Roosevelt Hospital Research Articles

Phase II Study of Danazol with Plasma Exchange and Corticosteroids for the Treatment of Thrombotic Thrombocytopenic Purpura

Background: Ahn and colleagues reported a decrease in plasma exchange (PE)/plasma infusion requirement with danazol in seven cases of thrombotic thrombocytopenic purpura (TTP) (Ahn Blood 2006;108(11):1057a). We reported an increase in platelet count (PLT) within 24 hours with danazol in two of three cases of human immunodeficiency virus-associated TTP resistant to PE (Torri Transfusion 2010;50:86a). In 2009, we initiated a phase II study of danazol with PE and corticosteroids (CS) for the treatment of TTP. This trial was approved by the institutional review board and was registered at ClinicalTrials.gov (ID# NCT00953771). We report the final results. Aims: To determine if danazol reduces number of PE's, time to remission (TR), and length of stay (LOS) when administered with standard therapy for the initial treatment of TTP. Methods: Experimental Group (EG): Patients with TTP (PLT < 100,000/µL and microangiopathy) receive daily PE, prednisone 1 mg/kg, and danazol 600 mg. Following remission (PLT > 150,000/µL for three consecutive days), PE is tapered to every other day for one week then stopped. Then prednisone is tapered weekly over four weeks then stopped. After one week danazol is tapered by 200 mg weekly then stopped. Historical controls (HC): Patients treated for TTP at St. Luke's-Roosevelt Hospital Center with PE with or without CS from 2000 to 2007 (n=20). Relapse definition: PLT < 100,000/µL with microangiopathy > 30 days after remission. Total number of PE's, TR, LOS, and continuous response rates are compared between the 2 groups. Accrual target: 16 patients to detect a 40% decrease in the number of PE's with 80% power and a level of significance of 0.05.The study was terminated in 2018 due to low accrual. Results: Nine patients were enrolled. Mean number of PE's (days) was 14.8 (EG) and 16.1 (HC), mean TR (days) was 11.4 (EG) and 11 (HC), and mean LOS (days) was 27.3 (EG) and 24.9 (HC), p > 0.05. Four patients in HC had a total of 6 relapses at our institution at a median of 28.25 months, range 2.75 to 97 months after the initial event. One patient in EG relapsed 43 months after study enrollment. One patient in EG died from an unrelated cause. None of the additional seven patients in EG have relapsed during a median follow-up of 49 months, range 12 to 125 months. One episode of pulmonary edema and one episode of hypotension occurred in EG, for which treatment was not discontinued. Discussion: Our study shows that danazol does not reduce PE requirement, TR, or LOS during treatment of TTP, but may prevent relapse. This pattern of response is similar to that which has been observed with rituximab. In a phase 2 study of rituximab in conjunction with PE and CS for the treatment of TTP (Scully Blood 2011), in which results were compared with historical controls who did not receive rituximab, median number of PE's (days) and median LOS (days) were 16.5 and 16.5 in the rituximab group versus 18.0 and 20 in the historical control group, p=ns. Ten percent of patients relapsed at a median of 27 months in the rituximab group whereas 57% of patients relapsed at a median of 18 months in the historical control group. Of interest, the cost of rituximab 375 mg/m 2 weekly for 4 weeks as given would have been approximately $ 25,366.50. The cost of danazol in our protocol would have been approximately $ 2196.00. Caplacizumab is a humanized monoclonal antibody fragment that inhibits von Willebrand factor binding to platelet glycoprotein lb-IX-V. In a phase 3 study (Scully N Engl J Med 2019), caplacizumab in conjunction with PE and CS for the treatment of TTP led to reduced PE's, time to normalization of platelet counts, and LOS, but increased relapses in comparison with placebo. In 2020, the International Society on Thrombosis and Haemostasis strongly recommended adding CS to PE for the treatment of TTP and conditionally recommended adding rituximab and caplacizumab to PE and CS (Zheng J Thromb Haemost 2020). Conclusion: Danazol in conjunction with PE and CS may be a low-cost option to prevent relapses of TTP.

