Revista Médico Científica UNACHI

Porencephalic cyst: an unusual radiological finding in adult-onset seizure

Wilfredo Pérez — 2026-07-31

We report the case of a 39-year-old male who presented to the emergency department with a new-onset seizure, without prodromal symptoms, and with a remote history of neonatal bacterial meningitis without subsequent neurological follow-up. Physical examination revealed chronic distal left-sided hemiparesis, consistent with long-standing neurological sequelae. Cranial computed tomography demonstrated a large, well-defined hypodense cavity within the right cerebral hemisphere, CSF-attenuation, and communicating with the ipsilateral ventricular system, involving the frontal, parietal, and temporal lobes. These imaging findings are consistent with a porencephalic cyst, likely secondary to perinatal encephalic injury. A diagnosis of symptomatic structural epilepsy was established, and antiepileptic therapy with valproic acid was initiated, with referral for specialized follow-up. This case highlights the need to consider long-standing cerebral malformations or post-injury sequelae as potential etiologies of new-onset seizures in adulthood, particularly in patients with undocumented chronic neurological deficits.

the DIAGNOSIS AND MANAGEMENT OF ACQUIRED METHEMOGLOBINEMIA: A REPORT OF TWO CASES

Alcibiades Arosemena — 2026-07-31

Methemoglobinemia is a form of hemoglobin with an inability to effectively transport oxygen due to the oxidation of heme iron from the ferrous state (Fe²⁺) to the ferric state (Fe³⁺). There are congenital and acquired forms, and the main clinical manifestation is usually cyanosis and decreased oxygen saturation (SaO₂), with no response to supplemental oxygen. This finding often raises suspicion of the condition, and once confirmed, the causal agent should be eliminated if identified. The use of enzyme inducers, such as methylene blue, should be considered based on the severity of the case.

We present two cases of 14-year-old female patients with herbicide ingestion and clinical symptoms compatible with biochemically confirmed methemoglobinemia.

Both cases highlight the severity of acquired methemoglobinemia due to oxidizing agents and emphasize the need for timely identification and management.

Abordaje integral en trauma multisistémico: reanimación hemostática, protección espinal y extricación técnica en un atrapamiento vehicular complejo.

Dani José Ochoa Garcia — 2026-07-31

The case documents the prehospital care of a 49-year-old male with Grade III vehicular entrapment and decompensated hypovolemic shock in Chiriquí, Panama. Coordinated intervention among SUME 9-1-1, SAMER, and the Fire Department integrated cervical immobilization, hemostatic resuscitation with tranexamic acid, thermal control, and a 45-minute technical extrication, delivering the patient in stable condition for successful surgery.

Baclofen Poisoning as therapeutic or Recreational use? : Case Report and Literature Review

Neyra Cedeño Caballero — 2026-07-31

Abstract

Introduction: Baclofen is a fat-soluble derivative of the neurotransmitter gamma-aminobutyric acid used as an approved medical treatment for spasticity related to multiple sclerosis and other spinal cord pathologies. In 2020, according to statistics, baclofen was reported as the only agent associated with overdose, with 2,112 cases of intentional use, 700 unintentional exposures, and 110 cases of adverse drug reactions, resulting in 2 to 12 deaths per year.

Clinical Case: A 32-year-old male patient who was admitted to the Emergency Department of the Dr. Juan Fernández Acute Care Hospital in the Autonomous City of Buenos Aires. The patient was found in a public area with decreased level of consciousness and episodes of apnea. Empty containers of baclofen and benzodiazepines were found in his possession, which initially suggested a possible suicide attempt by ingestion of these drugs.

In the initial management at the emergency department, he required mechanical respiratory support and was subsequently transferred to the critical care unit, where he remained hospitalized for 7 days. Afterwards, he continued follow-up in the toxicology ward for comprehensive care.

