Boletin De La Asociacion Medica De Puerto Rico[JOURNAL]
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200 papers
Pregnancy and neonatal outcomes of women receiving compounded 17-alpha hydroxyprogesterone at San Juan City hospital.
Pereira OM, Cruz Ortiz SG, Llorens A … +1 more , Rosa ER
Bol Asoc Med P R · 2013 · PMID 24282917
OBJECTIVE: To describe the pregnancy and neonatal outcomes of women receiving 17alpha-hydroxyprogesterone to prevent subsequent preterm birth in our institution. METHODS: Forty-two patient received treatment by VITA heal...
OBJECTIVE: To describe the pregnancy and neonatal outcomes of women receiving 17alpha-hydroxyprogesterone to prevent subsequent preterm birth in our institution. METHODS: Forty-two patient received treatment by VITA healthcare and their charts were reviewed for results and outcomes. RESULTS: An increase in average gestational age at the time of delivery was noticed as well as an increase in weeks gained compared to previous preterm birth. DISCUSSION: More than 75% of the patients prolonged their pregnancy with the use of 17alpha-hydroxyprogesterone. Continuation of the study and stratifying patients will help in identifying other risk factors and establishing criteria for improved prevention of preterm birth and prognosis.
Comparison of the appropriate use of antibiotics based on clinical guidelines between physicians in-training versus practicing physicians.
Fernández González F, Detrés J, Torrellas P … +1 more , Balleste CR
Bol Asoc Med P R · 2013 · PMID 24282916
The inappropriate antibiotic can lead to serious negative effects on health. This has been the cause of emergence of multidrug resistant bacteria and the need of surveillance of antibiotics in the inpatient setting. An a...
The inappropriate antibiotic can lead to serious negative effects on health. This has been the cause of emergence of multidrug resistant bacteria and the need of surveillance of antibiotics in the inpatient setting. An adequate knowledge on which and when prescribing antibiotics is essential to avoid these issues. Because of this problems, guidelines have been developed to educate and control the misuse and abuse of antibiotics and improve clinical outcomes. We evaluated the medical knowledge, medical trends, and the effectiveness of professional interventions among Puerto Rico physicians in promoting prudent antibiotic prescribing. A comparative study was performed using a questionnaire about prudent antibiotic use in common infections seen in Puerto Rico. It was distributed among the major three internal medicine training programs at San Juan, internal medicine physicians and general physicians. General physicians failed to treat adequately asymptomatic bacteriuria, and overall failed in treating other common conditions when compared with residents and internal medicine physicians. One of our questions was related to the treatment of Extended Spectrum Beta Lactamase (ESBL) positive Escherichia coli (E. coli) and more than 50% of the surveyed failed to answer the question correctly. Conditions as viral respiratory tract infections and community acquired pneumonia had the higher correctly answered questions among the groups. Our questionnaire demonstrates that guidelines have to reach the education among the general physician population to decrease the overuse of inadequate antibiotics, and education should be strengthen on those internal medicine physicians that have already completed formal training.
Magnesium: the forgotten electrolyte.
González W, Altieri PI, Alvarado S … +4 more , Banchs HL, Escobales N, Crespo M, Borges W
Bol Asoc Med P R · 2013 · PMID 24282915
UNLABELLED: Magnesium (Mg++), Potassium (K+) and Calcium (CA++) are important electrolytes in keeping a stable electrical status. The purpose of this study was to measure them in critically ill patients. METHODS: We eval...
UNLABELLED: Magnesium (Mg++), Potassium (K+) and Calcium (CA++) are important electrolytes in keeping a stable electrical status. The purpose of this study was to measure them in critically ill patients. METHODS: We evaluated the electrolytes in 28 consecutive patients. Eighteen were females and 10 males with mean age of 62 +/- 5 years. RESULTS: The admission diagnosis in 95% of the cases was congestive heart failure. Sixty-four percent of the patients had subnormal values of Mg++, 53% subnormal values of K+, and 28% subnormal values of CA++. Fourteen percent showed lower values of the three electrolytes and 35% only of Mg++ and K+ concomitantly. Twenty-eight percent showed prolonged QTC interval. All patients with prolonged QTC interval had low Mg++ and K+ levels. Twenty five percent of the patients showed atrial fibrillation, 25% ventricular tachycardia, and 3% junctional tachycardia. The ventricular tachycardia group had more electrolyte abnormalities than those with atrial fibrillation. None of the patients received Mg++ replacement during critical management while 50% received K+ replacement. CONCLUSION: This data shows physician overlook the Importance of Mg++ and K+ deficiency in critically ill patients.