Abstract P5-03-17: BRCA1/2 gene mutations in patients with high-risk breast cancer in a tertiary-level hospital in Guatemala

Abstract Objectives, to stablish the frequency of BRCA1/2 mutation rate in high-penetrance breast cancer susceptibility population Methods Based on NCCN guidelines for testing criteria for high-penetrance breast cancer susceptibility genes genetic counseling was offered to 140 breast cancer patients in the hemato-oncology unit of Roosevelt Hospital at Guatemala City performing test with NGS and MLPA technology from 2019 to 2021. Results The overall BRCA1/2 mutation rate high-risk patients were 23% (33/140). Of the patients with mutations, 66.6% (22/33) had BRCA1 mutation, 33.3% (11/33) had BRCA2 mutation, of the mutated population the median age was 45 years. Regarding the phenotype in the mutated population, 75% were triple negative, 16% luminal and 9% with Her2 overexpression. Of the patients carrying the BRCA1 mutation, we identified the c.212+1G>A mutation in 40% of the patients, possibly a founder mutation. In the triple negative population and under 45 years of age, the percentage of patients with BRCA 1/2 mutation is 40.9 (88.8% BRCA1 and 11.1% BRCA2). Conclusions: we found a percentage of BRCA 1/2 mutations in the selected population (NCCN criteria) similar to that reported in other Latin American countries, highlighting the high percentage of BRCA mutations in women under 45 years with triple negative phenotype, previous reports have highlighted the frequency of the c.212+1G>A mutation of BRCA1 in breats cancer patient in Guatemala, in this study 40% of the BRCA1 mutations correspond to said mutation, considering it as a probable founder mutation. Citation Format: Juan Alvarado-Muñoz, Agatha Reyes-Morales, Marco Chivalan, Silvana Torselli, Hector Valenzuela, Gozalo Yalibat, Mario Ordoñez, Rosa León, Egly Alvarez. BRCA1/2 gene mutations in patients with high-risk breast cancer in a tertiary-level hospital in Guatemala [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-03-17.

Setting the River on Fire: A Study of Genius, Mania, and Character

Setting the River on Fire: A Study of Genius, Mania, and Character

Induction Chemotherapy with Cisplatin, Paclitaxel, and Capecitabine (PTC) in Locally Advanced (LA) Squamous Cell Carcinoma of Head and Neck (SCCHN)

<h3>Purpose/Objective(s)</h3> In Guatemala's Roosevelt Hospital, most patients consult with locally advanced stages of SCCHN. Cisplatin, Docetaxel, and 5FU regimen has shown superiority over Cisplatin plus 5FU during the induction of LA cases, with afew reports supporting the substitution of 5FU with capecitabine for LA SCCHN. During the COVID-19 pandemic, we performed induction therapy with PTC in patients with LA SCCHN to reduce inpatient treatment. <h3>Materials/Methods</h3> We performed a retrospective analysis of patients with LA SCCHN with preserved swallowing function treated with Cisplatin 75mg/m², Paclitaxel 175mg/m², and Capecitabine 1000mg/m² twice a day for 14 days. RECIST and CTCAE were used to measure response and adverse events. <h3>Results</h3> A total of 16 LA SCCHN patients were treated with PTC induction. Treated patients were mostly men, smokers, and considered not candidates for surgical resection (Table 1). The mean of cycles administered was 3.5 (SD = 0.97). Regarding the response to the PTC regimen, 93.6% of patients achieved disease control. Only 6.2% of patients stopped capecitabine, whereas 37.5% required dose reduction. The main adverse events were nausea, vomiting, and diarrhea. <h3>Conclusion</h3> The PTC regimen worked as induction therapy for patients with LA SCCHN. The substitution of 5FU for Capecitabine requires prospective validation.

