Published: 2017-06-30

Historical Article

Póstumo Homage to Dr. Carlos Mejía Villatoro President of the College of Physicians and Surgeons of Guatemala 2010-2012

Authors:
Cesar Leonel González Camargo
Pages:
6
Abstract:
As a former teacher of the Faculty of Medical Sciences of the University of San Carlos de Guatemala, I was fortunate to have him as a student and later when he served as President of the College of Physicians and Surgeons of Guatemala and I as Editor of our magazine, we share some numbers , also in the activities of the Guatemalan Association of Infectious Diseases (AGEI), of which he was founder and President.
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Articles

Characterization of Kawasaki’s disease in four private hospitals from Guatemala

Authors:
Pablo J Grazioso
Pages:
7-10
Abstract:
Background: Kawasaki disease is an acute systemic vasculitis which mainly involves medium caliber arteries and has become the first cause of acquired heart disease in children. Its frequency is greater in children < 5 years. There is no known etiologic agent. It has not been described previously in Guatemala. Objective: Determine the clinical presentation, diagnosis, treatment, and results of the charts of children from 0 to 12 years of age diagnosed with Kawasaki disease.  Design: Descriptive, cross-sectional study, realized in private hospitals in Guatemala City.  Results: During the period of January 2003 and December 2013, 26 cases of Kawasaki disease where identified in the study group. All cases except 1 were in children under 5 years of age. All patients had a history of fever even though only 11 presented fever upon entering the hospital. More than 75% of patients had rash, red eyes without discharge, changes in oropharynx and changes in extremities. All patients received immunoglobulin and aspirin in their treatment. 7 received steroids. 15 were Complete Kawasaki, 7 Incomplete Kawasaki, and 4 were diagnosed with Kawasaki disease but not according to guidelines.  Limitations: Deficiency in the medical and paramedical teams to fill out correctly a medical chart. Difficulty in gathering data from archives, especially from old files.  Conclusions: The description of the disease resembles that in the literature and it is present in the population of the country. The disease was diagnosed and treated correctly.
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Prevalence of chronic infectious diseases in clinical autopsies

Authors:
Sergio Castillo, Jorge Navarro, Jairo Cabrera, Dairin Cruz, Ismar Hidalgo, Julian Saquimux, Roberto Orozco, Victor Argueta
Pages:
11-14
Abstract:
Chronic Infectious Diseases are a problem of public health around the world, being a major cause of death. In Guatemala there are not any recent postmortem studies on the topic, thus ignoring its prevalence in clinical autopsies around the country. This study islimited to the following illnesses: tuberculosis, candidiasis, neurocysticercosis, aspergillosis, coccidioidomycosis and histoplasmosis.  Objectives: to determine the prevalence of Infectious Chronic Diseases in clinical autopsies.  Material and Methods: past descriptive research based on protocols of 909 ballots of clinical autopsies from 2006 to 2015 at the Pathology Department in San Juan de Dios General Hospital in Guatemala City.  Results: from this research, 32 cases of Chronic Infectious Diseases and the distribution is the following: 20 of Tuberculosis, 7 of Candidiasis, 3 of neurocysticercosis, aspergillosis, coccidioidomycosis and histoplasmosis with 1 case each one. Out of these 32 cases, 19 were diagnosed in men and 13 in women, 9 of those between the ages of 0 to10 years of age. The most affected organ in 25 of those cases was the lung. 
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Epidemiological indicators of malaria in the Ixil area, Guatemala. 2012–2015

Authors:
Mirta Rodríguez, Katia Querol
Pages:
15-18
Abstract:
An observational descriptive study was conducted to determine some epidemiological variables of Malaria in the Ixil area the years 2012-2015, the sample of 171 patients representing 100% of the occurrence, analysis and processing for calculating descriptive measures included, for risk stratification mathematical calculations, weighted with the objectives of stratifying the risk of Malaria, determine historical trend of the disease, distribute cases according to sociodemographic variables, identify after the first symptoms to diagnosis time and precise history of the made disease patients. Concluding epidemic behavior for the years 2012 and 2013, reducing the risk of disease in recent years, with declining trend, identification of indigenous cases, the municipality of Chajul the most affected in the years 2012 and 2014 and Cotzal in 2013 and 2015, all Plasmodium vivax positive patients, younger age, male gender, only 12 cases with early diagnosis and 27 with a history of the disease are affected.
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Antibiotic prescribing pharmacies and non-prescription consumers, a combination that promotes antimicrobial resistance

