The "Medical Journal of the College of Physicians and Surgeons of Guatemala," is the official organ of the school and publishes original and unpublished research papers in the various areas of medicine. Convinced that medical literature must be free and freely accessible, the College is honored to inform you that the journal has been indexed in Latindex, Catalog: 2.0, becoming the First Magazine in Guatemala to receive its Credentials and therefore, will be online from the following number at https://revistamedicagt.org/, where there is also the “Open Journal System” platform for sending manuscripts.
Dr. Rafael Morales was born in the department of Huehuetenango, at the foot of the Andes Mountains, on October 24 (San Rafael Day), 1882. His parents were Don Felipe Morales Cardona and Doña María Ordoñez. He was the third son of three brothers, the first being Mr. Domingo Morales and the second Dr. Manuel Morales, both also of a brilliant career. At the age of 14 and under the direction of the competent pedagogue, Don Celso Herrera, he finished his primary school studies in the city of Huehuetenango.
A descriptive study was carried out that clinically and epidemiologically characterized the total number of diagnosed cases of Malaria in the period from 2015 to 2018, in the department of Izabal. The universe of study was constituted by the total population of the department, exposed to the risk of getting sick, by municipalities and health districts, and the total number of cases with the disease in the respective areas is shown in the period under investigation. Variables such as sex, age group, spatial distribution symptoms, among others were used. As a result it was observed that the most affected age groups were 25-39, 15-19 and 10-14. The male sex was affected by 60% and the fever was present in all patients. There was a decrease in the number of cases from 2015, however, between 2017 and 2018 the decrease was not significant. The risk of contracting this infection is geographically focused, to the northwest of the department, in the municipalities of Estor and Livingston.
Objective : To identify the mortality predictive value of the GAP scale (Glasgow scale, age and systolic blood pressure) messured during the pre-hospital phase on patients with trauma injuries admitted at the emergency room of the San Juan de Dios General Hospital, during the months of August to November, 2018.
Equipment and methods: Cross-sectional analysis, descriptive, realized at the place and time mentioned, on 420 patients that fulfilled the criteria of trauma injury with pre-hospital care; data collected by the form designed for it.
Results: The study was made with the objective of evaluating the GAP scoring system which establishes a mortality predictive value, variables provided by the Ambulance Corps at the emergency room of the Surgery Department. Patients were classified on groups by low, medium and high mortality risk as follows: 363 patients (86.4%) low, 46 patients (11%) medium and 11 patients (2.6%) high mortality risk. Results were analyzed, indicating that the VPP for the GAP scale is 100% while the VPN is 91%. With a sensibility of 24%, however, its specificity is of 100% which means that an adequate high mortality risk classification is a decisive predictor in our hospital context.
Conclusions: The GAP scoring system is a useful tool for the objective hospital triage because of its high precision on the mortality forecast in trauma injuries.
Purpose: to characterize the epidemiological factors related to childbirth in adolescent patients at the Poptún District Hospital. Material and method: retrospective descriptive study, in the period January - May 2019. Our sample consisted of 222 adolescent patients, including variables such as age, parity, gestational age, type of delivery, cause of caesarean section, birth weight. Results: of the variables studied, the age of the most prevalent patients was between 14 and 16 years of age, with a total of 144 patients for 65.1%. According to parity, the nulliparous were 112 patients for 50.4%. It is significant to note that almost half of these patients already had a history of childbirth and more, being teenagers. The most important gestational age was 37 to 39 weeks, for 67.1%. The type of childbirth that contributed most was the eutócico with 62.2%. The most important cause of caesarean section was Cephalopelvic disproportion with 20 patients for 23.8%, and previous caesarean section with 13%. The most prevalent birth weight was 3001 to 4000 g with 50.4%. Conclusion: Pregnancy in adolescents remains a prevalent problem in Guatemala.
Ingrid Lorena Sajmolo, M. A Melgar, MD, F. G Antillón, MD, C. R Nájera, MD
Pages:
76-80
Abstract:
Abstract
Diarrhea is an important cause of mortality and morbidity in pediatric patients with cancer (1). The causes are varied and the etiology includes bacteria among these C. difficile, viruses, fungi and parasites and can be associated with mucositis caused by the use of chemotherapy.
Purpose: To describe the intestinal parasites obtained in simple stool samples in patients attending the National Pediatric Oncology Unit of Guatemala (UNOP).