P-124 POST PARACENTESIS COMPLICATIONS IN PATIENTS WITH DIAGNOSIS OF LIVER CIRRHOSIS

Post paracentesis complications are correlated to a high morbidity and mortality rate in patients with a diagnosis of liver cirrhosis, among whom a high incidence of them has been observed after performing this procedure. To identify post paracentesis complications in patients diagnosed with liver cirrhosis in the Department of Internal Medicine of the Roosevelt Hospital from January 1 to December 31, 2018, Guatemala. Cross-sectional descriptive study carried out in patients with a diagnosis of liver cirrhosis who had undergone decompressive / diagnostic paracentesis. The majority of patients were male (70%) with child pug C liver cirrhosis (71%) aged between 40 to 49 years of age (44%), with less than 1 year of diagnosis of liver cirrhosis (64%). Persistent leakage of ascites fluid from the puncture site was the most frequent complication (35%), followed by secondary bacterial peritonitis and hematoma of the abdominal wall at the puncture site (13% and 12% respectively). A third of the patients did not present any complications after the procedure (31%). Alteration in liver function tests (0.0001), decreased platelets and prolonged clotting times (0.001) presented a statistically significant relationship of greater probability of presenting some complication after the procedure, the bilirubin level did not present a statistically significant relationship for complications occur. (0.3). A third of the patients were indicated decompressive paracentesis (48%), of which a higher rate of complications was observed after the procedure (67%). The most frequent complication was the persistent leakage of ascites fluid. Hypoalbuminemia, coagulopathy, and platelet alteration correlate with a higher risk of complications.

Implementation challenges to patient safety in Guatemala: a mixed methods evaluation

BackgroundLittle is known about factors affecting implementation of patient safety programmes in low and middle-income countries. The goal of our study was to evaluate the implementation of a patient safety...

#16: Use of a Multiplex PCR Panel for Diagnosis of Complicated Pneumonia in Pediatrics

Abstract Background Pleural fluid cultures performed in the period from April 2015 to April 2017 (prior to having the test) were reviewed, 120 cultures were found, of which 7.5% were positive. Methods Descriptive study in patients from 0 to 12 years old, from April 2017 to April 2019, at Roosevelt Hospital, Guatemala City, June 2019 Results In the period from April 2017 to April 2019, pleural fluids were evaluated in which multiplex PCR was performed, obtaining 41 results, 24 positive PCR for pneumonia producing bacteria in the community, of which only 1 positive culture was found, which, if correlated, which means 25 times more detection capacity, than the Gold standard of culture. Forty-one cultures of pleural fluids were evaluated, of which 58% were detected by FilmArray® The most frequently isolated microorganisms were Streptococcus pneumoniae 42%, Streptococcus sp. 3% Haemophilus influenzae 13% and Pseudomonas aeruginosa 3% Conclusion The use of Multiplex PCR in pleural fluid allowed the identification of a high percentage of microorganisms in the pleural fluid. Although the test is not valid for this use, its use could mean a great advantage for the etiological diagnosis.

Abstract PS7-64: Breast cancer in young women in a tertiary-level hospital in Guatemala

Abstract Background: Breast cancer is the frequent neoplasia in young women, which in developing countries is associated with more adverse outcomes. In Latin America, reports have shown an increased incidence of breast cancer in young women. No information exist regarding breast cancer characteristics in young Guatemalan women. We aimed to describe the clinical-pathological features among women aged 45 years or less treated in a tertiary-level hospital in Guatemala. Methods: We examined data from 119 women aged 45 years or less diagnosed with primary invasive breast cancer at the Oncology Unit Roosevelt Hospital in Guatemala between 2016 and 2020. Data were drawn from medical files on sociodemographic characteristics, histology, clinical stage, and breast cancer subtypes.Results: Of the total sample, breast cancer in women aged 45 years or less represented 31.2% of the cases. Of these, 24.36% is before 35 years, 28.57% between 35 to 39 years, and 47.05% between 39 to 45 years. Advanced clinical stages affected 66.6% of young women (48.33% for stages III and 18.33% stage IV). Data from specific breast cancer molecular subtype showed that 72.35% of cases in young women expressed an aggressive molecular subtype (Her-2 positive 27.06%, triple-negative 21.76%, and luminal/Her-2 positive 23.53%). Regarding treatment, most young patients received surgical treatment, as well as neoadjuvant or adjuvant chemotherapy. Only 24.37% received hormonal and 26.89% radiation therapy. Conclusions: Our finding suggested that young women treated for breast cancer at a tertiary-level hospital in Guatemala had a high proportion of aggressive molecular subtypes and a high rate of locally advanced disease. This aggressive cancer behavior among young women is consistent with findings in other Latin American countries. Evidence examining risk factors for aggressive cancer in young women, such as delay in diagnosis and treatment timing, is warranted. Table 1. Distributions of socio-demographic and cancer-related characteristics variables% (SE)n = 119ETHNIC GROUPMayan Indigenous12.61 (3.05)No-Mayan Indigenous87.39 (3.05)HISTOLOGYDuctal96.64 (1.66)Lobular1.68 (1.18)Other1.68 (1.18)CLINICAL STAGE*I1.67 (1.17)II31.67 (4.26)III48.33 (4.58)IV18.33 (3.54)BREAST CANCER SUBTYPELuminal27.65 (4.76)Her2 positive27.06 (5.11)Triple-negative21.76 (5.05)Luminal/Her223.53 (6.61)TREATMENTSurgery55.46 (4.58)Neoadjuvant Chemotherapy82.35 (3.51)Adjuvant Chemotherapy47.06 (4.59)Radiotherapy26.89 (4.08)Hormonotherapy24.37 (3.95) Citation Format: Juan F Alvarado-Muñoz, Agatha Reyes-Morales, Alba J Kihn-Alarcón, Marco Chivalan, Silvana Torselli, Victor Puac-Polanco. Breast cancer in young women in a tertiary-level hospital in Guatemala [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-64.

