Puerto Rico Health Sciences Journal最新文献

SARS-CoV-2 has spread widely throughout the world, and multiple mutations and variants of interest were detected in the late 2020 and continue to emerge. Although genetic diversity is common in RNA viruses, these variations at the genetic level have given it certain characteristics associated with transmission, resistance to neutralizing antibodies, and even suspected increased lethality. Better understanding of the genomic diversity in SARS-CoV-2 will help to take appropriate containment measures against the virus. It should be borne in mind that this diversity can originate anywhere in the world, especially in areas where there is a high number of infections. This highlights the need for continuous molecular surveillance to guide development, therapy, vaccine use and health policy.

Objective: To assess the contraceptive methods used by sexually active Hispanic women living in Puerto Rico.

Methods: From October 2016 through February 2018, 518 patients completed a self-administered questionnaire. The inclusion criteria were being over the age of 21 and having visited San Juan City Hospital or University District Hospital. The results were analyzed using descriptive statistics and a 2-sample t test, where P < .05 was considered significant.

Results: A total of 518 participants completed the questionnaire. Of the 518, 413 (81.0%) reported having used at least 1 form of contraception; 252 (49.4%) used OCPs, 305 (60.8%) used male condoms, 92 (33.8%) used the rhythm method, 83 (30.6%) undergone female sterilization, 98 (19.9%) used the withdrawal method, 92 (18.9%%) used an implant, 67 (13.5%) received progesterone injections, 41 (8.3%) used female condoms, 13 (4.9%) had partners who undergone male sterilization, 20 (4.1%) used the transdermal patch, 16 (3.2%) used a vaginal ring, and 26 (5.3%) used an intrauterine device.

Conclusion: Of the 518 women, 24.2% used LARC, representing an increase in the usage by this population; this increase is likely linked to LARC's being easily accessible and free of charge. Public health interventions should be developed to increase knowledge about sexual health, educate about the effectiveness of different contraceptive methods and the prevention of sexually transmitted diseases, and reduce both the barriers to acquiring contraception and, thereby, the number of unintended pregnancies in this population.

Objective: To understand the impact of the COVID-19 pandemic on the prenatal care of pregnant Hispanic women living in Puerto Rico.

Methods: This was a cross-sectional study. The participants' profiles were determined through an online questionnaire to analyze COVID-19 related behaviors and experiences.

Results: Our sample comprised 131 women with an average age of 28 years (±5.3 years). Most of the population was pregnant at the time of the interview (74.8%; n = 98), and the rest were in their post-partum period. Overall, 46.5% (n = 61) of the patients indicated that their prenatal care did not change during the pandemic. In addition, 92.50% (n = 111) reported not altering their plans for breastfeeding their babies. Overall, 77.86% of the participants reported feeling scared or overwhelmed due to the current pandemic, and 97% agreed that COVID testing should be performed as a screening method in all pregnant females.

Conclusion: Our findings describe the characteristics of pregnant Hispanic females living in Puerto Rico. The majority reported adhering adequately to their health services, with few or no changes in their prenatal care.

A 62-year-old female patient was evaluated for gradual vision loss, floaters, and photopsia in her left eye. A left fundus examination revealed vitreous cells, hypopigmented lesions, and retinal vasculitis, and a workup revealed a positive HLA-A29 serology, all of which findings were consistent with birdshot chorioretinopathy. The patient was treated with oral prednisone and mycophenolate mofetil, which resulted in the adequate control of her uveitis. Even though unilateral cases are exceedingly rare and do not meet the established research criteria, this case highlights the importance of not minimizing the significance of birdshot lesions in the differential of patients with unilateral multifocal chorioretinitis.

Objective: We aimed to investigate estradiol (E2) as a therapeutic drug for spinal cord injury (SCI) and elucidate the disagreement in the field about the use of this hormone after an injury.

