Puerto Rico Health Sciences Journal最新文献

Objective: The aim of this study was to determine the prevalence of severely increased albuminuria and the percentage of patients with the indication for canagliflozin in the type 2 diabetes population with chronic kidney disease (CKD) and low socioeconomic status in the San Juan City Hospital.

Methods: This cross-sectional study examined the electronic records of 129 Hispanic type 2 diabetes patients. CKD in this population was defined according to the most recent nephrology and endocrinology guidelines. Albuminuria was diagnosed with two positive urine albumin/creatinine ratio results within 3-6 months. Data was obtained from July 2017 to January 2020 and analyzed utilizing descriptive statistics and correlations.

Results: The prevalence of moderately and severely increased albuminuria in patients with type 2 diabetes and CKD were 51.2% and 18.6% respectively. The number of patients with type 2 diabetes who filled the FDA indication for canagliflozin were 16.3%. The prevalence of hypertension, coronary artery disease (CAD) and heart failure (HF) was 61.2%, 15.5% and 10.1% respectively. Between albuminuria severity and decreased renal function, a tendency was observed although not statistically significant (r = -0.14, 95% CI: -0.31, 0.03; P = 0.109). While evaluating association between albuminuria groups and CAD, there was a noticeable tendency close to reaching statistical significance (P = 0.060).

Conclusion: There is a scarcity of studies regarding the prevalence of severely increased albuminuria in type 2 diabetics with CKD and this study contributes to the literature. On analysis of associations, statistical significance not reached likely due to small sample size.

Objective: There is no consensus on the use of decompressive craniectomy (DC) to manage severe traumatic brain injury (sTBI). We evaluated the profile of pediatric patients admitted with sTBI and assessed functional outcomes, 6 months posttrauma, in patients who had a DC and in those who had not, and the functional outcomes of early versus late DCs.

Patients and methods: This case-control observational study evaluated pediatric patients admitted for sTBI in Puerto Rico (June 2016-October 2018); we included patients admitted within 24 hours of injury and had a Glasgow Coma Scale (GCS) of 8 or lower. 6-month post trauma outcomes were measured with the Glasgow Outcome Scale Extended Pediatric (GOS-E Peds).

Results: 20 patients were included; 15 underwent a DC and 5 comprised the control group. We found no differences in terms of sex, age, GCS score, Pediatric Risk of Mortality score, or Pediatric Trauma Score. However, in the DC group, a higher percentage of patients presented significant cerebral herniation in the initial computed tomography scan (CT) (DC: 73%; control: 0%; P = .005). No differences were found regarding intracranial pressure (ICP), cerebral perfusion pressure, mean arterial pressure, PaCO2, or temperature. Patients in the DC group had longer hospital stay (DC: 41; control: 17 days; P = .0005). All patients with DC survived, with an early procedure being associated with favorable outcomes.

Conclusion: As determined 6 months post-trauma, this study showed that early DC increased survival and improved functionality.

Objective: The French West Indies (FWI) and the Dominican Republic (DR) are also, by virtue of their geographical positions, exposed to infectious diseases. The objective of this study was to describe trends in scientific publication for the FWI and the DR using bibliometric analysis, to describe existing international collaborations for each site, and to identify directions for potential collaboration between the 2 sites.

Methodology: Using data (publications from 1990-2019) from the Web of Science and PubMed databases, a bibliometric analysis was performed. Three bibliometric indicators were used: quantitative, performance, and organization-specific.

Results: There were 3599 articles published in the indicated span of time, with at least 1 author affiliated with either the FWI (N = 2552) or the DR (N = 1047). Journals ranked in the first quartile, which represent the highest quality journals in each Journal Citation Record category, were the most strongly represented, (38% for the FWI and 50.32% for the DR). In terms of the FWI publications, authors from mainland France were the primary collaborators (1754, 35%); for publications from the DR, the US provided the largest number of collaborators (898; 43%). The infectious disease category predominated, with 2 clusters emerging: arbovirus infections (FWI) and HIV infection (DR).