Implementation Analysis of a Perioperative Patient Safety Program in Guatemala.

The implementation of programs to improve patient safety remains challenging in low- and middle-income countries. The goal of our study was to define the barriers and facilitators to implementation of a perioperative patient safety program in Guatemala. We conducted semi-structured interviews with 16 staff pre-intervention and a follow-up focus group discussion 1year later in the perioperative department at the Roosevelt Hospital in Guatemala. We performed qualitative thematic analysis to identify barriers and facilitators to the implementation process, with analysis guided by the Consolidated Framework for Implementation Research. We found several dominant themes affecting implementation of a patient safety program. Implementation facilitators included strong prioritization of patient needs, program compatibility with existing workflow, and staff attributes. Barriers included a lack of knowledge about patient safety, limited resources, limited leadership engagement, and lack of formal implementation leaders. Several program modifications were made to enhance successful implementation iteratively during the implementation process. Our analysis highlights several dominant themes which affect the implementation of a perioperative safety program in Guatemala. Understanding the barriers and facilitators to implementation during program deployment allows for program modification and improvement of the implementation process itself.

Pulmonary Function by Spirometry in Children with Perinatal HIV Infection

Background: In an age of antiretroviral therapy, the life expectancy of children perinatally infected with Human Immunodeficiency Virus (HIV) has significantly increased. At the same time, however, pulmonary pathologies secondary to opportunistic infections have decreased thanks to increased diagnostics and access to antiretroviral therapy (ART). Despite this, in these children an immune dysregulation is maintained due to chronic infection. There is evidence that these patients have increased probability of presenting with abnormalities in pulmonary function, mainly with chronic obstructive clinical pictures (25% - 40% of perinatally infected adolescents display some anomaly in the spirometry), which predisposes them to increased risk of chronic pulmonary disease. Since lung development occurs mainly during infancy, patients perinatally infected with HIV may suffer consequences. This can be secondary to opportunistic infections, chronic inflammation due to the virus, and immunologic effects of ART, mainly in non-industrialized countries, where late diagnosis is frequent. Methodology: An analytical, observational, cross-sectional study was conducted at Roosevelt Hospital Pediatric infectious disease clinic, from January to December 2019. A sample of 76 patients was obtained, out of a population of 362 patients. A total of 62 subjects, who met the criterion of reproducibility in the spirometry, were analyzed. Results were analyzed with percentages and the association of variables using the chi-squared test (χ2). Results: A decrease in pulmonary function was found in 34% of patients, mild obstructive pattern (16%) predominating. Significant association between basal viral load greater than 100,000 cp/ml and a decrease in Forced expiratory flow 25 - 75 (FEF 25-75) (p 0.046) and in relationship between forced expiratory volume and forced vital capacity (FEV1/ FVC p = 0.024) was observed, as well as a non-statistically significant relationship between advanced clinical stage at diagnosis and decreased pulmonary function. Conclusions: The prevalence of decreased pulmonary function related to advanced clinical stage and elevated basal viral load (>100,000 cps/ml) is higher than that reported in other studies (25%) and has an influence in the long-term decrease in pulmonary function.

