old woman who consulted the gynecology emergency room for vaginal bleeding of 5 days.
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Post-instrumentation subglottic stenosis

Authors:
René Villatoro-Martínez
Pages:
301-303
Abstract:
Subglottic stenosis presents a high morbidity and mortality for the patient. The variety of causes, location, severity, association with phonatory and swallowing disorders, together with the diversity of surgical procedures and techniques for their treatment, pose a constant clinical challenge. Here we present the case of a girl with this condition, successfully treated.
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Perforated Meckel diverticulum and ischemic ileal lesion

Authors:
Ana Herrera, María Macz, Guillermo Guarán
Pages:
304-307
Abstract:
The case of a 2 month old male patient is presented, who was admitted to the pediatric emergency, with a history of vomiting of bile content, abdominal distention and fever of 3 days of evolution. On physical examination, he presented abdomen with peritoneal irritation. He was taken to the operating room documenting a perforated Meckel's diverticulum at 2.6 m of Treitz's angle with a flange towards the meso that causes obstruction at this level, for which an exploratory laparotomy, was performed resection of the diverticulum and anastomosis of the small intestine. Patient is discharged in satisfactory condition
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A Lipoma in the transverse colon as a cause of acute abdomen

Authors:
Kimberly Morales-Cano, Marisol Gramajo
Pages:
308-310
Abstract:
Colonic lipomas are rare benign tumors of mesenchymal origin, which require adequate evaluation to guide the treatment plan. We present the case of a 60-year-old woman who consulted the emergency room for an acute abdomen.
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Sacrococcigeal cordoma, an unusual pathology

Authors:
Marco Cifuentes, Susan Vásquez, José Echeverría, Mary Cotí
Pages:
311-312
Abstract:
Sacrococcygeal chordoma is a rare entity, predominant in male sex.  For the differential diagnosis, it is necessary to make a comparison with other neoplasms. We present the clinical case of a 56-year-old male patient, who 14 months earlier presented pain in the lumbar region and the presence of a tumor accompanied by a decrease in muscle strength, paraplegia and sphincter incontinence.
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Peripartum cardiomyopathy

Authors:
Ana Pisquiy-Quemé, Gabriela Alvarado-Boj, Victor Pacajoj-Alonzo
Pages:
313-316
Abstract:
Peripartum cardiomyopathy (PPCM) is a life-threatening condition that usually presents as idiopathic cardiomyopathy that occurs late in pregnancy or in the months after delivery, abortion, or miscarriage, with no other causes of heart failure and with a fraction of left ventricular (LV) ejection (EF) <45%. The clinical presentation of this pathology is similar to that of heart failure of any etiology. A clinical case of heart failure secondary to peripartum dilated cardiomyopathy is presented below.
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Leiomyosarcoma of pancreas with liver metastasis

Authors:
Ricardo Salvadó, Pedro Parada, Pedro López, Yenni Cruz, Lisa De-León, Julia Ovalle
Pages:
317-319
Abstract:
Leiomyosarcomas of the head of the pancreas represent less than 0.1% of all pancreatic neoplasms, sporadic cases have been published. It is believed that they can originate from the wall of the blood vessels or the pancreatic ducts. The first case was reported by Ross in 1951. Currently, less than 100 cases have been reported worldwide. The approach is multidisciplinary due to the complexity of determining the primary site, however its detection is usually in advanced stages of the disease. We present the case of a 42-year-old female patient.  
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Pulmonary lophomoniasis

Authors:
Kenneth Escobar-Perez, Miguel Nolasco, Magdony Perez-Hernandez
Pages:
320-321
Abstract:
Pulmonary Lophomoniasis is a poorly recognized entity as a cause of lower respiratory tract disease. We present the case of a 10-year-old girl who consulted our hospital for chest pain and whose final diagnosis was this condition.
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Primary urinary bladder adenocarcinoma with vaginal invasion

Authors:
Eugene Velásquez, Emerson De-la-Rosa, Lourdes Herrera, Lucía Solé
Pages:
322-324
Abstract:
Primary urinary bladder adenocarcinoma is not a common tumor, it comprises between 0.5 and 2% of all bladder tumors. It has been linked to bladder exstrophy, chronic irritation, and pelvic lipomatosis. Next, the case of a 62-year-old female patient with primary urinary bladder adenocarcinoma and vaginal wall invasion is presented.
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Scalded skin syndrome in a newborn

Authors:
Blanca Mazariegos-Godinez
Pages:
325-328
Abstract:
Staphylococcus aureus produces exfoliative toxins, affecting newborns and young children, sometimes generating generalized affectation, causing detachment of the epidermis, with an incidence of 0.9 to 0.5 cases per million and its morbidity is high, with a mortality of 4 to 10%.
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Diaphragmatic eventration in a newborn

Authors:
Gabriel Papa-de-León, Roberto Estrada
Pages:
329-332
Abstract:
Diaphragmatic eventration is a rare presentation pathology, in which there is an abnormal elevation of the diaphragm, which can be due to congenital or acquired causes. The case of a 38-week gestational-age newborn with no documented prenatal morbidities and no complications during labor was presented. The patient starts with difficulty when breastfeeding, so he is admitted to the pediatric intensive care area. A chest X-ray is performed, showing an abnormality in the right hemithorax; An operating room is taken, where a right posterolateral thoracotomy is performed, showing diaphragmatic eventration, being corrected by plication and intercostal tube. Drainage is removed on the fifth day and the patient is discharged on the seventh postoperative day, tolerating diet and without respiratory distress.
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Oral candidiasis

Authors:
Rosmin Marroquín-Remón, Patricia Chang
Pages:
333-336
Abstract:
The following is the case of a 20-year-old male patient with a diagnosis of oral candidiasis. Antecedents include history of chronic kidney disease KDOQUI V, kidney transplant with graft dysfunction for 2 years, currently on hemodialysis, type B large cell lymphoma and HIV infection newly diagnosed.
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Semblance

Profile of Dr. Román Carlos as a medical researcher

Authors:
Roberto Orozco
Pages:
337-338
Abstract:
Dr. Román Carlos, in addition to being a caring person and an expert oral pathologist of international quality, cultivated another facet in his life, no less important, but less recognized in Guatemala than abroad, that of a medical researcher. The Medical Journal of the College of Physicians and Surgeons of Guatemala, of whose editorial board he was a distinguished member, wishes to recognize his achievements as a researcher, for which it considers it fair and objective to reproduce the evaluation that Google Scholar makes of his achievements as a researcher
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