Revista médica de Panamá

Acute lung injury is secondary to massive ammonia inhalation. Case report.

2025-10-13T19:09:54+00:00

Ammonia (NH3) is an irritant and corrosive gas, normally transported in liquid form under pressure in steel cylinders, and acute inhalation in high concentrations occurs mainly during workplace accidents in the agricultural and industrial sectors. The extent and severity of the damage depend on the concentration and duration of exposure to the toxin, which can cause skin, eye, and respiratory injuries and pose a risk of death. [1] Acute respiratory distress syndrome (ARDS) and acute lung injury are common complications after acute exposure to ammonia gas. [2] We present the case of a patient who was acutely exposed to high concentrations of NH3.

Autoimmune hemolytic anemia as the initial presentation of splenic marginal zone lymphoma. A case report.

2025-10-13T17:27:41+00:00

Introduction: We present the case of a 60-year-old female patient with generalized weakness, dyspnea, unintentional weight loss, and gastrointestinal symptoms, including intermittent epigastric pain and gastroesophageal reflux. The initial diagnosis suggested a possible gastrointestinal malignancy. Despite an initial approach to rule out infectious or neoplastic pathology, the direct Coombs test was positive for warm IgG antibodies, leading to a diagnosis of autoimmune hemolytic anemia (AIHA).

Management and treatment: Treatment was initiated with methylprednisolone and other supportive medications. Abdominal ultrasound and computed tomography revealed splenomegaly. Subsequently, the patient was transferred to a tertiary care center, where bone marrow aspiration confirmed infiltration by splenic marginal zone lymphoma (SMZ), with AIHA as the initial clinical presentation.

Results: The patient responded positively to treatment with Rituximab, showing clinical improvement, regulation of hemoglobin and bilirubin levels, and resolution of splenomegaly.

Conclusion: It is important to consider hematological diagnoses in patients with atypical AIHA presentation, as in this case, where SML debuted with AIHA. Early diagnosis and appropriate treatment with Rituximab allowed for substantial clinical improvement

Spatial analysis of adolescent motherhood by number of live births in townships of Panama, 2023

2025-10-08T16:37:00+00:00

Objective: To identify spatial patterns and factors spatially related to adolescent motherhood according to the number of live births in districts of the Republic of Panama in 2023.

Methods: A spatial analysis of motherhood in adolescents aged 10-14 and 15-19 years was carried out
using data from the National Population and Housing Census. Spatial dependence was analyzed with the
Global and Anselin Local Morán indices. Factors associated with the percentage of mothers according to
live births were identified using spatial regression models.
Results: The percentage of adolescents aged 10-14 years with one and two or more live births was 0.128
and 0.003, respectively, and in adolescents aged 15-19 years it was 7.314 and 1.700. Positive spatial
autocorrelation (p=0.000) was identified in the percentages of adolescents aged 15-19 years, with 62
districts located in high-high maternity clusters with one live birth and 74 in high-high clusters with two or
more live births. The provinces with the highest percentages of indigenous adolescents and the indigenous
regions had most of their districts in high-high clusters with one and two or more live births. Spatial
regressions showed significant (p<0.05) and positive relationships between the percentage of adolescents
with a live birth and early unions and school absence, as well as between adolescents with two or more
live birth and multidimensional poverty.
Conclusions: The spatial distribution of adolescents aged 15-19 years according to the number of live
births is related to sociodemographic and socioeconomic factors. Targeted actions are needed in the
country.

Factors associated with burnout syndrome in students at two medical schools in Panama

2025-10-08T17:28:06+00:00

Objective: To determine the factors associated with burnout syndrome
(BS) due to exhaustion in medical students enrolled in basic, preclinical,
and clinical courses at the University of Panama and Universidad Latina
medical schools.
Methodology: The relevant data for the cases and controls in this study
were obtained through a survey, which was answered anonymously and
virtually by medical students at the University of Panama and
Universidad Latina.
Results: A total of 210 responses were obtained from the anonymous
survey, 52 positive (case group) and 158 negatives (control group) for Burnout Syndrome, and only the first 52 controls were selected, for a total of 104 medical students. Among
the most prominent risk factors in students with Burnout Syndrome, 84.62% had failed exams, 90.38% had
considered dropping out of the course, and 94% were studying at a public university.
Conclusion: The onset of Burnout Syndrome in medical students was associated with failing exams, few
hours of weekly exercise, weekly study hours, and type of university, with the most relevant association
being considering dropping out of the course. Further studies are needed to evaluate and consider the
hours of sleep that lead to burnout.

Does HoLEP resolve prostatic obstructive renal failure?