1148: PREDICTORS OF PROLONGED MECHANICAL VENTILATION AND THE NEED FOR TRACHEOSTOMY IN RESPIRATORY FAILURE

1Mount Sinai St Luke’s & Mount Sinai Roosevelt Hospital Center, New York, NY 2Brookdale Hospital Medical Center, New York, NY

1117: THE OBESITY PARADOX IN ACUTE HYPERCAPNIC RESPIRATORY FAILURE: CORRELATION BETWEEN MORTALITY AND BMI

1Mount Sinai St Luke’s & Mount Sinai Roosevelt Hospital Center, New York, NY 2Brookdale Hospital Medical Center, New York, NY

Struma ovarii maligno: Reporte de caso

Presentamos el caso de una paciente de 46 años de edad procedente de Génova, Quetzaltenango, Guatemala; casada, analfabeta, ama de casa, religión evangélica; quien acude a la consulta externa del Hospital de Quetzaltenango con antecedente de dolor de mes de evolución en fosa ilíaca derecha, tipo cólico sin irradiación, que se atenuaba parcialmente con ibuprofeno. Historia obstétrica-ginecológica de 4 gestas, 4 partos, 4 hijos vivos y menarquia a los 11 años. Es remitida al Hospital Roosevelt, ubicado en la ciudad de Guatemala, donde se le realiza una histerectomía abdominal total. El espécimen se envió al departamento de patología, donde se realizaron todos los estudios anatomopatológicos e inmunohistoquímicos.

Semblanza del Dr. Jorge Antonio Henry Leiva

Hablar de alguien a quien uno considera un amigo, un maestro, un profesional exitoso y un gran ser humano, es un privilegio y un honor. El Dr. Henry Leiva ingresa a la Facultad de Ciencias Médicas de la gloriosa Universidad de San Carlos de Guatemala en 1963, en el plan de 8 años, y se gradúa en 1970. Luego es admitido al postgrado de Cirugía del Hospital Roosevelt en 1970, el cual concluye, como jefe de residentes, en 1972. Habiendo aprobado el examen norteamericano para médicos extranjeros (ECFMG), es aceptado como residente de Cirugía en la Universidad de Temple, Hospital Episcopal, Philadelphia Pensilvania, en 1972. Termina su entrenamiento con Honores y es jefe de residentes por oposición en 1974-75.

Transplant Cost Reduction in a Developing Country

Background Guatemala, situated in Central America, south-west of Mexico has a population of approximately 16 million people of which 60% are younger than 20 years of age. As any other developing country, Guatemala struggled with limited economic resources devoted to treat non-communicable diseases. Therefore, renal replacement therapy (RRT) competes with other urgent needs, such as treatment of infections. In 2010, FUNDANIER (Foundation for Children with Kidney Diseases) signed a cooperative agreement with the Ministry of Health, through Roosevelt Hospital, one of two tertiary level hospitals in the national network. The goal of the agreement was to create a comprehensive Pediatric Nephrology program, providing free access to RRT to Guatemalan children. In Guatemala, the pediatric ESRD incidence rate was calculated in 4.6 per million inhabitants under the age of 20. Of the 432 patients with CKD on our database, 193 patients had CKD stage 5. The majority received peritoneal dialysis (40.4%), followed by hemodialysis (26.4%), transplant (12.4%), and no RRT (conservative management; 17.6%). One of limitations for the kidney transplant is the high cost, which avoids transplant for the majority of patients. Many efforts had been made to decrease the transplant maintenance cost: Replacement of mycophenolate for azathioprine and the addition of Ketoconazole to our protocol. Methods In 2016, a retrospective, case-crossover was conducted. The study aimed to identify clinical endpoints post transplant with and without ketoconazole added to immunosuppressive maintenance protocol. Charts were reviewed if patients were younger than 18 years old, at least 3 months post transplant received tacrolimus protocol and were switched over to ketoconazole/tacrolimus combination and attended the outpatient transplant clinic. As security measures were compare: doses and levels of tacrolimus, number of rejection graft and level of transaminases before and after the dose of ketoconazole. Results A group 25 patient with an average age of 13.08 years. Patients were from living donors (96%). Twelve (48%) patients were male. The average tacrolimus dose before initiating was 0.13/kg/day and after ketoconazole was 0.06mg/kg/day. The median tacrolimus blood levels remains in limit range. None of the patients demonstrated a variation in the transaminase levels. Changes in eGFR and graft rejections were not significant. Conclusions The administration of ketoconazole reduced the amount of tacrolimus given to the patients without finding a relevant variation in the tacrolimus levels, number rejection graft or significant liver toxicity. This allowed the reduction of the cost used for maintenance of the anti-rejection medication.

