Vol. 159 Núm. 1 (2020): Enero - Junio, 2020

Published: 2020-06-25

Editorial

The precarious response to the Covid-19 pandemic in Guatemala

Authors:
Ángel Sánchez Viesca
Pages:
1
Abstract:
Guatemala continues to fight the second pandemic of the 21st century called COVID-19. "It is a health war," declared Emmanuel Macron, president of the French Republic, and, in these circumstances: "public health and the welfare state cannot be considered costs or burdens, they are precious goods that must be outside the law. From the market"
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Letter to the editor

The importance of autopsy in epidemics

Authors:
Victor Leonel Argueta Sandoval
Pages:
2-3
Abstract:
It is irrefutably documented that the autopsy has served as a guarantee of quality in the practice of medicine. Despite the multiple technological advances in clinical studies, the margin of diagnostic error, compared to the autopsy diagnosis, is very high, even in developed countries. That is why we consider that the postmortem study should be privileged, so that the medicine increases its quality and has more effective treatments, since it has objective findings on the pathophysiology of diseases, especially in deaths from unknown causes. At the current time of the Covid-19 pandemic, some countries have made the decision not to allow autopsies, which limits adequately investigating the pathophysiology of the disease and seeking adequate treatments. Autopsies have been shown to reveal the exact cause of death in a high percentage of cases and, in epidemics, it is a tool that can facilitate better diagnoses and treatments, which can help reduce the damage caused by the disease.
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Review / Guest Articles

Guides for management of patients with end stage renal disease and transplantation

Authors:
Manuel Humberto Toledo Solares, Elio Pérez, Alejandra Oliva, Dorian Toledo
Pages:
4-9
Abstract:
The coronavirus disease 2019 (COVID-19) pandemic is having a profund effects, since it was identified as the cause of a cluster de pneumonia cases in Wuhan, China. It has since rapidly spread resulting in a pandemic.  The World Health Organization designited the disease term COVID-19. The virus that causes COVID-19 is designated severe acute respiratory syndrome coronavirus 2 (SARS-Co-2). The mayor morbidity and mortality from COVID-19 is largely due to acute viral pneumonitis that evolves to acute respiratoy distress syndrome (ARDS). In this paper we will discuss aspects related with epidemiology, clnical features, test features, manegement of patients with chronic kidney disease, acute renal diseased developed during COVID-19, management of patients in hemodialisys and kidney transplantation .
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Neonates born from mothers positive to SARS-CoV-2

Clinical characterization, feeding with breast milk

Authors:
Francisco Julio Chew Bleb, Lourdes Ajiatas, Wendy Portillo
Pages:
10-17
Abstract:
The presentation of SARS-CoV-2 infection in neonates born to positive mothers is not clear, in studies carried out in other latitudes, there is still no evidence of vertical transmission. The objective is to present five cases of newborns born to SARS-CoV-2 mothers with perinatal infection, in addition to describing the clinical characteristics and the success of using contact and drop isolation techniques at the time of mother-child attachment and maternal feeding to avoid horizontal transmission. Five infants were analyzed during the month of April 2020, obtaining clinical and laboratory data from the clinical record and interviews. All mothers were asymptomatic to SARS-Cov-2 with a history of premature rupture of membranes, fetal distress, oligohydramnios, and preeclampsia. In 3 newborns, clinical alteration secondary to process is unrelated to SARS-CoV-2 infection (suspected sepsis and pneumonia) is evident. RT-PCR tests for SARS-CoV-2 performed in neonates, on different types of samples, were negative. All neonates received breast milk and hadmother-child attachment with isolation measures by drop transmission and contact with medical supervision. In this case report, it was demonstrated that, with the correct use of the techniques of isolation by drops and contact, information, supervision and accompaniment to the mothers, the risk of contact to the newborn was diminished. More studies are needed to determine if there is vertical transmission.
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Original Articles