Pregnancy outcomes and successful rate of nifedipine therapeutic protocol implementation in a hospital of San Juan.
Catalano LN, Villar Diaz M, Vázquez Guzmán M … +2 more , Negron I, Rivera Rosa E
Bol Asoc Med P R · 2013 · PMID 24282914
PRIMARY OBJECTIVE: evaluation of Nifedipine protocol success defined as postponement of labor for 48 hours. SECONDARY OBJECTIVE: evaluation of the presence of risk factors in patients that develop preterm labor and deliv...
PRIMARY OBJECTIVE: evaluation of Nifedipine protocol success defined as postponement of labor for 48 hours. SECONDARY OBJECTIVE: evaluation of the presence of risk factors in patients that develop preterm labor and delivery outcome. MATERIALS AND METHODS: Chart review retrospective study with patients admitted to the Hospital of the Metropolitan Area of San Juan in the period of January 1,2009 to December 31, 2010 with diagnosis of preterm labor. A total of 382 patient's records were evaluated for inclusion and exclusion criteria. 48 met all the requirements to be included in the study. RESULTS: There were 68.8% patients who successfully completed the 48 hours postponement of labor required to administer corticosteroid therapy for fetal lung maturation. Risk factors for preterm labor commonly observed in the study group were urinary tract infection (60.4%), previous preterm labor (43.8%), multiple gestations (12.5%), and preterm premature rupture of membranes (10.4%). DISCUSSION: The use of Nifedipine therapy in patients with preterm labor between 24-34 weeks of gestational age can be effective in the postponement of labor for 48 hours so that the patient can receive corticosteroid fetal lung maturation therapy. The most common risk factor observed in this group of patients with preterm labor was urinary tract infection.
Breast asymmetry pattern in women with idiopathic scoliosis.
Cruz NI, Korchin L
Bol Asoc Med P R · 2013 · PMID 24282913
Breast asymmetry is frequent in women with idiopathic scoliosis. To understand the pattern of breast asymmetry in these women a clinical study was performed in which 54 female patients with idiopathic scoliosis were eval...
Breast asymmetry is frequent in women with idiopathic scoliosis. To understand the pattern of breast asymmetry in these women a clinical study was performed in which 54 female patients with idiopathic scoliosis were evaluated. The information recorded for each patient included: age, weight, height, scoliosis type, Cobb angle, breast measurements, and presence of rib cage asymmetry. Breast volume was calculated using anatomic measurements (anthropomorphic method). The mean age of the group was 25 +/- 7 years. A right convex thoracic curve occurred in 85%, with a mean Cobb angle of 32 +/- 15 degrees. Our study indicated that women with idiopathic scoliosis consistently presented breast asymmetry that followed a predictable pattern. The breast on the side of the convex thoracic scoliosis curve is always smaller in volume (mean difference 59 +/- 39 mi). The affected side also presents a smaller areola, a higher position of the nipple (mean difference 2.2 +/- 1.3 cm) and a higher position of the inframammary fold (mean difference 2.1 +/- 1.4 cm) when compared to the opposite breast. Though the asymmetry is predictable, the degree to which the patient presents these changes does not correlate with the severity of the scoliosis (Cobb angle). We believe that the severity of the asymmetry is a result of the difference between the hypoplastic breast and the normal breasts. In women with very large opposite breasts the asymmetry appears to be worse.
[Sanitation infrastructure and health].
Izquierdo N
Bol Asoc Med P R · 2013 · PMID 24282912
Abstract loading — click title to view on PubMed.
Overview of thyroid physiology: an essential for understanding familial euthyroid multinodular goiter.
