Coronary heart disease (CHD) remains as the main cause of death in most countries of the world including Puerto Rico. Due to the importance of gathering knowledge regarding the harmful effects and risk factors associated...Coronary heart disease (CHD) remains as the main cause of death in most countries of the world including Puerto Rico. Due to the importance of gathering knowledge regarding the harmful effects and risk factors associated with the development of CHD some basic information is reviewed to stimulate the institution of measures for reduction of the prevalence of clinical CHD and its ultimate consequences. Special attention is given in the manuscript of the Puerto Rico Heart Health Program conducted in men aged 45-64 residing in four rural and three urban areas. The Puerto Rico and the Honolulu Study confirmed the initial publication on the epidemiology of coronary heart disease by the Framingham study. The presentation of some data collected among the three studies strengthen the message of avoiding the development of CHD by installing preventive measures for control and reduction of the risk factors. Concurrent data obtained in the three studies is presented. Although the degree of the involvement of the populations is higher in Framingham than in Puerto Rico and Honolulu, the deleterious effects of specific risk factors are harmful in all the three populations. Difference in the prevalence of risk factors among the urban and rural males in Puerto Rico is also illustrated. It is our hope that more intense measures be instituted in Puerto Rico at all levels in order to control risk factors and reduce the incidence of coronary disease in Puerto Rico.
Hernán Martínez J, Torres O, Mangual MM
… +5 more, Palermo C, Figueroa C, Santiago M, Miranda Mde L, González E
Bol Asoc Med P R
· 2013 · PMID 23767389
Hashimoto's encephalopathy (HE) is a rarely recognized neurocognitive syndrome that is associated with thyroid autoimmunity. It is more common in women. HE is diagnosed when patients present with nonspecific neurological...Hashimoto's encephalopathy (HE) is a rarely recognized neurocognitive syndrome that is associated with thyroid autoimmunity. It is more common in women. HE is diagnosed when patients present with nonspecific neurological symptoms associated to elevated titers of antithyroid antibodies and normal or abnormal thyroid function tests. Other neurologic disorders must be ruled out before diagnosis can be established. HE is associated to nonspecific EEG abnormalities as well as elevated cerebrospinal fluid proteins and nonspecific white matter changes. The pathophysiology of HE is unknown but an autoimmune etiology is strongly supported. HE responds to corticosteroids and immunosuppressive therapy, further supporting an autoimmune etiology. A high index of clinical suspicion must be present in order to promptly recognize and treat this disease.
The absence of the cranial bones is a rare entity usually incompatible with life. Agenesis of parietal bones has been rarely reported in the literature. A case of a neonate with bilateral parietal agenesis associated hyd...The absence of the cranial bones is a rare entity usually incompatible with life. Agenesis of parietal bones has been rarely reported in the literature. A case of a neonate with bilateral parietal agenesis associated hydrocephalus is reported. The cranial defect was managed conservatively. To our knowledge we present the first case of congenital agenesis of the parietal bone associated with hydrocephalus.
García Gubern C, Rolón Colon L, Vazquez Torres O
… +3 more, Martinez Alayón G, Santos Santiago A, Mulero Portela E
Bol Asoc Med P R
· 2013 · PMID 23767387
Endometriosis is defined as the presence of endometrial tissue in extra uterine sites. It affects 5-15% of females during their reproductive years. Thoracic endometriosis syndrome is characterized by the presence of func...Endometriosis is defined as the presence of endometrial tissue in extra uterine sites. It affects 5-15% of females during their reproductive years. Thoracic endometriosis syndrome is characterized by the presence of functional endometrial tissue within the pleura, the lung parenchyma or the airway. The overall prevalence of this condition is unknown due to a lack of epidemiological studies, variety of symptoms, signs and locations. We present the first reported case of recurrent catamenial pneumothorax in Puerto Rico and a review of recent literature.
Fernández González F, Betancourt J, Malpica JC
… +2 more, Laboy I, Colón M
Bol Asoc Med P R
· 2013 · PMID 23767386
Herpes simplex virus (HSV) is a host-adapted human pathogen. HSV-I usually infects non-genital sites at a variety of locations. HSV-2 primarily involves genitalia. Both types can cause genital and orofacial infections, w...Herpes simplex virus (HSV) is a host-adapted human pathogen. HSV-I usually infects non-genital sites at a variety of locations. HSV-2 primarily involves genitalia. Both types can cause genital and orofacial infections, which are clinically indistinguishable. Initial HSV infection is usually asymptomatic or mild and self-limited, but instead of disappearing from the body during convalescence, the virus establishes a latent infection that persists for life. Rarely, there is severe visceral dissemination. This is a case report of an unusual presentation of herpes simplex in an immunocompromised adult patient with generalized skin lesions on the entire body. To our knowledge, this is the first case reported in the literature of a disseminated herpes simplex in a patient with history of non-Hodgkin Lymphoma. Generalized HSV infection in immunodeficient adult patients could be fatal in spite of antiviral therapy. Early recognition of this entity is essential to expedite appropriate treatment and avoid future complications.