Social communities and research by university students

Authors:
Ingrid Lorena Sajmolo, Roberto Pineda, Daniel Ortiz, Ronaldo Salazar, Oscar Coti, Antonio Gaitán, Miguel Meneses
Pages:
18-22
Abstract:
The Internet is an indispensable tool, social communities favor publishing, sharing information and self-learning. Purpuse: Determine the use of virtual communities as a research tool for postgraduate students. Material and methods: Cross-sectional, non-experimental descriptive, through a survey aimed at the use of social communities in research to postgraduate students of the School of Postgraduate Studies, School of Engineering of the University of San Carlos de Guatemala, enrolled in 2019, randomly selected. Results: 60 people were studied, 50% female, all admitted the use of a virtual community, seven out of 10 use it as a reference for scientific research and three out of 10 use it for non-scientific information. The virtual community for consulting the most used scientific information is Google 86%, Google Scholar 46%, Google Drive 40%, YouTube 34%, WhatsApp 18%, Facebook 16%, other social networks 12%, and scientific journals 2%. Conclusion: A third of students use virtual communities 3 times or more per week as a tool in scientific research by search engines; other sources of scientific review are less used. Initiatives that promote communication, innovation, entrepreneurship and access to scientific information in virtual communities should be created.
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Proteinuria in inhabitants of a coastal village of Santa Rosa, Guatemala

Authors:
José Pablo de León Linares, Ilder Alvarado, Mónica Monjes, Marcela Vásquez, Mario De León, Francisco Ponce, José Eguizabal, Junior Ajche, Elmer Hernández
Pages:
23-25
Abstract:
General objective: Establish urine protein presence in a small village of coastal region in Santa Rosa, Guatemala.  July 2019. Population and methods: Descriptive and transversal study performed after informed consent in a 575 sample from Casas Viejas village, using a no probabilistic sampling method. Sampling was obtained by urine test strips. Results: Sociodemographic characteristics were: 55.48% (319) female, age median was 24 years old, 39.82% (229) students and 85.25% with no pathological background. Predisposing factors of KD (Kidney Disease) were noted as, 56.17% (323) consumed Non-steroidal Anti-inflammatory Drugs (NSAIDs), 82.26% (473) consumed carbonated drinks, 13.57% (78) alcoholic beverages, pure water median consumption was 6 glasses per day and 13.22 (76) were exposed to agrochemical pesticides. Proteinuria was found in 8.87% (51) of the sample. Conclutions: More than half of population were female and didn´t showed pathological signs; predisposing factors to KD (kidney disease) were frequent NSAIDs use and carbonated drinks consumption a no adequate hydration. Nine of each one hundred people studied presented urine protein.  
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Ultrasensitive reactive C protein and cardiovascular risk in patients with type 2 diabetes mellitus

Authors:
Clara Yesenia Sáenz Guzmán, Josseline Peralta, Elisa Hernández, Yuri Castillo, Walter Mazariegos
Pages:
26-30
Abstract:
Porpuse: To describe the cardiovascular risk of patients with type 2 diabetes mellitus (DM2), according to the values ​​of ultrasensitive C-reactive protein (PCR-us) of the Patronage of the Diabetic Zone 1, in the year 2019. Material and methods: Cross-sectional descriptive study, carried out in the Patronage of the Diabetic Zone 1 where 196 patients over 50 years of age can be taken, obtaining sociodemographic characteristics, anthropometric measurements using Rosthal® weight, flexometer and SECA 213 height meter; In addition to taking blood samples all of the above with prior informed consent, which were processed in iChroma ll where he learned the values ​​of ultrasensitive C-reactive Protein (PCR-us). Results: Patients had a mean age of 62 ± 8.62 SD, 74.4% (146) of the female sex, 54% (106) were Catholic and 82.1% (161) reside in Guatemala. The nutritional status was 26% (50) being normal, 11% (21) overweight and 63% (125) with obesity. For the waist hip index with respect to the female sex, an average of 0.89 ± 0.05 SD and a mean 0.97 ± 0.05 SD of the male sex were obtained. Regarding cardiovascular risk, an average of 2.9 ± 2.8 SD was obtained and 76% (148) were at moderate / high cardiovascular risk. Conclusions: Of the patients studied, 7 out of 10 were women, with a mean age of 62 years. 7 out of 10 were found to be overweight or obese with a mean waist hip index with respect to elevated sex. The cardiovascular risk presented an average of 2.9 ± 2.8 SD and 8 out of 10 are at moderate/high risk.  
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Temporal evolution of skin and soft tissue lesions, postmortem study using histochemistry and immunohistochemistry.