Martinez JH, Palermo C, González FF … +1 more , Laboy I
Bol Asoc Med P R · 2013 · PMID 23882995
Nontoxic goiter is a diffuse or nodular enlargement of the thyroid gland that does not result from an inflammatory or neoplastic process and is not associated with abnormal thyroid function. Familial forms of goiter in a...
Nontoxic goiter is a diffuse or nodular enlargement of the thyroid gland that does not result from an inflammatory or neoplastic process and is not associated with abnormal thyroid function. Familial forms of goiter in areas not known to feature iodine deficiency are much less common. However, not all individuals in the same iodine deficiency region develop goiter and iodine supplementation does not prevent goiter development in all treated individuals. The etiology of euthyroid goiter is still incompletely understood. It is assumed that the development of goiter depends on various interactions between genetic and environmental factors. We present an overview on the thyroid physiology, which is important for a better understanding of Familial Euthyroid Multinodular Goiter.
Mucormycosis of the vulva in an immunocompromised pediatric patient.
Colón M, Romaguera J, Mendez K … +3 more , Vilchez D, Navas EJ, Perez J
Bol Asoc Med P R · 2013 · PMID 23882994
Primary cutaneous mucormycosis is very unusual and rarely reported in the literature. The diagnosis is difficult and may mimic several infectious and immunologic diseases. We report a case of vulvar mucormycosis in a ped...
Primary cutaneous mucormycosis is very unusual and rarely reported in the literature. The diagnosis is difficult and may mimic several infectious and immunologic diseases. We report a case of vulvar mucormycosis in a pediatric patient with end stage renal disease. A female on her first decade of life presented with a small scar on the right labia majora that in matters of weeks progressed aggressively, ulcerated, extended to the contralateral labia and invaded the entir vulvar region. Subsequent surgical debridement was undertaken. Pathology revealed Mucor species with progressive tissue necrosis. The patient was successfully trea ed with systemic antifungal, wide debridement of the affected area, hyperbaric oxygen therapy and surgical reconstruction of the area
Ocular findings in patients with oculocutaneous albinism type ia with G47D tyrosinase gene mutation in Puerto Rico: a case report.
Rodríguez-Agramonte F, Izquierdo NJ, Cadilla C
Bol Asoc Med P R · 2013 · PMID 23882993
UNLABELLED: Previous studies have suggested that the G47D mutation leads patients to develop Oculocutaneous albinism (OCA) type IA. This mutation has been described in the Canary Islands. Historically, there has been a m...
UNLABELLED: Previous studies have suggested that the G47D mutation leads patients to develop Oculocutaneous albinism (OCA) type IA. This mutation has been described in the Canary Islands. Historically, there has been a migration from the Canary Islands to some regions of Puerto Rico. OBJECTIVE: To report on the ocular findings of two Puerto Rican patients with OCA IA due to the G47D Tyrosinase gene mutation. PATIENT AND FINDINGS: Two unrelated patients with OCA underwent a comprehensive eye examination and were referred for genetic analysis. Patients had almost total iris transillumination, clear lenses, foveal hypoplasia with transparent maculae, and albinotic mid peripheries. Both patients had nystagmus, and only one patient had strabismus. CONCLUSIONS: Patients with the G47D muta- tion leading to OCA IA have poor visual acuities and poorly pigmented phenotypic ophthalmic findings. Further studies comparing ocular findings in patients th several mutations leading to OCA IA are warranted. To our knowledge this is the first report on ocular findings in Puerto Rican patients with OCA type IA with the rare G47D mutation.
Penetrating eye globe injury from trauma with a metallic nail: a case report.
Almodóvar-Mercado JC, López-Beauchamp V
Bol Asoc Med P R · 2013 · PMID 23882992
We report a case of penetrating eye globe injury due to a metallic nail. This is the first case evaluated by our service that presented with an intact 2.5-centimeter nail penetrating the right eye with a significant intr...
We report a case of penetrating eye globe injury due to a metallic nail. This is the first case evaluated by our service that presented with an intact 2.5-centimeter nail penetrating the right eye with a significant intraocular component that the patient did not remove. We describe the initial presentation and the multi-step surgery that this complicated injury required. The early postoperative visual acuity remained unchanged when compared to the presenting. In addition, the patient had no retinal pathology or optic nerve damage after the procedure.