Authors:
Augusto Fuentes
Pages:
19-22
Abstract:
Introduction: Bacterial resistance is the partial or total refractoriness of the microorganisms to the antibiotics, is a problem that is in ascending to the world level which appears in natural form given by genetic mutations, nevertheless, this process is accelerated by the use Indiscriminate use of antimicrobials; Sometimes by the doctor himself, in others by sellers of medicines and by the same patients who buy them without a prescription and without a clear indication.  Objectives: To determine the prevalence of people who consult pharmacies instead of a doctor and the prevalence with which they acquire antibiotics without prescription in the municipalities of Quetzaltenango, San Marcos and San Pedro Sacatepéquez. Propose a change initiative to fight against bacterial resistance.  Material and methods: Descriptive observational cross-sectional study conducted through survey reports to 65 pharmacies and 382 people in three municipalities; Two from the department of San Marcos and one from Quetzaltenango. Data were introduced and analyzed in the software Epi Info 7.2.0.1 and excel 2016.  Results: "simple problem" is the main reason people visit pharmacies, 17 people had adverse effects on drugs prescribed by pharmacies.  Conclusions: The prevalence of people who visited a pharmacy instead of a doctor was 60% (95% CI, 55% -65%) and the prevalence of non-prescription antibiotics was 71% (95% CI, 65% -77 %). The Centers for Disease Control and Prevention (CDC) provides informational materials to educate the public about when antibiotics should be used, health personnel are encouraged to use this free material.
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Zero community maternal deaths by postpartum hemorrhage: a need for urgent intervention

Authors:
Edgar Kestler, Vinicio Mora, Leticia Canteo, Moisés Chen, Lisbet Cajas, Delia Chen, Mynor Ramírez, Herbert Ralda, Armeny González, Nancy Gutiérrez, Milvia Gómez
Pages:
23-29
Abstract:
Introduction: Postpartum hemorrhage continues to be the first cause of maternal death in countries with poor or stopped social and economic development. To date, there are success interventions that are used at institutional or community level in countries with high rates of home deliveries. Objective: To suggest interventions that improve the maternal health of the rural and poor indigenous population.  Material and Method: Secondary analysis was done on data-bases of programs monitoring maternal death in both studied departments. The database reviewed was the Management Health System (SIGSA and SIGSA2) on deaths in women of reproductive age and maternal deaths of 17 municipalities and 19 districts of Alta Verapaz and 32 municipalities of Huehuetenango, which have been previously analyzed by the maternal mortality committees. The maternal mortality ratio (MMR) by 100.000 live births, MMR adjusted by age, number of cases and proportions are presented.  Results: During the study period no change in the trend for maternal mortality by post-partum hemorrhage was found. Of the total of cases, post-partum hemorrhage continues to be the first cause of maternal death. 65% and 75% of these maternal deaths by post-partum hemorrhage occur at home in the Alta Verapaz and Huehuetenango, respectively, and retained placental is the main cause of death. Conclusions: Our results shows a dramatic situation for the rural women in the country in the XXI century. There is a necessity that the health managers and policy-makers determine and implement strategies to improve maternal health services at institutional and at community level.
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The importance of scientific publications on the ranking of universities: challenge for a public university

Authors:
Roberto Orozco, Julián Saquimux, Carlos Chúa, Victor Argueta
Pages:
30-34
Abstract:
Background: Ranking universities, in terms of their academic performance, emphasizes scientific research, judged by production and importance of publications in indexed journals. Universities need to know where they stand among other universities in the world in order to develop plans to improve their performance.  Objective: to investigate how much of the credit that belongs to the “Universidad de San Carlos de Guatemala” (USAC), as institution of affiliation, is being detected and evaluated by the university ranking systems.  Material and method: secondary research on data obtained from PubMed of articles published before 2017 by authors affiliated to the USAC.  Results: Most of the 102 articles with affiliations to the USAC did not grant credit properly to the university.  Discussion: The amount of papers published by the USAC in journals listed in PubMed is scarce, generally less than 5 articles per year. The citation of the papers is also low, with only 26 papers cited at least 26 times in indexed journals. There has been an increase in the number and diversity of publications during the last 4 year. There is no consistency in the way authors affiliated to the USAC grant credit to the university. It is possible to improve the USAC ranking with little effort.
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Vitamin D and breast cancer