2025-10-08T17:44:46+00:00

Introduction: in patients with benign prostatic enlargement, obstructive renal failure (ORF) is a common complication, and holmium laser enucleation of the prostate (HoLEP) is the treatment of choice. However, limited data is available on the evolution of urodynamic and renal function parameters in these patients. Our objective is to evaluate the effect of HoLEP on urodynamic and renal function parameters in this patient population.

Materials and Methods: in the Germans Trias i Pujol Hospital (Barcelona, España) a retrospective study was conducted on all patients with suspected ORF (those with an indwelling urinary catheter) who underwent HoLEP between 2017 and 2022. Two groups were defined for analysis: patients without ORF and those diagnosed with ORF at the time of evaluation. Demographic, surgical, renal function, and urodynamic data were collected before and after surgery.

Results: a total of 163 patients were included; 131 without ORF and 32 with ORF. No significant differences were observed in clinical, surgical, or urodynamic variables between the two groups. Patients with ORF had higher creatinine levels and a lower glomerular filtration rate before surgery. After surgery, ORF patients exhibited normal urodynamic and renal function parameters.

Conclusions: HoLEP is an effective treatment for patients with prostatic obstruction. In patients with ORF, the procedure restores renal function and urodynamic parameters to normal levels.

Characteristics of pulmonary tuberculosis in patients with chronic respiratory symptoms.

2025-10-13T16:35:37+00:00

Pulmonary tuberculosis continues to be a public health problem in Paraguay, especially in areas with high social vulnerability. The objective of this study was to describe the clinical and epidemiological characteristics of patients with a confirmed diagnosis of pulmonary tuberculosis and chronic respiratory symptoms treated at the Regional Hospital of Concepción during 2019. A quantitative, descriptive, cross-sectional, and retrospective study was conducted based on 50 intentionally selected medical records. Most of the patients were young men (60%), with a prevalence in the 20-39 age group (56%). The most common symptoms were persistent cough (90%), weight loss (68%), evening fever (60%), and night sweats (54%). Eighty-eight percent received first-line treatment, and a 10% dropout rate was reported. The most frequent comorbidities were alcoholism (20%) and diabetes mellitus (10%). The results highlight the need to strengthen early detection and therapeutic adherence strategies, especially in vulnerable groups.

Acceptability and sustainability of new resources.

2025-10-13T18:48:18+00:00

Introduction: Starting in 2011, the University of Panama incorporated research, bioethics, and medical education courses into medical residencies (clinical master's degrees) offered by the country's training services. However, by 2013, only 15% of residents had completed the corresponding research projects. In 2018, the accreditation of the Faculty of Medicine revealed weaknesses in clinical undergraduate research, and a situational analysis of residency programs identified a lack of databases, limited knowledge of research, limited access to mentors, difficulty in publishing, and limited technological innovation. Methodology: Using research funds from the Call for Proposals (CUFI), implementation research was conducted with outcomes of acceptability and sustainability to evaluate the viability of new research resources. Multiple interviews with experts and structured questionnaires were conducted. All were virtual due to the pandemic.

Results: There was a high level of acceptance of the strategies applied, with 95% participation from the experts consulted. The products included procedural guidelines for database disclosure, research regulations, virtual training, an obesity community of practice, and the legal and administrative structure of the Clinical Research Center (CILCI). Conclusion: The strategies implemented were acceptable and sustainable and strengthen clinical research at the Faculty of Medicine, making it possible to generate new knowledge.

Clinical characteristics of patients with ovarian granulosa cell tumors at the National Cancer Institute

2025-10-13T16:42:25+00:00

Granulosa cell tumors (GCTs) are rare, accounting for only about 5% of all ovarian cancers. Recent publications have focused on epithelial and germ cell tumors in Panama, but information on GCTs is lacking, prompting this investigation. A retrospective, descriptive study was conducted of cases evaluated at the National Oncology Institute (ION) between 2012 and 2022. Ninety cases were included. The median age was 47,5 years. FIGO stage IA was the most common, with 43 cases. The most common initial clinical presentation was abdominal pain. Most patients received surgical treatment and did not receive chemotherapy. Ten patients had recurrence, and of these, nine died at the time of study closure. The results obtained are like those reported in medical literature but with a slightly higher frequency in relation to tumors of epithelial origin.

Dental biofilm and periodontal therapy: a review of the scientific evidence

2025-10-13T17:02:00+00:00

Introduction: Dental biofilm is a thin, viscous layer composed of proteins, salivary components, gingival fluid, bacterial debris, host tissue cells, lipids, nucleic acids, and carbohydrates, and colonized by bacteria. It is bacterial biofilm, associated with periodontal disease, dental caries, peri-implantitis, root canal infection, and complications of potentially fatal systemic diseases [1, 2]. Biofilm affects periodontal tissues and, due to its potential role in oral disease, stimulates the search for therapeutic treatments. Objective: to provide relevant information that consolidates aspects of interest in periodontal therapy.