Solid pseudopapillary pancreatic tumor as a portal hypertension causal: the first reported case in Puerto Rico.
Torres-Miranda D, Garcia-Gubern C, Santiago M … +1 more , Sanchez-Gaetan F
Bol Asoc Med P R · 2013 · PMID 23882991
We describe the first reported case in Puerto Rico of Solid Pseudopapillary Tumor (SPT) of the pancreas causing portal hypertension. Clinical presentation and characteristic imaging findings are helpful to differentiate...
We describe the first reported case in Puerto Rico of Solid Pseudopapillary Tumor (SPT) of the pancreas causing portal hypertension. Clinical presentation and characteristic imaging findings are helpful to differentiate SPT from pancreatic carcinoma. Diagnosis can be confirmed by histopathological and immunohistochemical approach through biopsy. Timely surgical intervention can prevent portal hypertension as manifestation and be lifesaving in case of malignant degeneration, giving the patient an excellent prognosis after tumor surgical resection.
The cardiology and endocrinology connection between amiodarone and thyrotoxicosis: case report and review of the literature.
Palermo-Garófalo C, Martínez JH, Silva F … +5 more , González E, Torres O, Figueroa J, González J, de Lourdes MM
Bol Asoc Med P R · 2013 · PMID 23882990
Amiodarone is used in a large number of cardiac conditions. Amiodarone-induced thyroid dysfunction has been reported to affect up to 20% of users. Amiodarone can lead to both amiodarone-induced hypothyroidism (AIH) and l...
Amiodarone is used in a large number of cardiac conditions. Amiodarone-induced thyroid dysfunction has been reported to affect up to 20% of users. Amiodarone can lead to both amiodarone-induced hypothyroidism (AIH) and less commonly amiodarone-induced thyrotoxicosis (AIT). There are two main forms of AIT. Type 1 AIT, a form of io-dine-induced hyperthyroidism, and type 2, a drug-induced destructive thyroiditis. Type 1 AIT develops on individuals with underlying thyroid disease. Treatment of Type 1 AIT includes the use of antithyroid drugs and discontinuation of amiodarone. Type 2 AIT is commonly self-limiting in nature. In this article wedescribe a patient with Amiodarone-induced thyrotoxicosis discussing its clinical features and medical therapeutic approach.
Hypersensitive pneumonitis: a case report.
Reyes LI, Román VJ
Bol Asoc Med P R · 2013 · PMID 23882989
Hypersensitivity pneumonitis, also known as extrinsic allergic alveolitis, constitutes a spectrum of granulomatous, interstitial, bronchiolar, and alveolar-filling lung diseases resulting from repeated inhalation and sen...
Hypersensitivity pneumonitis, also known as extrinsic allergic alveolitis, constitutes a spectrum of granulomatous, interstitial, bronchiolar, and alveolar-filling lung diseases resulting from repeated inhalation and sensitization to a wide variety of organic aerosols and low-molecular-weight chemical antigens. We report a case of a 57 year-old-female with hypersensitive pneumonitis due to pigeon droppings. Early diagnosis during the acute phase of hypersensitive pneumonitis is important due to the irreversible damages caused by this chronic disease.
Cardiac amyloidosis secondary to multiple myeloma.
Parrilla F, Calderon RE, Figueroa R … +1 more , Gurrea C
Bol Asoc Med P R · 2013 · PMID 23882988
Amyloidosis is a multisystemic disease caused by extracellular deposition of pathologic beta fibrillar proteins in multiple organs. Deposited fibrils can be either innunoglobulin light chanis or amyloid-A protein. The in...
Amyloidosis is a multisystemic disease caused by extracellular deposition of pathologic beta fibrillar proteins in multiple organs. Deposited fibrils can be either innunoglobulin light chanis or amyloid-A protein. The incidence of anyloidosis derived from anyloid-A protein, usually associated to an underlying disease, has been dimisishing over the decades in the United States producing clinical evidence of cardiac involvement in less than 5% of all cases. The extent of cardiac involvement is the determining prognostic factor. Early diagnosis and therapy aimed at the underlying disease may halt progression of cardiac dysfuction and improve prognosis. We report a case of a 63-year-old man who was diagnosed with cardiac amyloidosis secondary to multiple myeloma.
