Published: 2019-06-30

Editorial

DE LAS COSTRAS AL SUERO HIPERINMUNE

Authors:
Carlos Chúa, MsC
Pages:
4
Abstract:
In the eighteenth century v ariola virus was ravaging Europe. In 1796 Edward Jenner performed the first inoculum of v ariola virus in a school child. The inoculum (vaccine today), was collected from a pustule from the hand of a woman who had been infected during the milking of a cow infected with the virus. There arose the first immunization in the history of medicine. In 1980, after a global campaign, the World Health Assembly announced the eradication of variola virus , one of the most lethal infectious diseases in humans
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Biography of Dr. Jorge Antonio Henry Leiva

Authors:
Mario Contreras, MD
Pages:
6
Abstract:
Talking about someone you consider a friend, a teacher, a successful professional and a great human being is a privilege and an honor. Dr. Henry Leiva entered the Faculty of Medical Sciences of the glorious San Carlos University of Guatemala in 1963, in the 8-year plan, and graduated in 1970. He was then admitted to the Roosevelt Hospital Surgery postgraduate in 1970, which concludes, as chief resident, in 1972. Having passed the American examination for foreign doctors (ECFMG), he is accepted as a resident of Surgery at Temple University, Episcopal Hospital, Philadelphia Pennsylvania, in 1972. He finishes his training with Honors and is chief resident by opposition in 1974-75.
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Articles

Zika in pregnancy and perinatal outcome

Authors:
Daphne Araneda Sazo, MD
Pages:
7-10
Abstract:
Received: May 12, 2019  Accepted: May 10, 2019 Objective: To determine the perinatal outcome of pregnant patients infected with the Zika virus, attending “Hospital General Juan José Arévalo Bermejo, Instituto Guatemalteco de Seguridad Social (IGSS)”, during the period of March 2016 to March 2017. Materiales y métodos: Retrospective cohort study performed in place and date describe in 56 patients who meet the criteria of a reliable case of Zika during pregnancy, data collected by the data collection ballot. Results: The variables with the highest risk were associated, showing that the patients who had the combination of being 35 years old and being in the first trimester of pregnancy during the infection by Zika had a 3 times higher risk of having adverse perinatal outcomes. The perinatal pathologies that were evidenced in pregnant patients with Zika within the studied population were preterm birth, microcephaly, dolicocephaly, intrauterine growth restriction, fetal death, hyperbilirubinemia and pielocallectasia. It was determined that a case of coinfection with flavivirus dengue was present in all the patients in the study and this patient did not present perinatal pathology. Conclusions: Pregnant women with Zika over 35 years of age, with four births or more, diagnosed with Zika infection in the first trimester, with vaginal delivery as a route of pregnancy resolution and preterm birth have a higher risk of adverse perinatal outcome.
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Improving Primary Health Services for Post Abortion Care in Guatemala

Authors:
Edgar Kestler, MD, Erick Morales, MD, María González, MD
Pages:
17-22
Abstract:
Received: Jan 28, 2019   Accepted: May 14, 2019 Objective. To introduce Post Abortion Care services in primary health centers in order to improve access and capacity building to strengthen health systems in areas with underserved indigenous population. Methods. From April 2014 to March 2016 a descriptive pilot study included a total of 247 women experiencing abortion complications. No treatment for abortion complications was offer before. Clinical education, training, monitoring and evaluation system were implemented. Results. Two hundred and thirty-two (94%) patients with incomplete abortion were treated with the state-of-the-art method of “manual vacuum aspiration”, never used before at service, 65% under para-cervical anesthesia, 20% with analgesia and sedation and 15% without any. Seventeen per cent of the patients treated were young girls under 19 years old and the largest age group treated for abortion complications were between 20 and 24 years old (26%). These two groups together represent 43% of the population served at the community level. Seventy-four per cent of the women received contraception counseling before and after the procedure and 57% were provided effective contraceptives before leaving the facility. Conclusions. Capacity building was successful for institutionalize post abortion services. Over 40% of patient treated at community level are younger population with active sex life and without information or access to contraceptive services.
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Social networks addiction in students specializing in scientific research