Conclusion: Baclofen intoxication is an increasing clinical problem, more frequently reported in North America and Europe, but also present in Latin America, often associated with recreational drug use. These cases may require advanced ICU management, including prolonged mechanical ventilation. The reported case highlights the importance of early airway intervention and intensive monitoring to support recovery. It also emphasizes the inappropriate use of baclofen for low back pain without clear indication, underscoring the need for strict prescription and follow-up. Finally, the potential concomitant use of other substances should always be considered as part of a comprehensive evaluation in such intoxications.

Disociación escapulotorácica compleja asociada a lesión ligamentaria del codo: desafío reconstructivo en trauma de alta energía

Yineth Yariel González Velásquez — 2026-07-31

Scapulothoracic dissection is a rare injury characterized by the traumatic separation of the scapula from the posterior humerus. We present the case of a 28-year-old woman who presented to the emergency department following a high-energy motor vehicle collision. Physical examination revealed significant swelling, deformity, and abrasions of the left clavicle and scapula, with signs of medial elbow instability, evidenced by a positive valgus stress test, with preserved distal perfusion. The management of these injuries remains controversial; although they are often treated conservatively with good functional outcomes, a surgical approach allows for better recovery of arm function and a shorter recovery time.

Diaphragmatic and gastric injury secondary to double penetrating thoracoabdominal trauma in pediatrics

Adriano Borace — 2026-07-31

El trauma toracoabdominal penetrante en pediatría es poco frecuente, pero representa un desafío clínico por la posibilidad de lesiones múltiples en un mismo evento. La ruptura diafragmática asociada a perforaciones gástricas es rara y exige diagnóstico oportuno e intervención quirúrgica inmediata.

Paciente femenina de 7 años, previamente sana, que sufrió una caída de dos metros de altura impactando sobre una rama de árbol, provocando herida penetrante en epigastrio con trayecto hacia hemitórax izquierdo y evisceración gástrica. En hospital periférico se cubrió la evisceración y se colocó un drenaje pleural tipo pigtail, siendo trasladada a centro de referencia bajo ventilación mecánica.

Se realizó laparotomía exploratoria, identificando tres perforaciones gástricas en curvatura mayor y cuerpo, que fueron reparadas en dos planos. El desgarro diafragmático, de aproximadamente 8 cm, fue suturado con material no absorbible. En el mismo acto quirúrgico se efectuó toracotomía izquierda, con lavado pleural, hemostasia y colocación de drenaje torácico. Requirió ingreso a la unidad de cuidados intensivos de inmediato, durante 72 horas.

Durante su evolución presentó infección pleural por Escherichia coli multirresistente, requiriendo dos lavados torácicos quirúrgicos adicionales y recambio de drenajes. Tras 16 días de hospitalización, egresó en buen estado general, con seguimiento ambulatorio multidisciplinario.

A propósito de un caso: cuerpo extraño extraocular, manejo y complicaciones en un paciente pediátrico.

Alfredo Moltó Isaza — 2026-07-31

Los traumatismos oculares son una consulta frecuente en nuestros cuartos de urgencias, que pueden llevar a consecuencias desfavorables como trombosis de seno cavernoso y pérdida de la visión, por lo que consideramos que la revisión del tema es valiosa para todos los colegas. Este caso trata de un masculino de 10 años, que sufre un trauma penetrante en órbita al caer de un caballo, cursando con pérdida de la agudeza visual y proptosis izquierda. Al examen físico presenta edema de tejidos blandos periorbitarios y trayecto fistuloso en párpado inferior. La tomografía computada (TC) arroja datos de trombosis de seno cavernoso, por lo cual se inicia el tratamiento correspondiente. Se realiza resonancia magnética nuclear (RMN), donde se evidencia presencia de cuerpo extraño en órbita; es explorado en el quirófano, con extracción de fragmentos de material vegetal. Ameritó antibioticoterapia de amplio espectro durante su evolución. Como consecuencia, presenta ceguera de ojo izquierdo y determinamos una adecuada cicatrización de heridas. En conclusión, a pesar de la frecuencia elevada del trauma ocular en el cuarto de urgencias, la presencia de cuerpo extraño no es común; esto causa un manejo muy variable de los casos. Consideramos que los estudios de imágenes son indispensables para el planeamiento quirúrgico.