Methods: Eleven animals underwent surgery (laminectomy at the T9-T10 levels) followed by an intravenous injection (100 μg) of an E2 bolus and the implantation of 0.5cm of Silastic tubing containing 3 mg of E2 (sham E2 + E2 bolus) immediately after the laminectomy. The SCI control animals received a moderate contusion using the Multicenter Animal SCI Study impactor device over the exposed spinal cord followed by an intravenous bolus injection of sesame oil and were implanted with empty Silastic tubing (injury SE + vehicle); treated rats received a bolus of E2 and a Silastic implant with 3 mg of E2 (injury E2 + E2 bolus). Functional locomotor recovery and fine motor coordination were assessed by the Basso, Beattie, and Bresnahan (BBB) open field test and grid-walking tests, respectively, from the acute (7 days post-injury [DPI]) to the chronic stages (35 DPI). Anatomical studies of the cord were performed using Luxol fast blue staining followed by densitometric analysis.

Results: As observed in the BBB open field and the grid-walking tests, E2 post-SCI did not improve locomotor function but instead increased spared white matter tissue, in the rostral region.

Conclusion: Estradiol post-SCI, at the dose and route of administration used in this study, failed to promote locomotor recovery but partially restored spared white matter tissue.

Objective: The mortality rate of schizophrenia patients is higher than that of the general population; cardiovascular disease (CVD) is their leading cause of death. This issue must be studied since people with schizophrenia are disproportionately burdened with CVD. Therefore, our goal was to identify the prevalence of CVD and other comorbidities, stratified by age and gender, in patients with schizophrenia living in Puerto Rico.

Methods: A retrospective, case-control, descriptive study was conducted. Subjects in this study were admitted to Dr. Federico Trilla's hospital from 2004 through 2014 for both psychiatric- and non psychiatric conditions. The sample populations were stratified by the confounding variables of tobacco use and alcohol abuse, and the resulting stratification was analyzed with the Cochran-Mantel-Haenszel method.

Results: A higher frequency of CVDs was noted in the patients with schizophrenia compared to those in the control group. Although hypertension was the most frequent pathology encountered in both groups, ischemic heart disease was approximately four times more frequent in the patients with schizophrenia. CVD represented 58.4% and 52.7% in the schizophrenia and non-schizophrenia groups, respectively, although a statistically significant difference was not observed. The prevalence of malignancies in patients without schizophrenia was higher than in patients with schizophrenia. Moreover, the prevalence of asthma was 10.9% in the control group compared to 5.3% in the schizophrenia group.

Conclusion: These findings should motivate a systematic approach to prioritizing the aggressive management, early diagnosis, and prevention of comorbid risk factors in patients with schizophrenia.

Objective: The association of smoking with many diseases is well known, as well as are the benefits of smoking cessation. While mentioning these benefits, the duration that passes after quitting smoking is always stressed. However, former smokers' history of smoking exposure is usually ignored. This study aimed to investigate the possible effect of the pack-years history on several cardiovascular health parameters.

Methods: A cross-sectional study was conducted on 160 ex smoker participants. A novel index was described and named the "smoke-free ratio" (SFR), which is the number of smoke-free years divided by the number of pack-years. The associations between the SFR and various laboratory values, as well as anthropometric and vital measurements, were investigated.

Results: The SFR was negatively correlated with body mass index, diastolic blood pressure, and pulse in women with diabetes. In the healthy sub-group, fasting plasma glucose was negatively and high-density lipoprotein cholesterol positively correlated with the SFR. A Mann-Whitney U test revealed that the cohort with metabolic syndrome had significantly lower SFR scores (Z = -2.11; P = .035). In binary grouping, the participants with low SFR scores had higher rates of metabolic syndrome.

Discussion: This study revealed some impressive features about the SFR, which is proposed as a novel tool for estimating metabolic and cardiovascular risk reduction in former smokers. Nevertheless, the actual clinical significance of this entity remains unclear.

Objective: This study aimed to explore how umbilical cord separation time and microbial colonization are affected by umbilical cord clamping distance.