Authors:
Lilian Isabel Cayax
Pages:
31-34
Abstract:
In the investigation of the facts surrounding a violent death, it is particularly useful to establish the age of the injuries that are observed. In this study, the temporal evolution of skin and soft tissue injuries was established in samples from cadavers. The medico-legal autopsies were performed at the Instituto Nacional de Ciencias Forenses de Guatemala (INACIF) and had determined the presence of injuries and a routine histopathological study had been carried out. New sections were made and stained with hematoxylin-eosin, Masson's trichrome and Immunohistochemistry. Positive identification to Collagen IV, CK 5 and EMA, established the presence of certain tissue components. Immunohistochemistry allowed specific identification of tissue constituents. Because different cellular elements appear or disappear according to the time that elapses from the time an injury occurs to the moment healing occurs, it is possible to establish the age of the lesions.  
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Case Report

Multicystic renal neoplasms - 5 year experience

Authors:
Marisol Gramajo, Alina Fortuny
Pages:
35-37
Abstract:
Predominantly cystic clear cell type Renal Cell Carcinoma (RCC) and Low Malignant Potential Multilocular Renal Neoplasia are very rare entities with excellent prognosis. Below we present the 5-year experience of these pathologies at the Guatemalan Social Security Institute.
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Dysplastic gangliocytoma of the cerebellum (Lhermitte- Duclos disease) associated with Cowden syndrome

Authors:
Marisol Gramajo, Pedro Parada-Roesch
Pages:
38-40
Abstract:
The dysplastic gangliocytoma of the cerebellum, known as Lhermitte-Duclos disease, occurs in the third or fourth decade of life, without sex predilection. It is not clear whether the condition represents cerebellar disembriogenesis, a hamartoma or a neoplasm, but clinically, It presents as an expansive mass in the posterior fossa, of slow growth. The case of a 31-year-old woman with an incidental cerebellar tumor is presented.
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Synchronic endometrioid carcinoma of the uterine corpus and Fallopian tube

Authors:
Javier Alberto Morán Mejía, Rosario Velásquez, Victor Argueta, Roberto Orozco
Pages:
41-43
Abstract:
The appearance of synchronous tumors in the female genital tract is uncommon. Little is known about the simultaneous presentation of endometrioid carcinomas of the endometrium and Fallopian tube. We present a case of a 38-year-old female patient, nulliparous, with a one-month history of vaginal bleeding, who underwent hysterectomy and left salpingo-oophorectomy. Definite pathologic diagnosis was endometrioid carcinoma of the endometrium and Fallopian tube simultaneously.
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Brown Tumor

Authors:
Marisol Gramajo, Ana Orantes
Pages:
44-46
Abstract:
The brown tumor is a bone neoplasia associated to increased levels of parathyroid hormone. When located in the mandible, it can be misdiagnosed as other bone giant cell tumors and, as a consequence, the parathyroid abnormality be neglected. The case of a man with mandibular tumor and hyperparathyroidism is presented.
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Glioblastoma with primitive neuronal component

Authors:
Eugene Velásquez, Marisol Gramajo
Pages:
47-49
Abstract:
Glioblastomas represent the most common central nervous system malignant tumor in adults. These may present various histological patterns, in which glioblastoma with primitive neuronal component (GPBC) is one of the rarest. The following case presentation corresponds to a 49-year-old woman, with a history of cervical mucinous adenocarcinoma, treated with chemotherapy 2 years previously, who was referred of a brain mass. Upon microscopic, the diagnosis corresponded to glioblastoma with primitive neuronal component.
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Interstitial pulmonary emphysema. Not all hyperlucency is pneumothorax

Authors:
Kenneth Escobar Perez, Alejandra Santizo-Paz, Boanerges Rodas, Julissa Granados, Andrea Rivas
Pages:
50-52
Abstract:
Differentiating thoracic hyperlucent images in neonatal patients can be a challenge for the clinician, as differential diagnoses of them are not limited to pneumothorax alone. We present the case of a 40-day-old patient, that as a result of his admission to the intensive care unit due to a community-acquired pneumonia, presented interstitial pulmonary emphysema as complication of the infectious process and mechanical ventilation. We review and present the findings available in the scientific literature on this rarely described condition, its diagnosis and therapeutical approach.
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Choroidal plexus carcinoma of extraventricular presentation

Authors:
Luis Edvin Guerra García, Lizza Paz
Pages:
53-55
Abstract:
Choroidal plexus carcinoma belongs to primary brain tumors. These malignant neoplasms are rare, especially in adults. It is classified by the World Health Organization (WHO) as grade III. In the total population it represents less than 1% of all brain tumors. It is more common in male patients. They are more frequent in childhood (80%); in adults its most frequent location is the fourth ventricle (63%). We present the case of a 59-year-old female patient with choroidal plexus carcinoma of extraventricular presentation, with invasion to brain tissue and without hydrocephalus.
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Molluscum contagiosum in an HIV patient