Guzmán L, Oppenheimer E, Lugo-Vicente H
… +1 more, Correa M
Bol Asoc Med P R
· 2013 · PMID 23767385
Chylous jejunal cysts are extremely rare entities and if not diagnosed promptly may lead to severe complications like bowel obstruction, loss of small bowel and even death. We present the case of a 4 year-old-male referr...Chylous jejunal cysts are extremely rare entities and if not diagnosed promptly may lead to severe complications like bowel obstruction, loss of small bowel and even death. We present the case of a 4 year-old-male referred to our institution with severe abdominal pain, constipation, abdominal distention and radiological findings of large amount of fluid in the lower abdomen with associated bowel obstruction. Operative findings were that of large chylous jejunal cyst causing segmental volvulus. Resection of the involved jejunal segment and cyst along with bowel detorsion was undertaken. Literature review on the subject follows.
Pérez-Rodriguez O, Ortiz-Oramas A, Stuart-Vazquez B
Bol Asoc Med P R
· 2013 · PMID 23767384
This is a case of a unilateral ovarian torsion in a 27-year-old female with 11 5/7 weeks of gestation who underwent laparoscopic detorsion and transabdominally oophoropexy using an innovative surgical technique. The pati...This is a case of a unilateral ovarian torsion in a 27-year-old female with 11 5/7 weeks of gestation who underwent laparoscopic detorsion and transabdominally oophoropexy using an innovative surgical technique. The patient continued with her prenatal care and vaginal delivery at term without complications.
Rodríguez-Ayala G, de la Vega A, Correa-Rivas M
… +1 more, Jímenez A
Bol Asoc Med P R
· 2013 · PMID 23767383
Placental chorioangiomas are relatively common benign placental tumors occurring with an incidence of approximately 1% of histologically studied placentas. However, they show clinical manifestations in very rare pregnanc...Placental chorioangiomas are relatively common benign placental tumors occurring with an incidence of approximately 1% of histologically studied placentas. However, they show clinical manifestations in very rare pregnancies usually at a median gestational age of 28 weeks. Our report presents an interesting and rare case of severe hydramnios with consequent preterm labor and delivery in the second trimester leading to neonatal death due to placental chorioangioma. An earlier diagnosis could have led to closer monitoring and prevention of the development of severe hydramnios with resultant preterm labor.
Vein of Galen aneurysms are a rare and complex vascular malformation of the brain. Their prevalence is somewhat less than 1 in 25,000 deliveries. Common associated anomalies include ventriculomegaly, cardiomegaly seconda...Vein of Galen aneurysms are a rare and complex vascular malformation of the brain. Their prevalence is somewhat less than 1 in 25,000 deliveries. Common associated anomalies include ventriculomegaly, cardiomegaly secondary to high cardiac output and enlarged neck vessels, the later being an almost pathognomonic sign. The prognosis for these neonates is poor with a mortality rate of 50% and a high risk for neurologic sequelae. Color flow Doppler studies of the fetal brain vasculature are a reliable method for diagnostic purposes. In this paper we present a case of a vein of Galen malformation diagnosed prenatally at 33 weeks of gestation using both 2D and color Doppler ultrasound modalities.