Authors:
Julissa Cano, Ada Canú, Juan Cux, Delmy Donis, César García, Astrid Godinez, Suellen Narciso, Sergio Ralon, Hugo Tecún
Pages:
35-39
Abstract:
Introduction. Breast cancer in Guatemala is second in frequency, surpassed only by cervical cancer1. The present study was conducted to determine the association between vitamin D levels and breast cancer in patients who attended the Hospital General San Juan de Dios.  Material and Methods. Case-controls study. The total sample was of 156 patients, 52 cases and 104 controls. Medical records were reviewed to confirm the diagnosis and a blood sample was taken to determine levels of 25OHD, which were processed in the Laboratorio Clínico Popular (LABOCLIP).  Results . Eight patients had optimal levels of 25 OHD, two of which (3.85 %) were cases and six (5.77%) controls, No toxic level was found. Suboptimal level was determined with an OR = 1.5 (CI 0.29-7.86) risk of developing breast cancer. The group of 66-70 years had the highest levels of vitamin 25OHD with an average of 22.01 ng/ml and for the group of 56- 65 years, a mean of 21.82 ng/ml. The higher the breast cancer stage, the lower the concentrations of vitamin 25OHD.  Conclusions . Of the patients evaluated, nine of ten had suboptimal levels of 25OHD, with an average of 20.65 ng/ml in cases and 19.71 ng/ml in controls. There is an inverse trend between serum 25- OHD and stage of breast cancer.
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Characterization of the premature retinopathy at the Hospital Nacional de Chimaltenango

Authors:
Verónica Burgos Elias, Nancy Del Cid, María José Sarti, Martin Paiz, Ana Marissa Rivas
Pages:
39-42
Abstract:
Objective: Retinopathy of prematurity (ROP) is a proliferative disorder of the blood vessels of the retina. In Guatemala, there are few data of the disease; so, this study was conducted to characterize and determine the prevalence of retinopathy of prematurity in the National Hospital of Chimaltenango.  Material and Methods: A prospective, descriptive, observational study was conducted during October 2015 to September 2016 at the National Hospital of Chimaltenango. 76 preterm infants were examined. Were included patients with birth weight 2000 g and /or gestational age 37 weeks.  Results: 17 (22,36%) patients with retinopathy of prematurity were found, of which 3 (3,95%) received treatment. The patients who develop plus disease had an average gestational age was 35,33 weeks (DS 1,15) and an average weight of 1861,67 gr (DS 734,76). 48,00% of the patients evaluated were beyond of recommended age for screening in Latin America guidelines, 18,00% of these had ROP including one case requiring treatment.  Conclusions: The prevalence of ROP is similar than other studies in developing countries. However, this study emphasizes the relevance of knows the prevalence and clinical characteristics of ROP in each Neonatal Intensive Care Unit; because cases of ROP were found beyond the thresholds recommend by the Latin American guidelines.
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Anxiety and Depression in patients with chronic renal failure in hemodialysis therapy

Authors:
Walter Villalobos, Pablo De León
Pages:
43-46
Abstract:
Objetive: To determine the prevalence of anxiety and depression in patients with chronic renal failure in hemodialysis replacement therapy in the Unidad Nacional de Atención al Enfermo Renal Crónico -UNAERC- Guatemala.  Population and Methods: A descriptive study conducted in a sample of 86 patients, through an interview made based on the Hamilton test for anxiety and depression.  Results: Of the sample 80 (93%) patients presented anxiety or depression, most of the most severe variants, 42 (49%) increased anxiety, and 34 (39%) very severe depression; 68 (85%) showed the presence of both conditions simultaneously. association was observed between time in hemodialysis longer than 12 months and the presence of depression; (X2): 10.23; Cramer V: 0.34 and P: 0.037.  Conclusions: In the Unidad Nacional de Atención al Enfermo Renal Crónico -UNAERC-, according to the Hamilton scale, nine out of ten patients with chronic renal failure in hemodialysis replacement therapy have some degree of anxiety or depression, of which more than three quarters present coexistence of these two affective disorders; and mostly suffer its most severe variants.
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Case Report

Cutaneous and viscerocutaneous loxoscelism. Report of 4 cases

Authors:
Erwin Castellanos, Lia Rodíguez
Pages:
47-50
Abstract:
The spider bite of the genus Loxosceles produces dermonecrosis at the site of the lesion and systemic complications secondary to enzymatic reactions of its venom, which increases the mortality rate. The objective is to report four cases of loxoscelism treated at the San Juan de Dios General Hospital, where the patients had a satisfactory evolution despite the non-existence of antivenom as the ideal management of toxicity.
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