Conclusion: This study is one of the first to perform a bibliometric analysis of the 30-year scientific output of the FWI and the DR. Both sites published articles about infectious diseases, indicating that this might be a strong area for future collaborations.

Objective: The visit-to-visit variability (VVV) of blood pressure (BP) has been recognized as a risk factor for cardiovascular events and chronic kidney disease (CKD). The objective of this study is to valuate the association between the VVV of BP and changes in estimated glomerular filtration rate (eGFR) in elderly CKD patients at different stages of renal function.

Materials and methods: For 60 months, we analyzed the medical records of 105 patients with and without diabetes and hypertension. Systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) were examined. A multivariable linear regression model was used to analyze the correlation between eGFR and the VVV of BP.

Results: No differences were demonstrated between the groups in the clinical characteristics. Mean SBP and DBP were not significant between the groups, and we observed no decrease in renal function. A significant negative correlation between PP and eGFR was observed in the total CKD population with a P of .010 (95% CI: -0.20, -0.03) and a correlation coefficient of -0.11.

Conclusion: Our study shows no statistical significances in terms of the VVVs of BP in any of the geriatric groups, with no significant decreases in renal function. However, we observed a significant negative correlation between PP and eGFR. We demonstrated that if a VVV of BP does not occur, there is no decrease in eGFR.

Our current understanding of tropical sprue is that it is a malabsorption syndrome that responds to treatment with folic acid and a broad spectra antibiotic. This realization came only after countless years of research by legions of investigators. Twenty-seven individual studies on various aspects of tropical sprue were published in the Puerto Rico Journal of Public Health and Tropical Medicine from 1925 to 1949. This article summarizes significant findings, presented chronologically, and speculates on the direction of future investigations into tropical sprue.

Objective: The objective was to describe opioid-use trends (2009-2018) at a university hospital emergency department (ED) in metropolitan San Juan, Puerto Rico.

Methods: The ED database of the University of Puerto Rico - Dr. Federico Trilla Hospital provided the data for the study.

Results: Non-fatal opioid overdoses surged 7.5-fold, increasing from 12.1 (±2.5) per 100,000 ED encounters for 2009 through 2016 to 91.2 (±8.7) per 100,000 ED encounters for 2017 through 2018 (P < .0001). Starting in summer 2017, the surge reached its peak in October after two major hurricanes. The opioid-related ED cases comprised 15.8% from 2009 through 2016, increasing to 67% in 2017 through 2018. Prior to October 2015, multiple drugs were mentioned in 65% of the opioid-related cases, decreasing to 37% of the total cases, thereafter. Cocaine was reported in combination with opioids in 53% of all opioid-related cases from August 2009 through September 2015, decreasing to 21% from October 2015 through December 2018, cannabis in 15 % and 10%, respectively, and alcohol in 10% and 6%, respectively. Amphetamines were mentioned once in combination with opioids. The overall male:female ratio for all opioid-related cases was 6.3 (rate: 8.8).

Conclusion: The data show an increase in opioid-toxicity cases in the area served by the above-named hospital beginning in mid-2017. Opioid-related cases overwhelmingly involved male patients. More work is needed to establish islandwide trends.

Objective: Studies addressing small and diminutive polyps and their potential of harboring advanced histologic features (AH) are scarce in Hispanics. We aimed to determine the prevalence of AH in a cohort of Hispanics.

Methods: A retrospective review of medical records of patients who had a colonoscopy from 2005 through 2010. The data collected included demographics, indications, history (personal/family) of colon cancer and/or polyps, and polyp histology. Polyps with high-grade dysplasia, prominent villous component, adenocarcinoma or serrated were classified as having AH.