Narváez Pérez K, Fernández Crespo L, Teresa Miranda M
… +1 more, Boulón Diaz F
Bol Asoc Med P R
· 2013 · PMID 23767381
Evaluation and measurement of intelligence contributes significantly to the scientific endeavor of psychology as a science. This study was exploratory and descriptive, with twenty young patients with epilepsy from Puerto...Evaluation and measurement of intelligence contributes significantly to the scientific endeavor of psychology as a science. This study was exploratory and descriptive, with twenty young patients with epilepsy from Puerto Rico of ages between 16-20 years. Compared the execution of a matched group of the normative sample and the group of adults 21 to 64 years with epilepsy belonging to the standardization sample in Puerto Rico. The data was analyzed using descriptive and inferential statistical calculations. Survey results reflect significant differences in the scores of the subtests that make up the intelligence scale EIWA-III. In all measures, the group of participants with epilepsy rate was lower than the reference group. The comparison of scores on the subtests that measure executive functions was analyzed by the working memory index (WMI). Based on the data obtained, the performance in executive functions EIWA-III is significantly lower in participants with epilepsy compared to the reference groups. Analysis of variance/ANOVA showed no significant differences between IQ scale for implementation (F = 8.77) with a probability of 0.001, CI scale (F = 4.35) was 0.01 and verbal scale IQ (F = 2.67) was 0.05 for the group of young patients from 16 to 20 years with epilepsy, their IQ score compared with the normative group on the subscales that comprise the Verbal Scale, Performance and Total rates of IQ trial EIWA-III. In light of these results, the statistically significant differences for each subscale: Verbal IQ, Performance, Total and indexes EIWA-III, suggest that the level of intelligence of sample group, 16 to 20 years old with epilepsy, was below average in comparison with the normative group. The results are consistent with the literature on cognitive neuropsychology and performance of subjects with epileptic diseases.
Miranda MT, Suárez E, Abbas M
… +5 more, Chinea A, Tosado R, Mejías IA, Boukli N, Dunston GM
Bol Asoc Med P R
· 2013 · PMID 23767380
Multiple Sclerosis (MS) is a complex disease where genetic and environmental factors have been implicated. The onset of symptoms occurs in individuals from twenty to fifty years of age, producing a progressive impairment...Multiple Sclerosis (MS) is a complex disease where genetic and environmental factors have been implicated. The onset of symptoms occurs in individuals from twenty to fifty years of age, producing a progressive impairment of motor, sensory and cognitive functions. MS is more frequent in females than in males with a ratio of 4:1. The prevalence of the MS varies among ethnics groups such as Europeans, Africans and Caucasians. The estimated prevalence of MS in Puerto Rico is 42 for each 100,000 habitants, which is more than the prevalence reported for Central America and the Caribbean. In spite of this prevalence, the genetic component of MS has not been explored in order to know the alleles' expression of Puerto Rican MS patients and compare it with the allele expression in other ethnic groups. Thirty-five patients and 31 control subjects were genotyped. The allele frequencies expressed in this sample were similar to those expressed for Puerto Ricans in the National Marrow Donor Program Registry (n = 3,149). The most prevalent alleles for MS patients were HLA-DRB1*01 and *03. HLA-DQB1*04 was the most frequent in the control group and HLA-A*30, in MS patients. These findings are in agreement with published data. HLA-DQB1*04 was a marginal protector in this sample and this role has not been described before. The accuracy of the results is limited due to the sample size. After performing a statistical power analysis it showed that by increasing the sample the values would be significant.
UNLABELLED: The presence of a major congenital anomaly is a frequent indication for late termination of pregnancy. The possibility of the fetus being born alive is significant, thus, feticide prior to the procedure is de...UNLABELLED: The presence of a major congenital anomaly is a frequent indication for late termination of pregnancy. The possibility of the fetus being born alive is significant, thus, feticide prior to the procedure is desirable. The purpose of this study was to assess the safety and efficacy of lidocaine 1% as a feticidal agent prior to second trimester termination of pregnancy. METHODS: We conducted a chart review of all patients who underwent a second trimester termination of pregnancy at our institution between March 2009 and June 2012. We collected data regarding the indication for the termination procedure, gestational age, site of lidocaine injection, dosage of lidocaine, need for additional to produce asystole, and maternal complications. RESULTS: We identified 54 patients who underwent second trimester termination following injection with lidocaine. Forty-six cases (85%) were done for major fetal anomalies and 8 cases (15%) were for maternal indications. The mean gestational age was 22 weeks (SD = 2.3). The mean volume of lidocaine 1% injected was 10.1 mL (range: 5-40 mL). Asystole was achieved in 1-2 minutes following intracardiac administration. Intracardiac injection was successful in 45/46 (98%) of cases. Intrathoracic administration was successful in 5/6 (83%). This approach was chosen when cardiac puncture was not effective. Two fetuses receiving an initial intraabdominal or umbilical vein injection required additional doses of intracardiac lidocaine to produce asystole. There were no maternal complications. CONCLUSIONS: Intracardiac administration of lidocaine is an effective method to induce cardiac asystole for second trimester pregnancy termination. Extra-cardiac injection, however, is less effective.
