Abceso esplénico, rara presentación de salmonela typhi / Splenic abscess, rare presentation of salmonella typhi

Absceso esplénico es una rara complicación de fiebre tifoidea. La incidencia es de 0.2 a 0.7 por ciento en estudios basados en autopsias. Existen menos de 500 casos reportados en la literatura mundial. La presentación clínica es inespecífica y es potencialmente un problema quirúrgico asociado a alta mortalidad. El tratamiento se basa en una combinación de esplenectomía total o drenaje percutáneo mas una terapia antibiótica adecuada (1,2) El absceso esplénico puede ocurrir secundario a infección del tracto urinario, apendicitis, trauma, endocarditis, neoplasia, fiebre tifoidea, embolias sépticas. Entre los microorganismos causantes más frecuentes encontramos Streptococcus, Staphylococcus, Enterobacterias. Nosotros reportamos un caso de absceso esplénico con documentación microbiológica de Salmonella typhi como agente causal.

Large epidemiological influenza a outbreak in a teaching hospital from guatemala city.

Objective. To describe the characteristics and interventions to control a large epidemiological Influenza A Outbreak. Methods. During the months of February to April 2006, a large outbreak of Influenza A was detected, which affected Health Care Workers and hospitalized patients in a large teaching Hospital in Guatemala City. Interventions to interrupt transmission were implemented and included barrier methods (N95 masks, respiratory isolation measures, etc.) and enhanced hand hygiene, vaccination of healthy Health Care Workers (HCW), restrictions for patient visits. Results. From February to April 2006, 59 hospitalized patients diagnosed with Influenza A. 19 AIDS patients (mortality: 71%) and 5/40 (12.5%) in other diseases: cancer (3), severe cardiac failure (1) and severe malnutrition (1). The attack rate at day 20 in doctors and medical students was 21% while in other HCW it was 10.5%. Within 3 weeks of the beginning of the plan, deaths were stopped and no more cases in HCW were detected after 3 additional weeks. Conclusion. A rapid, comprehensive plan for the control of nosocomial epidemic Influenza A outbreaks is essential to limit severe morbidity and mortality in hospitals who attend large immunocompromised populations, including AIDS patients. HCW regular vaccinations programs are mandatory.

Knowledge of HIV transmission and condom use among HIV-positive heterosexual men and women in Guatemala.

BACKGROUND: The prevalence of HIV/AIDS in Guatemala among the general population is 0.79%, and 94% of transmission is directly related to sexual contact. Studies have been conducted on high- prevalence HIV-positive populations (men who have sex with men, commercial sex workers and prisoners). Heterosexual transmission has gained importance in the epidemic in Central America. To our knowledge, no study addressing knowledge of mechanisms of HIV transmission and condom use has been done on HIV-positive heterosexual men and women. METHODS: A closed-ended structured interview that addressed knowledge of mechanisms of HIV transmission and condom use was conducted on 283 heterosexual HIV-positive men (54.8%) and women (45.2%) outpatients who attend the Roosevelt Hospital's Clinic of Infectious Diseases in Guatemala City. Differences between selected characteristics were examined for significance using the Chi-square test. A multiple logistic regression was done to determine socio-demographic variables associated with inconsistent condom use. RESULTS: Of the interviewed persons, 68.5% were either living with a partner or married, and 94.3% were currently using antiretroviral therapy. Most respondents knew the mechanisms of transmission of HIV. 81.7% and 87.3% reported always using a condom with their regular and casual sexual partner in the past year, respectively. There was no statistically difference in condom use according to the patient's formal education, gender, type of partner (regular or casual)or number of sexual partners. According to the interviewees, 72% of sexual partners in the past year were either HIV negative or of an unknown serostatus. Potentially, these HIV-negative persons are at risk of contracting the virus. Among the main reasons given for not using a condom were: "my partner did not want to use a condom"; and "the condom irritates or makes my partner uncomfortable". CONCLUSIONS: Since no socio-demographic or sexual behavior variable was associated with inconsistent condom use, we recommend intensive and regular condom counselling for every heterosexual HIV-positive outpatient who attends the clinic. Further studies should be done to determine condom use negotiation between partners; and to determine social, interpersonal and psychological factors that might affect the decision to use a condom or not.

Mucormicosis en Hospital Roosevelt de Guatemala / Mucormycosis at Roosevelt Hospital in Guatemala

Se estudiaron a 3 pacientes con diagnóstico de Mucormicosis, todas de sexo femenino. 2 de las pacientes confirmadas con biopsia de tejido afectado, dos de ellas tuvieron Mucormicosis Rinocerebral y como enfermedad de base tenían Diabetes Mellitus (1 paciente tipo 1 y 1 paciente tipo II) y la tercera paciente tuvo Mucormicosis Cutánea. Dos pacientes fallecieron luego de tratamiento radical y la otra paciente sobrevive aún con tratamiento conservador. La causa de muerte de las pacientes fallecidas fue Infarto Agudo del Miocardio, en la paciente con Mucormicosis Rinocerebral y fallo multiorgánico en la paciente con Mucormicosis Cutánea