Results: The population comprised 1884 patients, and 3835 polyps were evaluated; 63.3% were diminutive (1-5 mm), 22.7% small (6-9 mm), and 13.9% large (≥10 mm). The prevalence of AH for small and diminutive polyps were 4.9% and 1.1%, respectively. Of the polyps with AH, 11.9% were diminutive and 19.6% small. Small polyps were 5.04 times more likely to harbor AH than were diminutive polyps. Distal rather than proximal polyps were more likely to harbor AH. Furthermore, AH was >7 times more common in small (6-9 mm) polyps identified during diagnostic or surveillance colonoscopies compared to screening colonoscopies.

Conclusion: The prevalence of AH was significantly associated with size, location (distal), and procedure indication. Although diminutive polyps (<6 mm) were less likely to harbor AH, the risk for non-Hispanics was higher than previously reported. The "resect and discard" strategy for polyps ≤ 1 cm should be used with caution in ethnically diverse cohorts, as the risk for AH may be higher in Hispanics than in non-Hispanic Whites.

Objective: This study examines the heterogeneity of depressive symptoms among older adults residing on the Island of Puerto Rico and their association with risk and protective health factors.

Methods: Data from the Puerto Rican Elderly: Health Conditions study (PREHCO) to identify risk and protective factors associated with profiles of depressive symptoms. The sample was comprised of 3,114 Puerto Rican older adults ages 60 to 102 (71 ± 8.2 SD). The Geriatric Depression Scale 15-item short form (GDS-15) was used to assess the presence of depressive symptoms. Latent class analysis (LCA) was used to categorize depressive symptom classes. The association between depressive symptom classes and health status, lifestyle, health behavior and demographic characteristics were evaluated.

Results: A three-class model was identified, they were defined as "low depressive symptoms" (56%), "medium depressive symptoms" (31%), and "high depressive symptoms" (13%). Having chronic illnesses, mainly diabetes, heart disease and high blood pressure as well as a history of smoking, and poor self-rated vision were all associated with being in a higher depressive class. Exercising regularly and participating in volunteer activities were protective to being in a high depressive class.

Conclusion: Chronic illnesses and poor self-rated vision were associated with being in a higher depressive classification. These findings can inform targeted interventions for sub-groups of community dwelling older adults impacted by depression.

Objective: To evaluate the morphological changes of cardiomyocytes exposed to different sodium fluoride (NaF) concentrations, as well as to evaluate the behavior of the mitochondria.

Methods: Rat H9c2 cardiomyocytes were exposed to NaF at concentrations of 0.5 to 5 mmol/L. The morphology and number of mitochondria in these cells were monitored, and the calcium ion (Ca2+) concentration was determined.

Results: Morphological changes were evident in the cells treated with different NaF concentrations, and both the number of mitochondria and the Ca2+ concentration decreased in a dose-dependent manner.

Conclusion: Sodium fluoride induced morphological damage in cardiomyocytes, decreases the Ca2+ concentration and mitochondrial number.

Objective: This article proposes an engineering-economics model to determine the total cost of a neurological disease along its temporal progression. The objective was to develop a planning tool faithful to the reality of this type of ailment as well as to that of Puerto Rico (PR).

Methods: The proposed model organizes a given neurological disease into 3 progressive phases of deterioration; in each, the model collects the typical associated costs and adjusts them based on their value over time. This way, the total cost of the ailment is calculated and its present day dollar value expressed. Model verification was carried out using data from Puerto Rico related to Parkinson's, Alzheimer's, and Huntington's diseases.

Results: The method demonstrated here considered Parkinson's disease in PR. Our model calculated a total annual cost of $64,915 for a patient at the medium stage. This figure is larger than estimates from other authors, which fall between $41,689 and $51,600 for the USA. This difference is partially due to the proposed model considering the individual's opportunity cost of the loss of productive years, an original contribution of our work.

Conclusion: A neurological disease is one in which an individual goes through progressive phases of deterioration that will require significant economic resources. The model proposed here is designed across the commonalities between Alzheimer's, Parkinson's, and Huntington's diseases and illustrated using costs from PR. As an additional contribution, it allows the consideration of the opportunity cost of lost productivity, a characteristic that makes it more realistic.