Authors:
Astrid Bay, MD, Lenni Picén, MD, Gloria Surec, MD, Virginia Wong, MD, Renato Ponciano, MD, Jorge Galindo, MD
Pages:
23-26
Abstract:
Received: Nov 12, 2018 Accepted: June 23, 2019 Purpose: To determine social networks addiction in students specializing in scientific research at the Postgraduate School of the Engineering Faculty of the San Carlos de Guatemala University with the establishment of: obsession, lack of personal control and excessive use, during July August 2018. Material and Methods: A quantitative, cross sectional study carried out in all the population of students with 101 participants, 58 women and 43 men. The presence of social networks addiction was evaluated using the Escurra and Salas questionnaire which was adapted to the guatemalan context. Results: The students’'D5 average age was 26 years old, 57% of the population was female and 43% was male. 48% of participants preferred WhatsApp as their favorite social network, 29% chose Facebook, 20% picked Instagram and 3% selected Twitter. The obsession for social networks was established in 19% of the students, where 56% of this proportion was female; 20% presented lack of personal control, where 51% were also women; excessive use was reported in 7% of the population, where 55% were positive responses from men. Conclusions: Participants were almost entirely young and female. The favorite social networks were WhatsApp and Facebook. A fifth of the subjects presents obsession for social networks, one fifth has lack of personal control and one in ten students excessively uses these virtual platforms; those who are addicted are mostly women.
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Knowledge and attitude about organ donation and transplantation in medical students

Authors:
Estuardo Canek, MD, Alfonso Cifuentes, MD, Cesar López, MD, Rodrigo Menéndez, MD, Astrid Ordoñez, MD
Pages:
27-29
Abstract:
Received: March 9, 2019 Accepted: June 20, 2019 Purpose: Determine the level of knowledge and attitude about organ donation and transplantation in students of the Faculty of Medical Sciences (FCM). Material and Method: A non-experimental, descriptive, cross-sectional study was realized inthirdyear students of the FCM of the University of San Carlos de Guatemala (USAC) between july and august of 2018, with a sample of 60 students, the level of knowledge and attitude was evaluated through a survey prepared by the researchers and then the limits of these variables were calculated using the scale of Estaninos. Results: The sample studied was formed by 52% (31) of women and 48% (29) of men; the average age range is 20 to 21 years; the Catholic religion predominated with 47% (28), evangelical 43% (26) and other 10% (6). The level of knowledge was medium and with an indifferent attit de about organ donation and transplantation, which represented 40% (24) and 58% (35) of the total subjects under study respectively. Conclusions: Third year FCM students of the USAC presented a level of knowledge and attitude indifferent about organ donation and transplantation.
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Prevalence of depression and post-traumatic stress in volunteer firefighters

Authors:
Miriam Velásquez Velásquez, MD, Caren Castillo, MD, Iracema Mancilla, MD, Irene López, MD, Roberto Arenales, MD
Pages:
30-32
Abstract:
Received: Dec 31 2018 Accepted: May 23, 2019 Objective: To determine the prevalence of depression and post-traumatic stress in volunteer firefighters in the department of Guatemala. Material and Methods: This is a quantitative analysis, with descriptive, transversal design, work that has worked more than a year in the volunteer firefighters of stations No. 4, 10, 25, 50 and 100 of the department of Guatemala, Data were obtained through the evaluation of post-traumatic stress and the automatic applied Beck depression evaluation scale. Results: Volunteer fire stations showed that 20% had symptoms of depression and 10% had symptoms suggestive of post-traumatic stress. The age group most affected is that of 40 to 50 years. According to the classification of depression, 13% have mild depression, the rest is normal at the time of the study. Conclusions: It was observed that 2 out of 10 volunteer firefighters present symptoms of depression and 1 out of every 10 volunteer firefighters presents symptoms of post-traumatic stress.
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Microbiological profile of isolated patogens from urethral and vaginal secretions