Material and Methods: The results of simple stool samples admitted to the UNOP laboratory which belonged to pediatric cancer patients were included, from September 2016 to April 2017.
Results: A total of 487 samples were reviewed, 88% of the samples were negative The most prevalent parasites were: Blastocystis hominis in 27% (n = 16) and Giardia lamblia in 19% (n = 11).
Conclusion: There is an important frequency of intestinal parasites in the samples received in the UNOP laboratory from pediatric cancer patients, mainly Blastocystis hominis and Giardia lamblia. Studies that correlate the clinic of these patients are required to characterize them.
Abstract, Objective: to characterize outpatient surgery with local anesthesia, from the socioeconomic point of view, in patients with abdominal wall hernias compared with surgery in patients hospitalized for this disease, using regional anesthesia. Material and Method: a total of 208 operated in this period, 153 operated with local anesthesia and 55 with regional were studied. The surgical technique used was that of Mc Vay. Results: abdominal wall herniopasty is the first cause of elective surgery of the Hospital, in male patients, between the ages of 36 and 70 years. Conclusion: with the major outpatient surgery with local anesthesia an economic saving of (85.1%) was achieved for the institution. With the results obtained, it was demonstrated that the institution can use this ambulatory surgery system for which the protocol was proposed and approved by its board of directors.
Walter Oqueli Vásquez-Bonilla, MD, Diego F Moreno-Moriano, MD, Carlos Arango, MD, Roberto Orozco, MsC., Victor Argueta, MsC.
Pages:
85-92
Abstract:
Introduction : Liver biopsy (BH) remains a fundamental diagnostic technique in the study of liver diseases, in combination with various clinical and laboratory data. Objective : to know its usefulness and the diseases of the liver that were diagnosed in the histopathological study, at the Hospital General San Juan de Dios de Guatemala (HGSJDD), from 2014 to 2018. Methodology : descriptive and retrospective observational study in the Department of Pathology of the HGSJDD, in which cases of liver biopsies were identified. Results: Of 44,388 specimens received in the pathology department of the HGSJDD, from January 2014 to December 2018, 293 corresponded to liver biopsies (0.66%). Of these, 209 (71.33%) corresponded to adults and 84 (28.67%) to the pediatric population. In the adult population, 84 (40.19%) corresponded to neoplasms, with hepatocellular carcinoma being the most frequent 39 (46.43%), followed by metastatic adenocarcinoma 21 (25.00%). Of the 114 (54.55%) non-neoplastic cases, 30 (26.32%) corresponded to chronic unspecified hepatitis, which was the most frequent diagnosis. In the pediatric population, 3 (3.57%) cases were neoplastic, 2 of them were epithelial hepatoblastoma (66.67%). In non-neoplastic cases 77 (91.67%), the most frequent diagnosis was atresiating cholangiopathy 19 (24.68%). Conclusion : BH requires a very detailed study of its architecture, cytology, additional studies of histochemistry and immunohistochemistry, as well as clinical history and imaging studies .
Introduction: The high frequency of vaginal discharge in pregnant women, the difficult diagnosis in our environment, the lack of access to adequate treatment and the proven relationship between vaginal sepsis and complications of pregnancy and childbirth, has led to quality improvement. of reproductive health at the Santiago Ixcán Health Post. A diagnosis and treatment of vaginal discharge was performed in pregnant women. Objective: Raise the level of information on vaginal discharge in pregnant women. Material and Method: An educational intervention was designed for 39 pregnant women, for which a pre-experimental study was carried out before - after the intervention, during the month of April 2019. All pregnant women, at first, were questioned, a diagnosis was made about the presence of Vaginal Flow, and applied the survey to determine the level of information they had about the flow vaginal. Then an educational intervention was carried out based on the difficulties diagnosed in the survey. It was subsequently applied for a second occasion the instrument to assess the level of knowledge reached after training. Results: Before the intervention were identified with difficulty: Chlamydial and Candida infections; Inaccurate transmission pathways such as kissing and sharing needles and syringes, illiteracy and sedentary lifestyle as risk behaviors and poorly related low birth weight as a consequence of vaginal sepsis. Conclusions: Knowledge about vaginal discharge was significantly modified, demonstrating the effectiveness of the program.
