Hospital General San Juan de Dios

Timely diagnosis, treatment, and delays in systemic lupus erythematosus (SLE) remain underexplored in the Central America and Caribbean (CAC) region. The objective was to describe and analyze patient-level and health care system-level barriers and facilitators associated with diagnostic and therapeutic delays in SLE, based on experiences of patients and rheumatologists from 6 countries in the CAC region. A qualitative study was conducted in Cuba, the Dominican Republic, Guatemala, Honduras, Nicaragua, and Panama. Patients and rheumatologists were purposively recruited. Data were collected through in-depth interviews and focus groups. Thematic analysis was conducted. A total of 46 patients and 40 rheumatologists participated. Barriers and facilitators were grouped into 4 themes. Patient-related and context-related delays reflected disease interpretation and health-seeking behaviors: mild or nonspecific manifestations and self-medication delayed care, whereas visible symptoms and a family history of autoimmunity facilitated timely consultation. Health care system-related delay encompassed 3 themes: (a) accessibility-financial precarity, geographic barriers, and medication costs delayed care, though social support and universal coverage (Cuba) facilitated treatment; (2) technical and cultural competence-insufficient provider training and misdiagnoses hindered timely care, while trustful rheumatologist-patient relationships improved adherence; (3) health resources-shortages of specialists, diagnostic tests, and medications were major obstacles. Delays in SLE care in CAC are predominantly driven by systemic rather than patient-level factors. Strengthening health system capacity, expanding rheumatology services, and fostering culturally sensitive care are essential to reducing inequities and improving outcomes.

Abstract Purpose of the study: YAP1 is the most frequently amplified oncogene in cervical cancer. The Cancer Genome Atlas Research Network study showed that the YAP1 (11q22) oncogene is amplified in 11% of cervical cancer cases. Our lab recently identified that YAP1 oncogene amplification is associated with a 12-year earlier age of diagnosis, poorer survival, and defies a novel aggressive cervical cancer subtype that is more frequent in minority populations. The present study aims to characterize 19 YAP1 amplified cervical cancers from Guatemala and Venezuela via Oxford Nanopore technology (ONT) whole genome long-read sequencing. Methods: In this study, 380 cervical cancer patients were assessed for YAP1 amplification using a TaqMan assay, with 45 samples identified as positive for YAP1 amplification. These 45 samples were then subjected to whole genome sequencing with 5x coverage using Oxford Nanopore Technologies (ONT) to confirm the amplification status. A subset of 19 YAP1-amplified samples underwent deeper sequencing via ONT-LSK114 library preparation. The HPV integration status in these samples was determined by uploading the sequencing data (fastq_pass files) to the Cancer Genomics Cloud, where breakpoints were manually examined using the Integrated Genome Viewer (IGV). HPV and human DNA segments were further analyzed and identified using bioinformatics tools such as BLAT and BLAST. Results: In our study, we confirmed YAP1 amplification in 24 out of 45 tumor samples using barcode sequencing, and due to limited DNA availability (1 µg), only 19 of these samples underwent deep sequencing with 25-30x coverage. Notably, we observed a higher frequency of HPV integration (11/19) in YAP1-amplified tumors compared to those with episomal HPV status, suggesting a potential link between HPV integration and YAP1 amplification. We noticed that YAP1 amplification is driven by Breakage-Fusion-Bridge (BFB) events, which also lead to the co-amplification of the nearby BIRC2/3 genes, contributing to genomic instability and immune escape. This mechanism was further supported by a similar pattern observed in the TCGA whole genome sequence data, where 27 out of 31 YAP1-amplified cervical tumors also exhibited BFB events. Finally, treatment with the PIK3CA inhibitor Alpelisib resulted in a decrease in YAP1 protein levels in CaSki cells, a cervical cancer cell line with mutated PIK3CA and amplified YAP1 expression. Conclusions: These findings highlight a possible interplay between HPV integration and BFB-driven amplification of YAP1 and its neighboring genes, offering insights into potential therapeutic targets for this novel aggressive subtype of cervical cancer. Citation Format: Sonam Tulsyan, Hong Lou, Yi Xie, Emma Robinson, Danielle Kayembe, Eduardo Gharzouzi, Roberto Orozco, Enrique Alvirez, Michael Dean. Identifying a novel aggressive subtype of cervical cancer predominantly affecting minority populations through long-read whole genome sequencing [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Functional and Genomic Precision Medicine in Cancer: Different Perspectives, Common Goals; 2025 Mar 11-13; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2025;85(5 Suppl):Abstract nr B018.