Methodology: A narrative literature review was conducted of original research and reviews published in PubMed, Scielo, Science Direct, MedLine, Elsevier, Springer, Redalyc, dissemination portals (Dialnet), repositories, and degree theses from 2005 to 2024.

Results: 85 articles were evaluated and 40 were selected according to inclusion criteria.

Conclusion: There is scientific interest in the use of various therapies with effects on dental biofilm and the search to prevent, control, and treat periodontal disease. Therapeutic evidence shows beneficial findings that favor the process of controlling dental biofilm and periodontal disease through different innovative approaches, identifying the bacterial agent to avoid the inappropriate use of antibiotics and applying joint therapies. The relevant information highlights the need to continue research that demonstrates substantial efficacy. Although different therapeutic techniques aimed at the same objective have been achieved with positive results, they are not comparable due to variability.

Medical Internships In Latin America

2025-10-20T19:06:29+00:00

To become a Doctor of Medicine, the strategy used is to pursue a degree at universities, completing a curriculum designed for that purpose, and then completing hospital internships. These students, during these hospital internships, are recognized as undergraduate medical interns. These medical interns join the healthcare team under the supervision and responsibility of qualified physicians. In Latin America, there is no consensus on the criteria for completing this internship, and it varies between universities and countries. Most countries agree that medical internships are the responsibility of the training university, one year, and are not paid as a public employee. A total of seven years of medical training are required to obtain a qualified doctor. Panama differs from the rest of Latin America (medical internships) in that it requires an additional year, is paid as a public employee, and does not involve universities.

Undifferentiated round cell sarcoma with CIC-DUX4 rearrangement of the vulva: case report.

2025-10-13T18:42:31+00:00

We present an extremely rare case of vulvar sarcoma that required specialized genetic testing for its final diagnosis. Initially, it was mistaken for an infectious process. Then, the biopsy classified it as a sarcoma, and the patient was referred to the National Cancer Institute. The corresponding surgery was performed, and the tumor was reported as an undifferentiated small cell sarcoma. For the final diagnosis, paraffin blocks were sent to a center specializing in sarcomas in Italy. The patient's progress has been satisfactory.

Primary retroperitoneal paraganglioma diagnosed incidentally in a young patient. Case report

2025-10-13T18:58:56+00:00

Introduction: Retroperitoneal paragangliomas (PGLs) are rare neoplasms. Together with pheochromocytomas, they account for 0.2% of all retroperitoneal malignancies and are included in the subset of pheochromocytoma/paraganglioma (FPGL) neuroendocrine tumors. Case presentation: We present the case of an 18-year-old healthy male patient who consulted the emergency department due to one day of gastrointestinal discomfort. The initial ultrasound examination incidentally revealed a retroperitoneal mass, which was subsequently characterized by computed tomography (CT) and magnetic resonance imaging (MRI). The patient underwent total resection of the lesion, which was histologically consistent with an extra-adrenal PGL.

Conclusion: The incidental finding of a retroperitoneal PGL by ultrasound is rare. Although this technique is not very sensitive for the study of retroperitoneal masses, in experienced hands it allows an approximation of the anatomical location, morphological characterization, and involvement of adjacent structures, as shown in this case.

Renal H+-K+ ATPases IMPORTANT IN SODIUM HOMEOSTASIS?

2025-10-13T17:16:38+00:00

Traditionally, H+-K+ ATPases are associated with the exchange of hydrogen ions and potassium, for which they use the energy from ATP hydrolysis. These ATPases consist of a catalytic ? subunit, approximately 100 kDa in size, with 10 transmembrane helices and a catalytic site, and a glycosylated ? subunit of 30 kDa, essential for its transport and processing. In the kidney, there are two catalytic isoforms: HK? 1 (gastric) and HK? 2 (colonic). Numerous studies in nephron and collecting ducts, together with research in genetically modified mice, suggest that these ATPases transport ions other than protons and potassium. Recent evidence indicates that ATPases play a crucial role in sodium and potassium homeostasis, as well as in acid-base balance.

There is evidence that H+-K+ ATPases participate in sodium transport at the renal level. This review addresses their physiological function, regulation, and structure, highlighting their impact on sodium homeostasis and their clinical relevance in renal hypertension.

TUBERCULOSIS: HISTORICALLY ENDEMIC TO HUMANITY

2025-10-08T18:05:14+00:00