Abstract
Aim In 2012 Quanjer et.al. presented the global equations of pulmonary function in patients between 3 and 95 years. The aim of this paper is to know if the spirometric behavior of patients with allergic asthma using the tables of the Global Lung Function Initiative 2012 -GLI are similar to the spirometric values of Hsu HK et.al. used in our lung function laboratory for diagnosis. Method and Materials Descriptive study of a series of cases, in patients with allergic asthma diagnosed in 2018 and 2019; that met the inclusion criteria. Results Three patients presented z-score values for FEV 1 below the lower limit for normality and 6 patients presented z-score values below the lower limit of normal for the FEV 1 / FVC ratio. Compared with the pulmonary function values used in our unit, which are those described by Hsu KH, et al. the results were similar in both scales, obtaining the same number of patients with obstruction patterns. Only positive association was found between the level of IgE and the value of FEV 1 (p = 0.01) and between the level of IgE and the z score for FEV 1 (p = 0.03).
Conclusions The spirometric predictive values of Hsu et.al behave similarly to those of the Global Lung Function Iniciative, so we consider that any of the two tables of values are applicable to our population
Osman Agustin Batz, MD, Victor Argueta, MD, Hector de Paz, MD, Walter O. Vasquez Bonilla, MD, Roberto Orozco, MsC.
Pages:
106-110
Abstract:
Introduction : endometrial adenocarcinoma is the most common of the endometrial carcinomas, with a median age of diagnosis at 61 years; nevertheless, 2-14% of the cases can be diagnosed before menopause. Risk factors include nulliparity, estrogen exposition, obesity and Stein-Leventhal syndrome, amongst others.
Material and methods : descriptive-retrospective study of 6 cases of patients under 30 years of age, studied in the Pathology department of the Hospital General San Juan de Dios in Guatemala City between 2009 and 2019 with diagnosis of endometrial carcinoma. The diagnosis and differentiation grade were confirmed by the pathologist, and the clinical information was obtained when available.
Results : Clinical information of 1 patient was impossible to obtain. Two patients had previous pregnancy, the rest were nulliparous. Every patient had irregular cycles since menarchy and 2 had diagnosis of Stein-Leventhal Syndrome, while there was suspicion of the diagnosis in a third patient. Three patients had obesity at the moment of diagnosis.
Discusion : The frequency of endometrial adenocarcinoma in patients under 30 years of age is low. The literature has few reports; they are mainly focused on patients under 40 years of age. Our study provides 6 cases of patients under 30 years of age, with one being under 20 years, being the frequence of this specific age group 2.17% of the total of adenocarcinomas reported in this period of time.
Juan Carlos Barrera Toledo, Sergio Melgar, MsC., Edith Oregón, MsC., Elisa Hernández, MsC.
Pages:
111-114
Abstract:
The objective of this study was to quantify the reduction of time in the routine microbiological diagnosis of positive blood cultures, to detect 240 samples from patients in the different services of the San Juan de Dios General Hospital (HGSJDD), the samples were identified using both the Vitek method and the Maldi-tof method, obtaining favorable results in terms of reducing diagnostic response in favor of Maldi-tof technology.
Gabriel Pérez, PhD., Norberto Blanco, Marcelo Montero, Carlos Jaramillo, Laura Torres, Xavier Rivadineira, Rocío Montes, Matías Anauati, Carlos Tococcari, Alejandro Barbol
Pages:
115-117
Abstract:
Abstract : Myxomas are the most frequent primary cardiac tumors. The symptoms vary and the clinical presentation is usually progressive and is related to the size and location of the tumor. We describe the case of a patient who presented severe heart failure refractory to medical treatment as a manifestation of a giant cardiac myxoma and that required emergency surgery.
Servio Tulio Torres-Rodriguez, MD, Danilo Herrera, MD, Luis López, MD, Antonio Ferriño, MD, Elka Lainfiesta, MD
Pages:
118-122
Abstract:
Coccidioidomycosis is a disease with endemic characteristics from the south of the United States to Argentina. The causal agent is C. Immitis and C. posadasii. The factors that favor its incidence are the humidity, desert soils and the immune suppression of the host. Patients and methods : Three patients diagnosed with pulmonary coccidioidomycosis were included by histopathological study obtained through open pulmonary biopsy by mini-thoracotomy based on clinical, epidemiological and radiological suspicion. Results: Patients of the seventh decade of life with exposure to wood smoke, two of them diabetic women. The predominant symptom was dry cough and radiological patterns were nodular and micronodular. One patient presented spontaneous pneumothorax secondary to left apical cavitation lesion. The pharmacological treatment indicated was itraconazole, obtaining good clinical relocation. Conclusions : Coccidioidomycosis despite being endemic in the American continent, is a rare disease in Central America. Demand for multiple factors that favor their development and diagnosis requires a high clinical suspicion and confirmed by histopathological study.