Varicella presents a public health challenge in Guatemala, with limited evidence regarding its impact; vaccine is currently absent from the national immunization program. Generating local data on the economic and health burden can support immunization policies. This study describes the use of hospital resources, costs of care, clinical and demographic characteristics, and complications in children with varicella. A retrospective review of medical records from patients admitted in four public institutions in Guatemala between January 2015 and December 2019, with diagnosis of varicella was performed. A total of 124 hospitalized patients, aged 0 to 14 years, were analyzed, of whom 46% had cancer. The average cost of hospitalization was USD 3,793.24 for complicated cases and USD 1,131.11 for uncomplicated cases. The average hospital stay was 11 days for patients with complications and 5 days for those without complications. In total, 66.1% of patients presented complications, with related infection complications being the most common. In conclusion, hospitalizations for varicella impose a significant economic and clinical burden in Guatemala. Complications increase the cost of care by three times, highlighting the importance of considering the inclusion of the varicella vaccine in the National Immunization Program to prevent the disease.

'One Health' initiatives to tackle the rising risk of antimicrobial resistance (AMR) have flourished due to increasing detection of Enterobacterales producing extended-spectrum beta-lactamases (ESBLs) and carbapenemases (CPs). This study aimed to conduct an in-depth holistic analysis of Escherichia coli (Ec) and Klebsiella pneumoniae (Kp) isolates recovered from landfill-foraging white stork faecal samples and clinical isolates from a nearby hospital. Faecal samples (n = 211) were collected from storks foraging at two landfills in Spain. Ec/Kp stork isolates were recovered on selective media and whole-genome sequencing (WGS), together with isolates obtained from the nearby hospital. These genomic data were compared with public genomes from different contexts (clinical, environmental, or animal hubs) to understand global transmission dynamics. A wide range of blaESBL/blapAmpC (blaCTX-M/blaSHV-12/blaDHA) were detected in 71 stork samples (33.6%), while blaCP (blaKPC/blaNDM/blaOXA-48/blaVIM) were identified in 28 (13.3%) samples. Clonal and plasmid transmissions were evidenced inside and between both landfills. Mapping against 10 624 public Ec/Kp genomes and from those of nearby hospital revealed that identical strains (<10 allelic differences with Ec-ST38/ST131 and Kp-ST512 lineages) and epidemic plasmids (full identity/coverage with IncN/blaKPC-2, IncF/blaKPC-3, IncX3/blaNDM-7, IncL/blaOXA-48) were found from clinical isolates in countries located along the storks' migration routes. Storks may be contaminated by bacterial isolates from a likely human origin and become non-human reservoirs of critical genes, which can be dispersed over long distances. Identifying strains/plasmids along the stork's routes that are identical or closely related to those described here opens new perspectives for large-scale research to understand the AMR transmission dynamics.

Aims & Objectives: Define the physiological stability in patients admitted to PICU and determine the relation of the cardiac arrest and cardiopulmonary resuscitation events. Methods: Descriptive study, 95 medical records were revised, of patient whom were admitted to PICU during March - May 2023, a registration form from the event was filled and registered the events. Results: The PRISM III score was used to the physiological stability at the admittance of the PICU. The 59% (56) of them had a low risk of mortality, 40% (38) had medium risk of mortality and only 1 % had high risk of mortality. 32 events related with cardiopulmonary resusctitation it happen in 33 % of patients with confidence interval 95 % and in 27 % of patients with confidence interval 95 % who had cardiac arrest and do not reach return of the spontaneus circulation. Conclusions: Physiological stability it was a good predictor of events that could be related with cardiopulmonary ressucitation. In this study it is important to define the risk of mortality to anticpate the event realted with deterioration and further monitoring of the patients admitted to the PICU. Education about deteriorating child and acute patient it is important to apply the physiological stability to make risk groups and determine the precited and observed mortality (Standarized Mortality Ratio) Keywords: quality assurance, Cardiac Arrest, cpr

This project aimed to successfully implement the Stop the Bleed® (STB) program in Guatemala by targeting key providers in various communities across the country. The course was conducted in rural community centers, fire stations, tertiary care centers, and medical school facilities. We included agricultural occupational health workers, firefighters, medical providers, and medical students throughout the course. We successfully trained 247 people in Guatemala in STB and certified 13 instructors and four associate instructors. Through pre- and postcourse surveying, we determined that the course improved the participants' comfort level in managing bleeding emergencies. Creating partnerships with key providers at different community levels leads to the successful implementation of public health initiatives. Further research should be geared at determining the course's dissemination by new instructors.

