Revista Médico Científica UNACHI

Tropical Spastic Paraparesis due to HTLV-1. A Case for Reflection.

2025-05-20T08:25:41-05:00

The Human T-lymphotropic Virus Type 1 (HTLV-1) is a globally distributed retrovirus, with endemic regions including South America, Japan, equatorial Africa, and the Caribbean islands. It is estimated that 15 to 20 million people are infected, with 95% of cases remaining asymptomatic. Spastic paraparesis develops in less than 4% of patients, a condition characterized by upper motor neuron symptoms in the lower limbs and bladder, rectal, and sexual dysfunctions. In Panama, seroprevalence ranges from 1–2%, with the Ngäbe-Buglé region being the most affected, showing a 9% seropositivity rate. HTLV-1-associated spastic paraparesis progresses slowly and is caused by spinal cord atrophy triggered by a cytotoxic immune response that crosses the blood-brain barrier. Physical therapy is the cornerstone for improving patients' quality of life. We present the clinical case of a 60-year-old male originating from eastern Panamawith a two-year history of spastic paraparesis.

Intervención educativa de simulación clínica de ritmos cardíacos en el aprendizaje.

2025-05-16T07:29:46-05:00

The research focuses on the effectiveness of an educational intervention through clinical simulation of cardiac rhythms among emergency medical students at the Universidad Autónoma de Chiriquí. The goal is to evaluate whether the use of an interactive simulator, along with multimedia support and guidance from instructors, significantly improves knowledge about recognizing cardiac rhythms compared to a control group. The central question is: Is there an effectiveness of the educational intervention of clinical simulation of cardiac rhythms among students?

Hypothesis: Students using an interactive simulator with multimedia support and instructor guidance experience a significant improvement in acquiring knowledge about recognizing cardiac rhythms compared to those who do not receive this intervention.

Methodology

Study type: Quantitative, cross-sectional cohort, and experimental.

Technique: Survey through a Google Form.

Participants: First, second, and third-year emergency medical students.

Results

Participants had an average age of 20.6 years, with a predominance of the female gender.
55 % of the intervention group had prior experience with simulation.
Both groups showed an average pre-test score of 26.8.
Significant differences were found in the intervention group (p=0.01) and in the control group (p=0.024), with effect sizes of 0.52 and 0.32, respectively.
The intervention group demonstrated a greater effect in improving knowledge about cardiac rhythms.

This study suggests that clinical simulation can be an effective method in emergency medical education.

Características clínicas, epidemiológicas y mortalidad por pancreatitis aguda en el Hospital Dr. Rafael Hernández L. durante el año 2022, David, Chiriquí.

2025-07-15T21:57:15-05:00

ABSTRACT

Introduction: Acute pancreatitis (PA) is an inflammatory disease of the pancreas that is generally a common gastrointestinal cause of hospital admission due to various etiologies (biliary, alcoholic, hypertriglyceridemia, and others). PA has many clinical scales, such as the RANSON, BISAP, Glasgow, and APACHE II, among others. Therefore, by stratifying each case, the patient can be provided with appropriate and timely management of their disease.

General Objective: Describe the prevalence, clinical, epidemiology, and mortality of patients with acute pancreatitis at the Dr. Rafael Hernández L. Hospital in David, Chiriquí, during 2022.

Method: This is a retrospective, observational, and descriptive study with a sample of 217 clinical records of patients with PA. A data collection instrument was used to identify key variables (etiology, RANSON, BISAP, local or systemic complications). Microsoft Excel is planned to be used to construct tables and graphs representing the data obtained from the variables studied.

Results: Throughout 2022, the prevalence of patients with PA was 22% per 1,000 admitted patients at the Dr. Rafael Hernández L. Hospital. The mortality rate was 0.8% per 1,000 patients, and the case fatality rate was 4% among patients with PA.

Conclusions: The most common local complications detected in PA were free intra-abdominal fluid and free peripancreatic fluid, respectively, in first and second place. The most frequent systemic complications in PA were, in this order, pleural effusion, renal failure, and atelectasis.

Efficacy of methotrexate as monotherapy in the treatment of neutropenia in Felty's Syndrome. A literature review.

2025-06-01T09:43:38-05:00

Introduction: Felty’s syndrome (FS) is a rare and severe subtype of rheumatoid arthritis (RA), characterized by the triad of splenomegaly, neutropenia, and RA. Methotrexate (MTX), a folate antagonist that inhibits dihydrofolate reductase and thymidylate synthase, is considered first-line therapy in FS.

Objective: To evaluate the efficacy and safety of MTX in neutropenia associated with FS.

Materials and Methods: A literature review was conducted using PubMed, TRIP database, ClinicalTrials.gov, Cochrane, and SciELO. From 114 identified articles, 7 studies were included, analyzing a total of 11 patients diagnosed with FS were included. The effect of MTX on absolute neutrophil count was analyzed.

Results: 11 clinical cases were analyzed, of which all showed a clinical and statistically significant (p<0.01) improvement in absolute neutrophil count, with an average of 2,763.9± 1,629.6 cells/ mm³; Additionally, 91% of the patients showed joint improvement and reduction of erythrocyte sedimentation rate (ESR), with an average reduction of 41.29 mm/h ± 29.68 mm/h. No patient had an adverse effect indicating therapy replacement, only two had a skin rash and mild gastrointestinal symptoms.

Conclusion: Methotrexate as monotherapy is a safe and effective treatment option for FS, improving neutrophil counts, reducing infection risk, and managing underlying RA symptoms. However, larger and controlled studies are necessary to confirm these findings.

Imagen médica- Litiasis coraliforme completa: indicación de nefrectomía ante compromiso funcional severo

2025-07-17T00:07:46-05:00

33-year-old female patient with a history of arterial hypertension and a two-year evolution of right complete staghorn calculus, associated with multiple hospitalizations due to recurrent urinary tract infections. A renal scintigraphy with DTPA and diuretic showed a relative GFR of 34% in the right kidney with severe, non-reversible obstruction. A contrast-enhanced CT scan revealed severe hydronephrosis and cortical thinning secondary to the complete staghorn calculus. An elective right simple nephrectomy was performed. During surgery, the right kidney measured approximately 10 cm. A direct incision was made into the specimen, confirming the presence of a complete staghorn calculus occupying the entire pelvicalyceal system. Histopathological examination revealed interstitial nephritis and atrophy, consistent with chronic parenchymal damage. The postoperative course was satisfactory, and the patient was discharged with follow-up by urology, nephrology, and psychology.

Editorial

2025-07-31T06:07:03-05:00

Editorial del Volumen 2, Número 2, 2025