Javier Alberto Morán-Mejía, MD, Eugene Velásquez, MD, Rosario Velásquez, MD, Elisa Suárez, MD
Pages:
123-126
Abstract:
Abstract
Right-sided congenital diaphragmatic hernia represents 20% of the diaphragmatic congenital defects. One of its complications is hepatopulmonary fusion, of which, 23 cases have been reported worldwide. This can be fibrovascular or parenchymatous.
Case report: 34 gestational weeks femenine newborn, with severe respiratory difficulty, who dies 6 days after birth. The autopsy findings show a right-side hemidiaphragm, with a central defect and herniation of a portion of the right hepatic lobe into the thoracic cavity, presented as an ipsilateral fusion to the right lung, which was hypoplasic.
Joan Michell Espinoza, Salvador Porres, MD, Erwin Mayen, MD, Roberto Orozco, MsC.
Pages:
127-129
Abstract:
Delusional parasitosis or Ekbom syndrome is a psychodermatosis, is determined by the delirious idea of infestation by parasites; in which the patients self-harm in order to get rid of them. It is a challenge for the dermatologists to diagnose this syndrome and the management must be accompanied with psychiatry.
Cisticercosis is an infectious diseace endemic to Central and Southamerica. It is considered one of the most important infectious neurological diseaces around the world, especially because of it’s symptoms. A case of a 7 year-old female with diagnosis of neurocisticercosis with a favorable course.
Cedrick Calderón Vargas, Reyna Sánchez, MD, Ana Chinchilla, MD, Beatriz Barrios, MD, Jacqueline Castañeda, MD, Carmen Samayoa, MD, Ana Ruiz, MD, Andrea Corado, MD, Adriana Estrada, MD, Marcelino Alvarez, MD, Jorge Garcia, MD
Pages:
132-134
Abstract:
22-year-old male patient with a history of arterial hypertension since the age of 11 with follow-up in a public hospital where they perform imaging and laboratory studies with which adrenal mass suggestive of pheochromocytoma is diagnosed in 2015, the patient and his parents are indicated the need for surgical treatment but for personal reasons they refuse such treatment. In January 2018, a new tomography is performed reporting heterogeneous solid mass in the left adrenal gland and in February 2019 it is taken to the operating room for adrenal mass resection.
Osman Agustin Batz, MD, Héctor De-Paz, MD, Julia Ovalle, MD
Pages:
135-137
Abstract:
Pentalogy of Cantrell is a rare congenital disorder, it was first described in 1958 by Cantrell J.R. The complete spectrum includes 5 anomalies: 1- Anterior diaphragm defect, 2-supraumbilical anterior mid-line defect, 3- diaphragmatic pericardium defect, 4- inferior sternum defect and 5- any intracardiac defect. We present an autopsy case of a 27 week old stillborn with complete Pentalogy of Cantrell.
José David Palma-Zambrano, MD, Gladys Beatriz Murga, MD, José Rodolfo Gil, MD
Pages:
138-140
Abstract:
We present the case of a 46 years old patient from Genova, Quetzaltenango, Guatemala; married, illiterate, housewife, christian religion; who came to the emergency with a history of a month pain evolution, in right iliac fossa, colic type without irradiation, which partially was alleviated with ibuprofen. With obstetric-gynecological history of 4 gestations, 4 deliveries, 4 living children and menarche at 11 years old. She was referred to Roosevelt Hospital located in Guatemala City, where she undergoes a total abdominal hysterectomy. The specimen was sent to the pathology department, where all anatomopathological and immunohistochemical studies were carried out.
The case of an 18-year-old patient is presented, who is evaluated in the Hospital de Día unit, with a history of 8 months of difficulty swallowing solid foods, tolerating only the ingestion of liquid foods, associated with nocturnal regurgitations. who consults a private doctor who performs complementary tests and refers her to this unit for treatment. The physical examination does not present alterations, persisting with dysphagia, so it is programmed to perform videolaparoscopic Heller's esophagomyotomy.