Authors:
Katherine Giselle Klussmann, Patricia Elizabeth Chang
Pages:
56-58
Abstract:
A case of a 32-year-old patient with a diagnosis of molluscum contagiosum is reported, through which she is diagnosed with a human immunodeficiency virus infection.  
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Brain tuberculomas simulating metastatic disease

Authors:
Marisol Gramajo, María Ximena López Cervantes
Pages:
59-61
Abstract:
Tuberculosis is one of the leading causes of death due to an infectious agent in the world, the central nervous system condition represents approximately 1% of all extrapulmonary cases. It causes more than two million deaths annually and 98% of these cases occur in developing countries. Its presentation can be atypical, which leads to late and sometimes erroneous diagnosis, mainly in immunocompetent patients, without any other apparent risk factor, where the diagnostic delay is four times greater than in immunocompromised patients. The diagnosis is the high clinical suspicion, supported by the study of cerebrospinal fluid and imaging, an early and timely treatment contributes significantly to the evolution of the patient. Below is the case of a 42-year-old female immunocompetent patient who had an insidious presentation, which delayed her diagnosis
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White Surface Onychomycosis

Authors:
Katherine Giselle Klussmann, Patricia Elizabeth Chang
Pages:
62-64
Abstract:
A case of a superficial white onychomycosis in an immunocompetent patient is reported for the infrequent manifestation of this type of onychomycosis.  
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Congenital pseudoarthorisis of the tibia associated to Neurofibromatosis type I

Authors:
Marisol Gramajo, Ricardo Salvadó, Julia Ovalle
Pages:
65-67
Abstract:
The congenital pseudoarthrosis of the tibia is a rare pathology that may be associated with type I neurofibromatosis. A case of congenital pseudoarthrosis of the tibia is presented for every two hundred and fifty thousand people. It is suspected when they present multiple pathological fractures. The approach is multidisciplinary, for its early detection and the diagnosis of associated pathologies; to improve the quality of life of patients. We present the case of a patient of three years and seven months with a diagnosis of congenital pseudoarthrosis of the tibia associated with neurofibromatosis type I.
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Hand-foot-mouth disease in adult

Authors:
Elda Marcela Mendoza Fajardo
Pages:
68-70
Abstract:
Hand -foot-mouth disease (HFMD) is an acute pathology, highly contagious, viral exanthem that commonly affects children younger than 5 years. Classic HFMD manifests with fever and a distinctive papulovesicular eruption, limited to the hands, feet, and oral mucosa. The infection is caused by viruses of the genus enterovirus, which are transmitted via faecal-oral route, or by direct contact with an infected individual. The most common causative agent is coxsackie virus A16 (CVA16), which causes a mild, self-limiting infection. This disease is rare in adults, and can be severe; it is estimated that only 11% of those exposed to the virus become infected and that 1% of these present clinical manifestations. I present a case of a 28-year-old adult with EPMB with atypical clinic characteristics.  
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Veins of the Lower Member. Subfascial Endoscopic Ligation.

Authors:
Allan Keithel Molina Estrada, Douglas Ernesto Sánchez Montes
Pages:
71-73
Abstract:
Chronic venous insufficiency is a prolonged condition of incompetent venous circulation and its appearance is due to partial obstruction of veins or blood leaks around the venous valves, being more frequent in females between the third and fourth decade of life. lifetime. Clinical Case: We present the case of a male patient of 16 years of age, without relevant history, referred from the Departmental Hospital due to edema in the lower left limb and pain at walking for 1 year. Discussion: Chronic venous disease is a multifactorial pathology, whose main etiology is genetic factors, causing functional as well as aesthetic problems. Conclusion: Subfascial Endoscopic Ligation of Perforating Veins of the lower limbs is a minimally invasive procedure, aimed at interrupting blood flow through incompetent perforating veins and thus decreasing venous hypertension.  
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Anesthetic management of a patient with Henoch-Schönlein purpura and abdominal pain in the right iliac fossa

Authors:
Daniel Marcelo Morales Villatoro, Claudia Muralles
Pages:
74
Abstract:
The Henoch-Schönlein purpura is a systemic disease characterized mainly by small vessel vasculitis, abdominal pain, arthralgia (or arthritis) and kidney damage, particularly observed in the pediatric population between 2 and 6 years of age and manifesting specific features that represent a challenge for the anesthesiologist during the perioperative period. The anesthetic management of a minor under 9 years of age who comes to the emergency room with abdominal pain in the right iliac fossa and is admitted to the operating room to perform an appendectomy is reported below.
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