UNLABELLED: Several reports on liver transplantation and pregnancy have been published recently. Uncertainty remains regarding appropriate management of these patients. METHODS: The study included pregnant women of all a...UNLABELLED: Several reports on liver transplantation and pregnancy have been published recently. Uncertainty remains regarding appropriate management of these patients. METHODS: The study included pregnant women of all ages with liver transplant referred to our center. A total of eight patients were identified and qualified for our study. The following variables were obtained: age, date of liver transplantation, date of conception, reasons for liver transplantation, type of immunosuppressive therapy, complications during pregnancy, gestational age at birth, birth weight, mode of delivery, the interval of time from liver transplantation to conception and co-morbidity. RESULTS: The mean age of our population was 24 years. Four of the eight were nulliparous. The mean time interval from transplantation to pregnancy was eight years. The indication for liver transplantation in 75% of patients was autoimmune hepatitis. Two cases were associated with viral hepatitis. Combination therapy with more than one immunosuppressant was given to 75% of patients. The most prevalent complication was pyelonephritis in (38%), followed by gestational thrombocytopenia and preeclampsia. Most deliveries (75%) were vaginal and at term (88%). The median for gestational age was 39 weeks. The median birth weight was 2,898 grams. CONCLUSIONS: This study proves that successful and uneventful pregnancies are likely in liver transplant patients under optimal obstetric management.
The fundamental treatment of atrial fibrillation is based on maintenance of sinus rhythm or control of ventricular rate and preventing arterial thromboembolism. Warfarin has been the anti-thrombotic agent of choice for t...The fundamental treatment of atrial fibrillation is based on maintenance of sinus rhythm or control of ventricular rate and preventing arterial thromboembolism. Warfarin has been the anti-thrombotic agent of choice for the last 50 years. However multiple interactions with other drugs and certain types of food and vegetables with high Vitamin K content complicate its use. It also requires multiple blood tests to adjust the dose in order to reach adequate and stable anticoagulation. Three new, di-fferent anti thrombotic agents are described. They are as or more effective than Warfarin with decreased incidence of hemorrhagic events. Dabigratan is a direct antithrombotic inhibitor, Rivaroxaban and Apixaban inhibits factor Xa. Their use will probably depend on their cost effectiveness in the population at risk for thromboembolic events.
Metastatic tumors to the breast from colon adenocarcinomas are very rare. They are indicative of disseminated disease, so their prognosis is poor. In such cases radical operation should be avoided unless for palliation p...Metastatic tumors to the breast from colon adenocarcinomas are very rare. They are indicative of disseminated disease, so their prognosis is poor. In such cases radical operation should be avoided unless for palliation purposes. Partial mastectomy with chemotherapy is adequate therapy and offers the patient an aesthetic and oncologically safe surgical procedure. We report the first case of recurrent breast cancer metastatic from a colon adenocarcinoma after review of the literature.
A frequent complication after head trauma is cerebrospinal fluid fistulas. They usually resolve spontaneously. Rhinorrhea is a cardinal sign that suggest the presence of such fistula. We review the case of a 47 year-old-...A frequent complication after head trauma is cerebrospinal fluid fistulas. They usually resolve spontaneously. Rhinorrhea is a cardinal sign that suggest the presence of such fistula. We review the case of a 47 year-old-female with a five-month history of rhinorrhea after moderate head trauma 20 year before. The patient initially managed with medical therapy needed a lumbar-peritoneal derivation that satisfactorily cured her rhinorrhea
Perez-Yepes C, Moscote-Salazar LR, Alcala-Cerra G
… +4 more, Villa-Delgado R, Castellar-Leones SM, Matorel-Bello E, Badillo-Alvarez D
Bol Asoc Med P R
· 2012 · PMID 23763226
HIV/AIDS corresponds to a systemic disease whose pathogenic mechanism by direct cellular infection by the virus followed by high levels of viral replication and a severe state of immunosuppression predisposes to numerous...HIV/AIDS corresponds to a systemic disease whose pathogenic mechanism by direct cellular infection by the virus followed by high levels of viral replication and a severe state of immunosuppression predisposes to numerous opportunistic infections as well as tumor and autoimmune disease. The association of AIDS and stroke in young patients is rare. We present a case of a 16 year-old-female with a diagnosis of HIV infection and massive infarct of the left cerebral hemisphere and right basal ganglia segment with herniation We conduct a review of the association of HIV infection and cerebrovascular disease in children.