Revista Médica de la UCR 6(2)

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    WALDENSTRÖM MACROGLOBULINEMIA; CASE REPORT AND UPDATE
    (2013-03-05 00:00:00) Quirós Quirós, William; Rojas Castrillo, Yaoska
    The Waldenström Macroglobulinemia is a rare hematologic malignancy characterized by medullar infiltration of  lymphocytes clonally related, which secrete monoclonal IgM protein. According to the World Health Organization  classification, this entity corresponds to a B-cell No Hodgkin Linfom known as lymphoplasmacytic lymphoma that occurs most often in people over 65 years and particularly in Caucasian males. It is essential to make a proper differential diagnosis between this disease and other similar entities associated with monoclonal component. The etiology is unknown but has been associated with genetic factors and family. We report a case of a patient with symptomatic Waldenström Macroglobulinemia, which present an aggressive clinical picture of retinal  bleeding  plus others typical signs caused by the disease.
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    MEDICAL SPECIALIZATION IS THE UNIQUE OPTION FOR FUTURE PHYSICIANS?
    (2013-03-05 00:00:00) Trujillo Galván, Francisco David; Pérez Márquez, Guadalupe; Necoechea Silva, Norma Claudia; Trujillo Alcivia, Francisco David
    Today, many students of medicine and bachelor graduates still consider the specialty as an option for excellence to which they have to devote their efforts.  Not include general medicine as their area of professional development, however know that the vast majority of applicants to join a specialized course difficult to materialize such a claim because the bid for a place, is by far exceeded by the many doctors who  are competing each year. This may have its origin in the stigma that society has condemned to medicine, under the assumption that a higher level of specialization, more social recognition, better development opportunities and labor income, although the pathological profile countries like ours, require more and better  general practitioners whose pattern of action, are predominantly preventive activities and those that promote health in the population changes from the health education curriculum as well as modifications and vocational guidance to enable us to GPs get engaged and satisfied with their work under a transdisciplinary vision.
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    “PEGAS” OR “EMPACHOS" IN COSTA RICA AND CENTRAL AMERICA. HISTORICAL AND SOCIOANTHROPOLOGICAL PERSPECTIVE OF A FOLK DISEASE.
    (2013-03-05 00:00:00) Campos Navarro, Roberto; Vargas Escamilla, Bianca
    Introduction. “Empacho” (or "pegas" in Costa Rica) is a popular constructed disease which refers to digestive system’s disorders due to stagnation or partial arrest of gastrointestinal transit.  Methods and Materials. A historical and anthropological review about this  pathological entity was made from 121 texts collected in public and private libraries around the region.  Results. Many files about “empacho” exist in Central America since the sixteenth century to our days. The concept, the epidemiology and prophylaxis, etiology, signs and symptoms, even treatments are similar from Guatemala to Panama. Discussion and conclusions.  “Empacho” is widely recognized by the popular and native people in Central  America. At least within bibliographical references, it is more frequent in Guatemala, Nicaragua, and Costa Rica. Every country along the region has shown an important conflict between folk medicine and biomedicine, it has been underestimated by academic physicians that approach it as any other digestive disorder such as dyspepsia, irritable bowel syndrome, intestinal obstruction, or gastrointestinal infection. “Empacho” is still, a long-lived and day-to-day health problems.
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    Antibioticoterapia en el ambiente hospitalario costarricense: el caso Hospital Clínica Bíblica enero-junio 2012
    (2013-03-05 00:00:00) Flores Siles, Vivian; García Bermúdez, Leonardo; Cordero García, Eugenia; Díaz Madriz, José Pablo; Chaverri Fernández, José Miguel
    El uso apropiado de antibióticos es un factor fundamental para incrementar la supervivencia de los pacientes, limitar efectos adversos y la resistencia bacteriana. El presente trabajo analiza la farmacoterapia antibiótica utilizada en pacientes internados del Hospital Clínica Bíblica, San José, Costa Rica que recibieron tratamiento al menos durante 48 horas, y cuyo diagnóstico fuera una de las siguientes patologías: osteomielitis, infecciones de tracto respiratorio inferior, celulitis, sepsis, endocarditis invasiva, meningitis, infecciones intraabdominales, infecciones de tracto urinario e infecciones intravasculares asociadas a catéter. La selección de estas patologías responde a la epidemiología y a las necesidades planteadas localmente. Según los datos recolectados, en el 93% de las ocasiones (97 casos) los antibióticos se prescriben adecuadamente. Cuando se utilizaron tratamientos antibióticos combinados, en el 75% de las ocasiones no se siguieron las recomendaciones de referencia, y sólo en un 30% de los casos se conoce la bacteria involucrada en el proceso infeccioso. Se puede concluir que la selección de la antibióticoterapia debe estar fundamentada con datos que validen la sensibilidad local. El aporte que puede incorporar la interconsulta con un infectólogo y el farmacéutico clínico puede prevenir los errores relacionados con el uso de este grupo de fármacos en el Hospital.
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    CHRONIC APPENDICITIS AS A CAUSE OF CHRONIC RIGHT LOWER QUADRANT ABDOMINAL PAIN
    (2013-03-05 00:00:00) Ramírez Chacón, Jorge Luis
    Abdominal pain is a frequent problem in the medical and surgical consult. There has been written a big number of causes  of chronic abdominal pain, of which there is an estimate of 10-30% that can be explained by a structural or biochemical problems, and in the cases left (70-90%), even though the advances of diagnostic methods, will not be found an organic cause, and it defines as a functional type of abdominal pain. The chronic appendicitis it is always a topic of discussion, due to is not accepted by everyone  as an independent clinical entity. We made an analysis of 20 clinical cases with pathologic diagnosis of chronic appendicitis, from those cases, we subtracts gender,  age, clinical presentation, evolution (time), diagnostic studies made to the patient and treatment, to realize the casuistic of this pathology as a cause of chronic abdominal pain. The criteria to realize a clinical diagnosis of chronic appendicitis is a history of recurrent adbominal pain, more intense in the right lower quadrant, during a time period of more than two weeks, with or without of symptoms associated to appendiceal disease.  The definitive diagnosis of this pathology can be made only by histopahology analysis of the surgical tissue, which reveals data of chronical inflammation.  The only treatment so far is surgery.
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    RESEARCH IN COSTA RICA INVOLVING HUMAN BEINGS AND ITS IMPACT ON THE HEALTH OF COSTA RICANS
    (2013-03-05 00:00:00) Granados Zúñiga, Jorge
    We evaluate the benefits of clinical research carried out in Costa Rica from the published results and a sample of informed consent forms of approved protocols. We found 30 studies on 28 pharmaceuticals and 23 published scientific papers. Results: Of surveyed medical conditions, 19% are directly related to the main causes of mortality and morbidity in our country does not seem to have been necessary for drug registration.  A placebo as control was ued in 27% of investigations; of all studies with results, 30% had not published results, 37% published positive results, 17% ambiguous or contradictory results and 13% ended prematurely. Out of the major authors responsible for the publications, 91% were affiliated with research centers abroad. Conclusions: We conclude that there is insufficient evidence to claim  that analyzed clinical research has provided a significant benefit to the health of Costa Ricans, represents a significant therapeutic option, or has provided a significant contribution to scientific research in Costa Rica.