Cervical dysplasia and pre-term birth in San Juan city hospital: a cohort retrospective study.
Torres A, Rosa ER, Méndez K … +2 more , Menéndez A, Romaguera J
Bol Asoc Med P R · 2013 · PMID 23882987
UNLABELLED: Cervical dysplasia alters the release of cytokines and inflammatory mediators in pregnant woman with cervical dysplasia. This study evaluates a cohort of pregnant patients screened for cervical dysplasia to d...
UNLABELLED: Cervical dysplasia alters the release of cytokines and inflammatory mediators in pregnant woman with cervical dysplasia. This study evaluates a cohort of pregnant patients screened for cervical dysplasia to determine the relationship between cervical dysplasia and preterm labor (PTL). METHODS: Retrospective chart review of pregnant patients screened for cervical dysplasia at the San Juan City Hospital between October 2006 and December 2010. Patients with low or high-grade squamous intraepithelial lesions (LGSIL or HGSIL, respectively) were evaluated with colposcopy. Primary outcome was the event of PTL and the risk factor evaluated was presence of cervical dysplasia. RESULTS: A total of 2,059 patients were screened for cervical dysplasia and 59 were evaluated with colposcopy due to LGSIL or HGSIL. From those, 29% were negative for intraepithelial lesions and malignancy (NILM), 54% had cervical intraepithelial neoplasia (CIN)-1, 17% where diagnosed as CIN-2/3 where no invasive cervical cancer was identified. In the group of NILM, 24% had PTL compared to 18% in patients who screened negative on initial cytological evaluation. In cases where CIN-1 was confirmed by colposcopy 28% had PTL compared with 40% in patients with CIN-2/3. Other risk factors associated with PTL were not significantly different among the groups. CONCLUSIONS: Cervical dysplasia in pregnancy may represent an increase risk for premature labor.
[Exploration study of knowledge and attitudes related to prevention and transmission of dengue in Puerto Rico in 2012].
Rivera Rodríguez IJ, Puig Rivera AA, Morales-Borges RH
Bol Asoc Med P R · 2013 · PMID 23882986
We got one of the most significant epidemics of the history of Dengue in Puerto Rico despite all major educational efforts made. The objective is to determine how much knowledge the people have about the prevention and t...
We got one of the most significant epidemics of the history of Dengue in Puerto Rico despite all major educational efforts made. The objective is to determine how much knowledge the people have about the prevention and transmission of Dengue virus. We administered a questionnaire of fifteen questions to 140 people of different communities at the metropolitan area as well as in the East area of Puerto Rico during the months of September to November of 2012. 88% were adults, 100 were women and 40 men. The majority was from Caguas, Carolina, San Juan, and Bayamon. 60% were professionals. One hundred percent knew what Dengue is and 90% knows the mosquito. 77% of the participants know the actual epidemics, but the men got a 10% higher knowledge than women on the subject. Around 47% are not prepared to fight the Dengue virus, but they have great knowledge about the preventive measures and the clinical Management of Dengue Syndrome. 66% did not know that Puerto Rico has a Dengue Center from the CDC located at the Island. Only 17.5% of the participants knows that the Dengue Virus can be transmitted through transfusion of blood components. Our study met our objectives showing that we have good knowledge about Dengue, but there is poor knowledge about the transmission of Dengue Virus through transfusion of blood components. There is a big necessity to develop community strategies to eliminate this disease. We recommend repeating this study with more collaboration from other entities, more questions, and more participants.
[Embolization of skull-base hypervascular tumors: description of a series of cases and proposal of a therapeutic algorithm].
Péreza RA, Espinosa-García H, Alcalá-Cerra G … +3 more , de la Rosa Manjarréz G, Gómez FO, Barrios AR
Bol Asoc Med P R · 2013 · PMID 23882985
UNLABELLED: Preoperative embolization allows reducing intraoperative blood loss caused by hypervascular intracranial tumors and its undesirable consequences. AIM: To describe the experience with preoperative endovascular...