Síndrome de Gerstman secundario a malformación arteriovenosa del lóbulo parietal izquierdo. Reporte de caso

El síndrome de Gerstman se caracteriza porque los pacientes presentan 4 síntomas: alteraciones en la capacidad de expresar ideas por la escritura (agrafia), incapacidad para contar y realizar operaciones aritméticas sencillas (acalculia), imposibilidad de reconocer los dedos de la mano (agnosia digital) y desorientación derecha izquierda.&#x0D; Se asocia habitualmente con la lesión de una parte específica del cerebro, el giro angular del lóbulo parietal del hemisferio izquierdo. Habitualmente suele ser secundario a un accidentecerebro-vascular cerebral que afecta el territorio de la arteria cerebral media. La importancia del cuadro radica en su pronta detección por las consecuencias como afectación del lóbulo parietal posterior dominante para el lenguaje.&#x0D; El objetivo: es hacer una correlación anátomo-clínico-quirúrgica de este síndrome. A continuación se enmarca un caso de malformación arteriovenosa en la región parietal izquierda una paciente que consultó al departamento de Neurocirugía del Hospital Roosevelt por cefalea y alteración conductual.

Invasive Infections for Endemic Fungi in Pediatrics in Guatemala

Background: Invasive fungal infections are common opportunistic diseases in patients with AIDS, other conditions related to immunodeficiency and healthy infants. Most publications on this subject are related to industrialized countries, and in adult population, with limited data in Latin America (except for Brazil, Colombia, and Argentina), and especially in pediatric population. These patients present a variety of clinical manifestations representing a diagnostic and therapeutic challenge for the health system. Objective: The objective of the study is to describe the epidemiological and laboratory characteristics of children with invasive fungal infections in Guatemala. Methods: A review of the microbiology service database was carried out at Roosevelt Hospital in Guatemala. Positive cultures were taken from children under 15 years of age, in a period of seven years, from 2007 to 2014, with its corresponding medical history. Results: Finally, 23 isolates were documented but only 15 patients were included in the study with complete information; 10 Histoplasma capsulatum cases, 4 Cryptococcus neoformans cases and 1 Coccidioidessp case. The average age was 7 years old for Histoplasma and 9 years old for Criptococo, with an age range from 6 months to 14 years. Around 60% of the patients were older than 5 years, of which, more than two-thirds were HIV positive children without antiretroviral therapy, who presented an invasive fungal infection at the time of HIV diagnosis. These infections are endemic in Guatemala, so the distribution was mostly uniform. Around 80% of the patients had some disease related to immunodeficiency and 70% were infected with human immunodeficiency virus (HIV). The microbiological isolation was from blood, bone marrow, lymph nodes, cerebrospinal fluid and urine. The predominant laboratory findings were decrease in hematological series. The most frequent clinical syndromes were fever, adenomegaly, hepatosplenomegaly, respiratory, gastrointestinal, neurological and weight loss. Mortality rate was 53% (from them, 62% were HIV positive). From these patients, an87% did not receive antifungal treatment in time due to late diagnosis of the infection. Conclusions: These infections should be considered when treating pediatric patients from tropical regions, with nonspecific systemic symptoms and signs, lymph node involvement and hematological alterations related to the mononuclear phagocytic system, mainly if they are patients infected by HIV in an advanced stage, infants, or children with a disease that weakens the immune system. When there is a high suspicion of a fungal infection, screening for HIV is mandatory; cultures should be taken early and together with rapid diagnostic tests. An antifungal treatment should be started immediately and then modified accordingly to laboratory results.