Authors:
Ebelin Illescas, MD, Wendy Cárcamo, MD, Edson Pérez, MD, Christian Coxaj, MD, Vivian Lara, MD, Raúl Palacios, MD, Aída Barrera, MD
Pages:
33-36
Abstract:
Received: Nov 6, 2018 Accepted: Apr 10, 2019 Purpose: To determine the microbiological profile of isolated pathogens in the vaginal and urethral secretion of the adult population between ages 18 to 60 years in outpatient clinic of the Sexually Transmitted Infections (STI) of zone 3 Health Center, Municipality of Guatemala, Department of Guatemala, during June–July 2018. Population and methods: Descriptive, cross sectional study developed in a convenience sample of 120 outpatients of both sexes who consulted the STI clinic. Results: The predominant age group was from 18 to 22 years, only 2 patients were male. Microbial growth was evidenced in 59 samples, 66 pathogens were isolated: Candida albicans 36.3% (24)9, Gardnerella vaginalis 25.7% (17), Candida glabrata 16.65% (11), Trichomona vaginalis 15.1% (10), Candida parapsilosis 3% (2) and Neisseria gonorrhoeae 3% (2). We having found 7 case  of mixed infection. The predominant clinical simptomatology was thitish, semelly discharge, > 2 weeks of evolution with itching and pain. Antimicrobial resistance: Candida glabrata presented 63.64% (7) and Candida albicans 41.7% (10) to fluconazole, Gardnerella vaginalis 53% (9) to metronidazole and clindamycin and Neisseria gonorrhoeae 50% (1) to ciprofloxacin, cefexime and ceftriaxone. Conclusions: The microbiological profile included Gardnerella vaginalis, Neisseria gonorrhoeae, Trichomonas vaginalis, Candida albicans, Candida glabrata and Candida parapsilosis, predominantly in females on ages between 18 to 22 years.
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Risk factors associated with lesions in runners 16 to 68 years of age

Authors:
Zeasseska Noriega Barneond, MD, María Aguilera Cuevas, MD, Marcell Nicole, MD
Pages:
37-40
Abstract:
Received: March 20, 2019 Accepted:  May 15, 2019 Purpose: Since 2010 there has been an increase in amateur athletics or "street races" and by 2015 around 200 races a year have been held in the country. The increase of amateur racers has also led to an increase in the pace of training and therefore the risk of injury. Different studies place the rate of injuries, about 20 - 79%. Methods: An e-mail invitation and WhatsApp electronic survey was administered to club-runners to determine the existence of risk factors associated with injury. Results: 233 surveys were obtained for analysis. The majority of the respondents 64.38% (150) were men. The average age was 35 years; have more than 5 years of practicing athletics 28.33% (66); the average number of days invested in weekly training is 4; the average weekly distance traveled was 26.79 kilometers; are advised by a coach 61% (141); they use special running shoes and their type of posture 65% (150); they usually train on asphalt 91% (212); and have presented lesions 74% (172). The most frequent injury was tendinitis 43% (101). Their strongest lesions were considered to be moderate 31% (72). Conclusions: Most runners have had an injury. The time of practicing athletics, weekly time invested in training, number of kilometers per week, type of advice received, running foot posture and habitual training surface; were statistically associated with the appearance of lesions.
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Clinical and epidemiological characterization of patients with neurocysticercosis diagnosis

Authors:
Carlos Pozuelos, MD, Cristha Alquijay, MD, Luis González, MD, María Castillo, MD, Yorgi Ordoñez, MD, Pedro Brol, MD, Gerardo Taylor, MD, Gabriel Longo, MD, Elisa Hernández, MD, Oscar Palacios, MD, Juan Barrios, MD
Pages:
41-44
Abstract:
Received: Feb 20, 2019 Accepted: May 10, 2019 Objectives: this research made this characterization for patients from three Guatemala’s hospitals diagnosed with neurocysticercosis. Materials and Methods: the data from a 5 years registry was used to make the characterization of the patients with age from fifteen to fifty years old. To make the characterization, we use seven variables where we included social and clinical characteristics. Results: Headache, hydrocephalus and seizures are the prevailing symptoms, found in more than fifty percent of the cases. The parasites colonizemore frequently the parenchymatous and the ventricular regions. Epidemiologically, we determined that the prevalence of the parasite is one in a thousand patients.
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Results of the sentinel surveillance exercise for suspicious cases of chronic kidney disease