UNLABELLED: Preoperative embolization allows reducing intraoperative blood loss caused by hypervascular intracranial tumors and its undesirable consequences. AIM: To describe the experience with preoperative endovascular embolization of hypervascular skull base tumors, and to develop a therapeutic algorithm. MATERIALS AND METHODS: A retrospective examination of preoperative neuroimaging and results of preoperative embolization was carried out. RESULTS: Fifteen cases were identified, with a median age of 36 years old, most of them harboring meningiomas, nasopharyngeal angiofibromas or paragangliomas. The external carotid artery was involved in 93% of cases and was the only afferent to 60%. In 27%, there were branches from the internal and external carotid arteries simultaneously. An extensive or complete occlusion grade was achieved in 95% of the branches of the external carotid artery. No branch of the internal carotid artery was treated, because poor contribution to tumor irrigation or was not possible to catheterize the pedicle. There were not recorded procedure-related complications. CONCLUSION: Based on the unification of the experiences described in this study and using data from published series, we present an algorithm for rational selection of skull base tumors that can benefit from preoperative embolization.
Differences in prevalence of inflammatory bowel disease in Puerto Rico between commercial and government-sponsored managed health care insured individuals.
Vendrell R, Venegas HL, Pérez CM … +3 more , Morell C, Roman RV, Torres EA
Bol Asoc Med P R · 2013 · PMID 23882984
BACKGROUND: Evaluation of ethnic and racial patterns of Inflammatory Bowel Disease (IBD) has demonstrated a higher incidence of IBD in Jews, and lower rates in blacks and Hispanics when compared to whites. There is limit...
BACKGROUND: Evaluation of ethnic and racial patterns of Inflammatory Bowel Disease (IBD) has demonstrated a higher incidence of IBD in Jews, and lower rates in blacks and Hispanics when compared to whites. There is limited data describing incidence and prevalence among Hispanics, the fastest growing minority in the United States. METHODS: To estimate the prevalence of IBD computerized records of all physicians billing and hospital discharges classified with ICD-9-CM IBD related codes were searched. Prevalence was estimated by age group, sex, and type of insurance (commercial versus government-sponsored managed care). RESULTS: Of 1,248,993 insured individuals in 2005, 186 had a diagnosis of Crohn's disease and 291 of ulcerative colitis. The estimated prevalence per 100,000 was 14.9 for Crohn's disease, 23.3 for ulcerative colitis, and 38.2 cases for IBD. The most significant difference was found when comparing insurance type, with a total IBD prevalence rate of 61.75 cases among commercial versus 14.36 cases among government-sponsored insured. CONCLUSIONS: The prevalence of IBD in this insured population in Puerto Rico places it among the highest described in a Hispanic population. Given the continued rise in prevalence of IBD and the limited studies describing the epidemiology of IBD in Hispanics, further studies which may provide important clues to the etiology of the disease as well as valuable information for appropriate health care planning are important.
Neutropenia and thrombocytopenia in very low birth weight infants of women with preeclampsia.
Claudio NA, García I, García L … +1 more , Valcárcel M
Bol Asoc Med P R · 2013 · PMID 23882983
OBJECTIVE: Determine the incidence of neutropenia and thrombocytopenia during the first week of life in very low birth weight (VLBW) infants born to mothers with preeclampsia. METHODS: Medical records of infants born to...
OBJECTIVE: Determine the incidence of neutropenia and thrombocytopenia during the first week of life in very low birth weight (VLBW) infants born to mothers with preeclampsia. METHODS: Medical records of infants born to mothers with preeclampsia admitted to NICU from 2005-2007 were reviewed. RESULTS: A total of 93 infants were included with a mean birth weight of 988 g and gestational age of 29 weeks. Neutropenia was present in 49% of the infants and thrombocytopenia in 56%. Infants with neutropenia had lower birth weights (p<0.01) and were born at lower gestational ages (p<0.01). Neutropenia was associated to a higher prevalence of positive blood cultures during the first week of life especially coagulase negative organisms. CONCLUSIONS: In this group of VLBW infants born to mothers with preeclampsia, neutropenia was common and it was associated to increase risk of bacterial infections during the first week of life.
[Coalitions in favor of patients].
Izquierdo N
Bol Asoc Med P R · 2013 · PMID 23882982
Abstract loading — click title to view on PubMed.
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