Association of TGFβ3 variants with Nonsyndromic Cleft Lip and Palate in Guatemalan Population.

Introduction: Nonsyndromic cleft lip with or without cleft palate (NCL/P) is a common orofacial anomaly with a multifactorial etiology. The genetic component of NCL/P etiology is complex with multiple genes involved. The transforming growth factor beta 3 (TFGβ3) is among the strong susceptibility genes that have been shown to be involved in morphogenesis of lip and palate. Materials and Methods: Case-control study design was used in this study. Cases (n=237) were patients affected with NCL/P identified at the Roosevelt Hospital in Guatemala City, Guatemala. Controls (n=168) were individuals with no history of NCL/P from the same hospital. Genotypes were established by PCR and PAGE for TGFβ3 rs2300607 A/T SNP and by PCR and sequencing for TGFβ3 rs2268625 C/T SNP. Results: For rs23000607A/T, a proportion of TT homozygotes was significantly higher (p=0.029) in cases than in controls (13.92% vs 5.36%). T allele frequency was 0.340 in cases and 0.274 in controls. Also for rs2268625 C/T, a significantly higher proportion of TT homozygotes was found among cases than among controls (p=0.041; 54.0% vs. 48.98%). Frequency of mutated T allele was 0.744 in cases and 0.694 in controls. Conclusion: The results of our study showed for the first time the association between TGFβ3 rs2268625 C/T polymorphism and NCL/P and confirmed for Guatemalan population the association between TGFβ3 rs2300607 A/T polymorphism and NCL/P found by Ichikawa in Japanese by Ichikava et al. in 2006. Thus, our findings suggest that rs2268625 C/T and rs2300607 A/T mutations in the TGFβ3 gene are associated with NCL/P in Guatemalan population.

The Challenging Endemic and Epidemic Enterobacteria Increase of Extended Spectrum β-Lactamase Producers and Carbapenemases Producers, Detected by Vitek II and the Carba-R in Isolations From the Adult Intensive Care and Pediatric Intensive Care Unit (ICU) of Roosevelt Hospital in ICUs in Guatemala (2014–2015)

The Challenging Endemic and Epidemic Enterobacteria Increase of Extended Spectrum β-Lactamase Producers and Carbapenemases Producers, Detected by Vitek II and the Carba-R in Isolations From the Adult Intensive Care and Pediatric Intensive Care Unit (ICU) of Roosevelt Hospital in ICUs in Guatemala (2014–2015)

Factores psicosociales asociados en mujeres con aborto. Hospital Roosevelt, Guatemala, septiembre 2015

Antecedentes: La salud materna es un proceso complejo que debe manejarse de forma integral, detectando factores biológicos y psicosociales que produce efectos adversos en el embarazo y pueden ser prevenibles si se detectan oportunamente. Objetivo: Identificar los factores psicosociales en mujeres con aborto en el Hospital Roosevelt de Guatemala. Diseño: Estudio descriptivo, transversal, observacional. Materiales y Métodos: se entrevistaron 61 pacientes empleando un cuestionario estructurado de 29 preguntas usando como base el cuestionario PRAMS (Pregnancy Risk Assesment Monitoring System). Resultados: La edad promedio fue de 24.8 años (IC95%; 22.8-26.8). El indicador epidemiológico de riesgo se encontró en 47.5% (29); hábitos de riesgo 16.4% (10); mal control prenatal 67.2%(41); consejería deficiente 36.1% (22); embarazo no deseado 31.1% (19); percepción de inseguridad 8.2% (5); inestabilidad familiar 19.7% (14). Las pacientes con aborto espontáneo tuvieron mayor edad (p=0.0078), fue un embarazo deseado (p=0.00007) y planificado (p=0.03174) y tenían hogar integrado (p=0.01052) Conclusiones: La deficiencia en el control prenatal fue el indicador más frecuente. Las pacientes con aborto espontáneo expresaron aceptación del embarazo, tenían hogar integrado y menos indicadores de riesgo.