Blood donor questionnaires are tools used to screen prospective blood donors to determine their eligibility. There are limited data regarding blood donor questionnaires and infectious disease screening of the blood supply in Latin American countries. This study aimed to survey donor centres in Latin American countries to learn more about blood donor screening and infection assessment. An international team of transfusion medicine professionals including medical directors and supervisors who work or collaborate with Latin American donor centres, called 'Comité de Investigación en Medicina Transfusional', designed a survey (16 questions) to characterize blood donor eligibility in Latin America. Eighty-two institutions from 14 Latin American countries responded to the survey. Most donor centres (66%; 54 of 82) had a donor deferral percentage between 5% and 25%, and the most common causes of deferrals were low haemoglobin and high-risk behaviour. Most donors in blood centres were directed family donors compared with voluntary donors. Infection evaluation included mostly serologic assessment (81%; 30 of 37) for human immunodeficiency virus (HIV), Hepatitis B, Hepatitis C, Treponema pallidum and Trypanosoma cruzi rather than nucleic acid tests (5%; 2 of 37). Heterogeneity exists in donor selection and infectious disease screening in Latin American countries. This survey provides valuable information to understand Latin American blood centre practices.

El Linfoma Cardiaco Primario se define como linfoma no Hodgkin (LNH) que afecta sólo al corazón y/o al pericardio, o LNH con manifestaciones cardíacas, especialmente cuando la mayor parte del tumor se encuentra en el corazón. Ocurren en pacientes inmunocomprometidos. Los tumores cardíacos primarios (PCT) son raros y ocurren en 1,38 a 30 casos por 100.000 personas al año. Alrededor del 75-80% de los PCT son benignos y más de la mitad de ellos son mixomas. El linfoma cardíaco primario (LCP) es un tumor poco común que representa el 1,3% de los tumores cardíacos primarios. En términos de espectro histológico, el linfoma no Hodgkin difuso de células B grandes es el linfoma cardíaco primario más común (58%), seguido del linfoma de células T (16%), la neoplasia del linfoma de Burkitt y el linfoma linfocítico pequeño (6%). Los síntomas complicados asociados con el linfoma cardíaco primario pueden incluir disnea, dolor torácico, fatiga progresiva, sudores nocturnos, pérdida de peso, arritmias cardíacas y síndrome de la vena cava superior. Alrededor del 20 por ciento de las personas con PCL pueden desarrollar insuficiencia cardíaca aguda antes de que aparezcan otros síntomas. Sin embargo, los linfomas cardíacos primarios suelen presentar síntomas inespecíficos y, a menudo, se descubren de forma incidental. Se reporta un paciente masculino de 56 años la cual acude al servicio de emergencias por presentar disnea que evoluciona de grandes esfuerzos a pequeños esfuerzos progresiva y dolor interescapular izquierda.

OBJETIVO: describir la sedación y analgesia para procedimientos en emergencia. MÉTODO: se recopiló información de revista médica clínica Los Condes, revista mexicana de Anestesiología, MBA surgical empowerment, sociedad española de anestesiología, InnovaHONCO, Ocronos, Tintinalli, libros, revistas médicas donde se encontraron artículos, guías y protocolos sobre la sedación y analgesia para procedimientos en emergencia. RESULTADOS: El uso de la sedación y analgesia para procedimientos en el servicio de emergencia corresponde al uso de analgésicos de acción corta y medicamentos sedantes que permiten el desarrollo de procedimientos no programados de manera segura, mientras se monitorea a los pacientes para detectar posibles eventos adversos cardiorrespiratorios. CONCLUSIÓN: La sedación y la analgesia para los procedimientos de emergencia se describen como un estado en el cual se priva a los pacientes de las sensaciones no placenteras provocadas por los distintos procedimientos médicos no programados y que no requieren realizarse en el quirófano, además de proporcionar un estado de ausencia de la percepción del dolor.