Published: 2018-06-30

Articles

Evaluation of Shortened Treatments Protocols of the National Tuberculosis Program.

Authors:
Tulio S Rodríguez, MD, MPH
Pages:
8-14
Abstract:
Received: Feb 4, 2018 Accepted: May 16, 2018 Introduction. The implementation of any health care protocol, requires the synergy of efforts of authorities which ensure the implementation of the system and human and material resources for its development and function. Objectives. The objective of the study was to evaluate shortened anti-tuberculous  treatments in patients admitted to Hospital San Vicente, diagnosed as new cases or retreatment from January 1 to December 31 of the year 2015. Methodology. From a total of 304 patients admitted with a diagnosis of Tuberculosis, 110 patients who comply with exclusive diagnosis of pulmonary tuberculosis and began treatments strictly referred to in Plan ”A" and "B". Results. Recorded according to categories: Cured in the 65% of the patients substantially below the national standard of the 85%. Full treatment 8%, high, in relation to the standard of 2%. High rate of abandonment, 17% compared to the established norm of 6%. Rate of recovered abandonment of the 6% which continue treatment and a rate of global mortality of 9.72%. Conclusions: The effectiveness of the treatment expressed in the rate of cure, was high during the initial phase in the hospital San Vicente but very low thereafter in the outpatient consolidation phase not complying with the national goal standard of 85% due to the high rate of abandonment and deceased.
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Health-related life quality of the primary caregiver of patients with chronic renal disease

Authors:
Erika López, MD, Silvia Ávila, MD, Anna Reyes, MD, Irma Miranda, md
Pages:
15-17
Abstract:
Received: Dec 12, 2017 Accepted: May 13, 2018 Purpose: To determine the health-related life quality of the primary caregiver to patients with chronic renal disease attending the nephrology clinic of the Out Patient Service of the “Instituto Guatemalteco de Seguridad Social”, during the period April- June 2017. Material and method: Descriptive cross-sectional study with a population and sample of 1695 and 349 primary caregivers, respectively. Data was collected applying an instrument based on the Coop-Wonka Questionnaire (HRQOL) and the Zarit test (subjective overload). Results: The average age of caregivers was 43 years with a standard deviation of +/-15 years; 76.7% (268) are female, 39.5% (168) belong to metropolitan region; 33.2% (116) have diversified schooling; 41.2% (144) are spouses; 95% (333) are informal caregivers; 58.4 (204) present good quality of life and 73.3 (256) present an intense subjective overload. Conclusions: Most primary caregivers are spouses, females, informal and from the metropolitan region. The health-related quality of life is mostly good and in terms of subjective overload predominates an intense level.
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Education by competencies, challenge in teaching cellular and molecular biology

Authors:
María Lara, MD
Pages:
18-20
Abstract:
Received: May 15, 2018 Accepted: June 15, 2018 The present investigation was carried out on a group of professors of the courses of cellular and molecular biology, Faculty of Medical Sciences, Universidad de San Carlos of Guatemala, during the months of February and April of the year 2015, with the objective of establishing the perception that the teachers have of the acquired learning and competences to reach by the students when approving such courses. Teachers' perception of the students' learning is based on Vygotsky's theory of constructivism. Theory that refers to how the student acquires learning and progressively builds his knowledge, based on his previous experiences. The analysis of the results obtained in the investigation gave us valuable information to make recommendations to the authorities in charge of coordinating and distributing the contents of the courses.
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Changes in sperm quality with multivitamin supplement in patients with sperm alterations.

Authors:
Judith Becerra, MD, Victor Arroyo, MD, Hugo Mendieta, MD
Pages:
21-24
Abstract:
Received: Dec 10, 2017 Accepted: May 24, 2018 Male factor accounts for 15% of infertility cases. Our goal was to assess changes in sperm quality after multivitamin supplements. It was an observational, cross-sectional, retrospective study performed at the Reproductive Biology Clinic of the Maternal Perinatal Hospital "Mónica Pretelini Sáenz", from January 1 to July 30, 2016, in patients who attended to the consultation for primary infertility and with alterations in direct spermatobioscopy. All were given daily supplement with multivitamin. Initial Spermatobioscopy was performed in 129 patients, in which astenteroatozoospermia was present in 35%, teratozoospermia in 35% and 3% had normozoospermia. We found significant improvement in mobility in 51% and in volume in 46%, but only 22% presented improvement in morphology. We conclude that multivitamins improve sperm quality, especially improving mobility in patients with asthenozoospermia.
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Case Report

Multiple coronary aneurysms. Clinical case report

Authors:
Mauricio O'Connell, MD, Alexis Enríquez, MD, Carlos Herrera, MsC, Héctor Mora, MD
Pages:
25-29
Abstract:
Kawasaki disease was first described in Japan by Tomisaku Kawasaki in 1967, and the first cases outside of Japan were reported in Hawaii in 1976. It is a frequent vasculitis in childhood, affecting children usually under five years of age, although more often to children from one to three years of age. Boys are affected more frequently tan girls by a ratio of 1.5 to 1.0. Originally it was thought to be a rare condition, but this disease has become the most frequent cause of heart disease acquired during pediatric age in developed countries. Most patients seem to have a benign prognosis, but a subset of these patients with coronary artery aneurysms are at risk for ischemic events and require lifelong treatment. Objective: Describe coronary aneurysms as a complication of Kawasaki disease, sensitize the medical group about this complication and insist on early diagnosis and treatment. Conclusion: Coronary aneurysms are a latent complication of Kawasaki disease. It is necessary, therefore, to develop a higher index of suspicion of this disease, and thus enable an opportune treatment that diminishes its occurrence.
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Moyamoya disesse. Case report