Methods: The randomized controlled study included 99 healthy newborns and was conducted at a hospital in Kahramanmaras, Turkey. The newborns were randomly divided into 3 groups: intervention group I (cord length: 2 cm); intervention group II (cord length: 3 cm; control group (not measured). On postpartum day 7, a sample of the umbilical cord was taken to assess microbial colonization. The mothers were contacted via mobile phone on the 20th day for an at-home follow-up. The data were analyzed by applying Pearson's chi-square test, Fisher's exact test, a 1-way analysis of variance test, and Tukey's post hoc Honest Significant Difference test.

Results: The mean umbilical cord separation time of the newborns was found to be 6.9 (±2.1) days in the intervention group I, 8.8 (±2.9) days in the intervention group II, and 9.5 (±3.4) days in the control group. The difference between the groups was statistically significant (P < .01). Microbial colonization was detected in 5 of the newborns, across the groups; no significant differences were found between the groups (P > .05).

Conclusion: In this study, it was determined that clamping the umbilical cord from a distance of 2 cm in vaginally delivered full-term newborns contributed to the shortening of the cord fall time and did not affect microbial colonization.

Objective: This study examined individual factors associated with serious psychological distress (SPD) in mothers.

Methods: The study used National Health Interview Survey data (1997-2016), with analysis being restricted to pregnant women and non-pregnant mothers whose youngest child was 12 months old or younger. The Andersen framework, a reliable tool to study health services, was used to examine the effect of individual predisposing, enabling, and need factors.

Results: Of 5,210 women, 13.3% had SPD, as determined by the Kessler-6 scale. Compared to those without SPD, those with SPD were more likely to be 18 to 24 years old (39.0% vs. 31.7%; all P values < .001), never have been married (45.5% vs. 33.3%), not have completed high school (34.4% vs. 21.1%), have a family income below 100% of the federal poverty level (52.5% vs. 32.0%), and have public insurance (51.9% vs. 36.3%). Furthermore, women with SPD had a lower proportion of "excellent" health status (17.5% vs. 32.7%). Multivariable regression found that having any formal education was associated with a lower likelihood of perinatal SPD than was not completing high school. For example, the bachelor's degree odds ratio was 0.48 (95% CI: 0.30, 0.76). A receiver operator curve analysis revealed that individual predisposing factors (e.g. age, marital status, and education), accounted for more explained variation than did enabling or need factors.

Conclusion: There are high levels of poor maternal mental health. Prevention and clinical services should focus on mothers with less than a high school education and those reporting poor physical health.

Objective: The analysis of morbidity and mortality is fundamental for improving the quality of patient care. The objective of this study was to evaluate the combined medical and surgical morbidity and mortality of neurosurgical patients.

Methods: We performed a daily prospective compilation of morbidities and mortalities during a consecutive 4-month period in all the patients who were 18 years of age or older and had been admitted to the neurosurgery service at the Puerto Rico Medical Center. For each patient, any surgical or medical complication, adverse event, or death within 30 days was included. The patients' comorbidities were analyzed for their influence on mortality.

Results: Fifty-seven percent of the patients presented at least 1 complication. The most frequent complications were hypertensive episodes, mechanical ventilation for more than 48 hours, sodium disturbances, and bronchopneumonia. Twenty-one patients died, for an overall 30-day mortality of 8.2%. Mechanical ventilation for more than 48 hours, sodium disturbances, bronchopneumonia, unplanned intubation, acute kidney injury, blood transfusion, shock, urinary tract infection, cardiac arrest, arrhythmia, bacteremia, ventriculitis, sepsis, elevated intracranial pressure, vasospasm, stroke, and hydrocephalus were significant factors for mortality. None of the analyzed patients' comorbidities were significant for mortality or longer length of stay. The type of surgical procedure did not influence the length of stay.

Conclusion: The mortality and morbidity analysis provided valuable neurosurgical information that may influence future treatment management and corrective recommendations. Indication and judgment errors were significantly associated with mortality. In our study, the patients' comorbidities were not significant for mortality or increased length of stay.