DENGUE MYOPERICARDITIS: CASE REPORT

Miguel Ángel Valdés Camaño — 2026-07-31

Cardiac complications in dengue are rare but can be serious and sometimes fatal. These complications include pericarditis, myocarditis, or a combination of both. I present a case of dengue myopericarditis.

The Description of transcatheter arterial embolization as an alternative treatment in patients admitted with digestive bleeding at the Regional Hospital Dr. Rafael Hernández L., January 2024 - June 2025.

Jelissa Inés Rodríguez Saldaña — 2026-07-31

Introduction: Gastrointestinal bleeding (GIB) is a potentially life-threatening clinical condition and a common cause of hospitalization worldwide. Transcatheter Arterial Embolization (TAE) is a minimally invasive therapeutic alternative when primary management fails. In Panama, there is currently no published local evidence regarding its clinical outcomes.

Objective: To describe transcatheter arterial embolization as an alternative treatment in patients admitted with gastrointestinal bleeding at Dr. Rafael Hernández L. Regional Hospital between January 2024 and June 2025.

Methods: A retrospective, descriptive, observational study was conducted through a review of the medical records of patients who underwent TAE as an alternative treatment for gastrointestinal bleeding between January 2024 and June 2025. Gastrointestinal bleeding was confirmed by computed tomography angiography and/or abdominopelvic arteriography. Seventeen patients were initially identified; five were excluded due to portal hypertension-related (variceal) bleeding, resulting in a final sample of 12 patients. Demographic, clinical, angiographic, technical, and outcome variables were analyzed using descriptive statistics.

Results: The predominant age group was 60–79 years (41.7%), with an equal distribution between males and females (6 each). Lower gastrointestinal bleeding was the most frequent presentation (66.7%), with hemorrhoidal disease as the leading etiology. The superior hemorrhoidal arteries were the most commonly embolized vessels (58.3%). Microspheres were the most frequently used embolic agent (50%). Technical success was achieved in 100% of cases, while clinical success was observed in 83.3%. Rebleeding occurred in two patients (16.7%), one minor vascular access-related complication (8.3%) was documented, and in-hospital mortality was 16.7%, with no deaths directly attributable to the procedure. The median hospital stay was 15 days (IQR: 7–24).

Conclusion: Transcatheter arterial embolization was described as an effective alternative treatment for non-variceal gastrointestinal bleeding, achieving a 100% technical success rate, 83.3% clinical success, and a low rate of procedure-related complications in patients treated at Dr. Rafael Hernández L. Regional Hospital between January 2024 and June 2025.

Renal Function and Occupational Exposure in Banana Plantation Workers from Baco, Chiriquí, Panama

Javier Torres — 2026-07-31

Introduction: Panama has reported an increase in cases of chronic kidney disease of non-traditional causes, particularly among agricultural populations.
Objective: To describe renal function and explore its association with sociodemographic, clinical, and occupational exposure variables among banana plantation workers from Baco, Barú.
Materials and Methods: A descriptive, observational, cross-sectional study was conducted involving 40 agricultural workers who completed a questionnaire designed to assess the variables of interest. In addition, blood samples were collected for serum creatinine determination and estimation of the estimated glomerular filtration rate (eGFR) using the CKD-EPI equation.
Results: Most participants presented renal function values within ranges considered normal; however, 20% showed some degree of reduced eGFR, ranging from mild reductions to one case compatible with renal failure. Reduced eGFR values were observed mainly among older workers and those with longer occupational histories in the plantations. No clear association was observed between renal function and the use of personal protective equipment.
Conclusions: The findings suggest that age and prolonged occupational exposure may be associated with decreased renal function in this population. Strengthening periodic renal function monitoring in agricultural workers and conducting longitudinal studies to further investigate factors associated with renal impairment are recommended.
Keywords: renal function; chronic kidney disease; agricultural workers; occupational exposure; pesticides; occupational health.