Authors:
Jackeline Flores, MD, Luis Rodríguez, MD, Kevin Guerra, MD
Pages:
30-31
Abstract:
Moyamoya disease is a rare and progressive cerebrovascular disorder characterized by the narrowing or occlusion of major vessels to the brain. Moyamoya in Japanese means ‘puff of smoke’ because of the appearance of the collateral vessels on the cerebral angiogram. The female to male ratio of moyamoya disease is 1.8:1. Ages for patients with moyamoya disease range from 6 months to 67 years, with the highest peak in the first decade and smaller peaks in the third and fourth decades.
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Uterine cervix amebiasis. Case report

Authors:
William Alarcón, MD, Emerson De la Rosa, MD, Víctor Argueta, MD, Roberto Orozco, MsC
Pages:
32-33
Abstract:
Cervical amebiasis is a rare condition. Few cases have been reported. It may be confused clinically with other entities, such as cervical cancer. Our objective is to report a case diagnosed at the Hospital General San Juan de Dios, which allowed timely treatment and resolution of the clinical picture.
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Proteus Syndrome. A case report

Authors:
M Morales, MD, A Reyes, MD, E González Flores., MD
Pages:
34-35
Abstract:
Proteus syndrome (PS) occurs in one out of every million live newborns. Approximately 120 cases have been published in the medical literature. It has characteristics such as excessive, progressive, segmental growth from different tissues of all germ layers. It most commonly affects bone, skin, central nervous system and adipose tissue. It starts between 6 to 18 months of life.
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Gerstman syndrome secondary to arteriovenous malformation in the left parietal lobe. Case report

Authors:
Herbert González, MD
Pages:
36-38
Abstract:
Gerstmann syndrome characterized patients that have four symptoms: alterations in the ability to express ideas in writing (dysgraphia), inability to count and perform simple arithmetic operations (acalculia), inability to recognize the fingers (finger agnosia) and left-right disorientation. for the consequences as posterior parietal lobe involvement dominant for language. The goal is to make a surgical-clinicalanatomical correlation of this syndrome. Here is a case falls arteriovenous malformation about the left parietal region with a patient who consulted the department of neurosurgery Roosevelt Hospital headache and behavioral alteration.
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Bicitopenia. Report of a case

Authors:
Federico Castillo, MD, Jonathan Vielman, MD
Pages:
39-40
Abstract:
Bicitopenia is defined as the decrease of two of the three cell lines, with the possibility of anemia and leukopenia, anemia and thrombocytopenia or thrombocytopenia and leukopenia [1, 2]. The aim of the present work is to report a case of bicitopenia (anemia and joint thrombocytopenia) attended at the San Juan de Dios General Hospital (HGSJDD) where it is studied for the diagnosis in question to determine its etiology and in the same way to establish its therapeutic.  
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Hyperimmunoglobulin E Syndrome. case report

Authors:
Mónica Morales, MD, Andrea Reyes, MD, E González Flores., MD
Pages:
41-43
Abstract:
The Hyperimmunoglobulin E Syndrome is an extremely rare primary immunodeficiency, occurs in approximately one in every million live births [1], in Guatemala there isn’t at the moment any documented case. Hyperimmunoglobulin E Syndrome presents recurrent abscesses by Staphylococcus aureus, recurrent pneumonias with pneumatoceles formation, serum levels of immunoglobulin E (IgE) greater than 2,000 IU / mL and eosinophilia.
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Systemic coccidioidomycosis with multiple calcifications of the microorganism. case report

Authors:
Alejandra Sánchez, MD, Víctor Argueta, MD, Roberto Orozco, MsC, Werner De León, MD
Pages:
44-49
Abstract:
Introduction: Coccidioidomycosis is a systemic fungal infection caused by dimorphic fungi. Two species are known: C. immitis and C. posadasii. It is acquired by inhalation of arthroconidia, the infection is usually benign, but in patients whose immunity is compromised, it is severe and may be fatal. In addition to lung disease, it can spread and cause infections in skin, subcutaneous tissue, brain, bones, joints, and others organs. Objective: to present a case of systemic coccidioidomycosis, which was not diagnosed clinically and had problems of diagnosis in postmortem study, because of the presence of multiple micro calcifications. Material and Methods: postmortem study of a 55-year-old male patient with chronic pulmonary condition. In-hospital studies, no specific diagnosis was obtained. Histological sections stained with hematoxylin-eosin, PAS and Grocott were performed. Results: Grossly, nodular lesions, some indurated, up to 1.5 cm in diameter, in lungs, liver, spleen, mesentery, omentum and kidneys were found. The microscopic examination showed chronic inflammation with formation of granulomas and giant cells, abundant calcified organisms, endospores and arthroconidios. Microorganisms were identified by H & E staining, PAS and Grocott. Conclusion: The case corresponds to a disseminated coccidioidomycosis with numerous calcified microorganisms, which hampered the diagnostic interpretation.
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Photo gallery

Photographs of Interesting Clinical Cases

Authors:
Roberto Orozco, MsC
Pages:
50
Abstract:
Teaching practice hospital, pediatrics General Hospital San Juan de Dios, Guatemala, city.
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