Authors:
Berta Sam Colop, MD, Pedro Dávila, MD, Angie Aguilar González, MD, Lorena Gobern, MD, Randall Lou Meda, MD
Pages:
11-16
Abstract:
Received: Nov 22, 2018   Accepted: March 19, 2019 Introduction: The prevalence and mortality rates of Chronic Kidney disease in Guatemala have increased during the last decade. In order to obtain epidemiological information and establish the relationship of the CKD with risk factors, an epidemiological vigilance in selected national hospitals marker was monitored. Methods: The results of the Quetzaltenango, San Benito Petén and Chimaltenango Hospitals are described during the period from October 2017 to March 2018. Results: Nine hundred and sixty eight patients were recruited. The mean age was 41 years (SD, 17.4) and 32% were male. Forty eight percent of the patients were from Chimaltenango Hospital, followed by Quetzaltenango Hospital with 37% and San Benito Hospital with 15%. Forty percent of the patients had an adequate weight, 14% had a history of arterial hypertension and 9% had diabetes mellitus. The mean eGFR of the patients was 98.7mL/min/1.73m2 (DS, 31.32). Sixty-five p e r c e n t o f t h e p a t i e n t s h a d eGFR>90mL/min/1.73m2, 28% between 90 60mL/min/1.73m2 and 7% eGFR<60 mL/min/1.73m2. Of the patients with eGFR <60 mL/min/1.73m2, 29% were overweight and 13% were obese. These patients have 2.18 times the probability of having high blood pressure and 4.48 times of having diabetes mellitus in relation to patients with eGFR> 90 mL/min/1.73 m2. Conclusion: Seven percent of the patients presented an eGFR <60 mL/min/1.73m2. Hypertension and diabetes mellitus was significantly associated with a low eGFR.
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Case Report

Knee Ostheoarthrosis. Treatment with Platelet Rich Plasma. Report of 29 Cases

Authors:
Claudia Morales, MD, Erika Pérez, MD, Antonio Galindo, MD
Pages:
45-46
Abstract:
Knee osteoarthritis is a chronic disease with a high world prevalence. When human populations become older, the number of people affected rise with a great impact in the quality of life. The treatment of this disease has been difficult and collateral effects may be dangerous. The chronicity of the disease requires prolonged treatments with worst collateral effects and high costs. The intraarticular application of platelet rich plasma has been utilized for a long period with few collateral effects reported, but, the costs are high when certain procedures are used for the collection of the plasma. In this report we describe the demographic characteristics of 29 people treated in the Physical Medicine and Rehabilitation Department at the San Juan de Dios Hospital. All patients have reported beneficial effects and practically none important collateral effect. The samples were obtained in the Clinic Laboratory at the Hospital, where, with the actual equipment and personal is obtained with a very low cost. This resources are available in every hospital in our country, we propose its utilization with an important reduction in costs and a great impact in the quality of life of the affected persons.
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Central nervous system primary melanoma associated with neurocutaneous melanosis

Authors:
Ana Orantes, MD, Patricia Chang, MD, Julia Ovalle, MD, Marisol Gramajo, MD
Pages:
47-48
Abstract:
Primary melanomas of the central nervous system are rare and associated, in up to 40-50% of cases, with neurocutaneous melanosis. A case of an adult patient with this an unfavorable course of this disease is presented.
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Rehabilitation of anterior cruciate ligament rupture in a soccer player

Authors:
Silvia Jiménez, MD, Silvana Chávez, MD
Pages:
49-50
Abstract:
Case of pre - and post - surgical rehabilitation in the rupture of the anterior cruciate ligament (ACL) in a footballer. After 24 weeks of treatment, a Lysholm scale of 91 points is obtained. The patient must be treated comprehensively to ensure adequate functionality and the early return to sport.  
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Nephrectomy for grade IV hydronephrosis Case report

Authors:
Gustavo González Reynoso, MD, Allan Molina Estrada, MD
Pages:
51-52
Abstract:
Hydronephrosis is defined as a dilatation of the renal collecting system due to difficulty in the elimination of urine, caused by the existence of an obstacle somewhere in the urinary system, which may be mechanical or functional. It is accompanied by progressive atrophy of the renal parenchyma. The most common causes differ with age. Clinical Case: We present the case of a 47-year old female patient admitted to the hospital with no relevant history due to consultation of left lumbar pain of three weeks of evolution. Discussion: This is a complex syndrome that results from interactions between glomerular hemodynamics and alterations in associated tubular function. Conclusion: The delay in the diagnosis due to the nonspecific symptoms and the beginning of the treatment lead to a worse prognosis.
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Severe urinary tract infection associated to SGLT2 inhibitors Report of a case

Authors:
Mario Nitsch Montiel, MsC, Alejandro Nitsch Prado, MD
Pages:
53-54
Abstract:
A case of severe urinary tract infection in a 56 years old male with diabetes mellitus who required intensive care treatment associated to the use of canagliflozine for one year is reported. Literature review is presented and the importance to provide adequate instruction to patients about possible adverse effects of medications is emphazised.
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