Puerto Rico Health Sciences Journal最新文献

COVID-19 infection has been associated, particularly in severely ill patients requiring hospitalization, with a hypercoagulable state. The case presented herein was a 66-year-old man with SARS-CoV-2 infection who did not have any respiratory symptoms. He presented with the following clinical manifestations: portal vein and hepatic artery thrombosis, liver infarction, and a superimposed abscess of the liver. In this case, early detection and the administration of anticoagulants and antibiotics led to a significant improvement within weeks of the diagnosis. We encourage physicians to be aware of COVID-19-associated hypercoagulable state and its potential complications, regardless of the acuity of the presentation or the absence of respiratory symptoms.

Objective: Approximately 20% of the errors committed at hospitals are attributed to medication error, which is one of the main things threatening the safety of patients. Every hospital has a list of medications that are considered time-critical scheduled medications. Opioids with a specific schedule of administration are included on these lists. These medications are used to treat patients with chronic or acute pain. Any variation in the established schedule can cause undesired effects in patients. The objective of this study was to assess the compliance rate of opioid administration; that is, determine whether these medications were being administered within the appropriate window (30 minutes on either side of the scheduled time).

Methods: The data were collected by reviewing the handwritten medical records of all the hospitalized patients who received time-critical opioids from August 2020 through May 2021 at a specialty cancer hospital.

Results: In total, 63 interventions were evaluated. Of the 10 months included in the analysis, the percentage of administration required by the institution and accrediting agencies (95%) was met in 3. September was the month with the lowest rate of compliance, this being 57%.

Conclusion: The study demonstrated low compliance in terms of the administration time of scheduled opioids. These data will help the hospital institution to find areas that can be improved to achieve better accuracy in the administration of this category of drugs.

Objective: The aim of this study was to investigate sleep quality and quality of life, sociodemographic variables that may affect sleep quality, and the relationship between sleep and quality of life in patients with atrial fibrillation (AF).

Materials and methods: This descriptive cross sectional study had a sample of 84 individuals (AF patients from April 2019-January 2020). The Patient Description Form, the Pittsburgh Sleep Quality Index (PSQI), and the EQ-5D health-related quality of life instrument were used to collect data.

Results: The mean total PSQI score was 10.72 (±2.73), we found that most of the participants (90.5%) had poor sleep quality. While there was a significant difference between the sleep quality and employment status of the patients, there was no significant difference between age, gender, marital status, education level and income status, comorbidity, family history of AF, continuously used medication, non-drug AF treatment, and AF duration (P > .05). The sleep quality of those working in any job was better than of their non-working counterparts. Regarding the correlation between sleep quality and quality of life, a medium-level negative correlation was found between the patients' total mean PSQI and EQ-5D visual analogue scale scores. However, no significant correlation was found between the total mean PSQI and EQ-5D scores.

Conclusion: We found that sleep quality in patients with AF was poor. In these patients, sleep quality should be evaluated and taken into consideration as a factor that affects quality of life.

Objective: This study aimed to evaluate the effect of support given to pregnant women during labor on their perception of childbirth and their breastfeeding self-efficacy.

Methods: This descriptive and relational study was conducted with 331 primigravid women who had a vaginal delivery in a maternity unit from December 15, 2018, to March 15, 2020. Data were collected using a descriptive characteristics form prepared by the researcher and based on the relevant literature, the Scale of Women's Perception for Supportive Care Given During Labor (SWPSCDL), the Perception of Birth Scale (POBS), and the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF)." The data were analyzed using descriptive statistics, a t test, a variance test, and Pearson's correlation.

Results: The mean total SWPSCDL, POBS, and BSES-SF scores of the participating women were 102.19 (±14.99), 54.75 (±9.39), and 76.24 (±11.37), respectively. A positive correlation was found between supportive care for women during delivery and both women's perceptions of childbirth and breastfeeding efficacy. In addition, training given in antenatal classes positively increased the perception of support during delivery among the women.

Conclusion: Supportive care given during delivery had a positive effect on the perception of childbirth and on breastfeeding self-efficacy. Interventions to encourage more couples to participate in training given at antenatal classes and to improve the working conditions of midwives working in delivery rooms would contribute to the support that pregnant women require during delivery and would provide a more positive delivery experience for these women.

Objective: To study the factors associated with the occupational risks affecting coffee harvesters from Timbío, Cauca, Colombia.

Methods: This descriptive study assessed workplace conditions, aiming to design a mitigation proposal that would help alleviate the dangers currently facing the studied population. The data were collected through 19 visits to the coffee plantations. A survey to characterize workers and determine the presence of musculoskeletal lesions was applied; in addition, the Colombian Technical Guide (GTC 45, by its initials in Spanish) was consulted.

Results: Coffee harvesting comes with several high priority risks, of which those that are biomechanical stand out. These are the result of strained positions, antigravity postures, repetitive movements, high physical effort, and the manual handling of heavy objects. Additionally, there are psychosocial risks attend the kind of contract, the low wages, the lack of social security, and the lack of affiliation with the occupational risk-management system. During the data collection, 18% of the workers reported having had an occupational accident while harvesting coffee.

Conclusion: The process for identifying danger and assessing risk established, for all the cases, a level 1 risk. According to the rating scale of the GTC 45, such a level is unacceptable. We concluded that it is necessary to take immediate measures to control the identified dangers. To improve the health of the members of the studied sample, we propose the implementation of an epidemiological surveillance system for musculoskeletal injuries.

Objective: Currently, in Puerto Rico, there is a paucity of data regarding emotional health and depression in health professionals, specifically regarding trainees such as medical students and nursing students. The study intended to shed light on the prevalence of depression symptoms among medical and nursing students at a school of medicine in Puerto Rico.

Methods: In the fall of 2019, a descriptive cross-sectional study that included nursing and medical students in their first, second, and third years was performed. A survey consisting of the Patient Health Questionnaire (PHQ-9) and sociodemographic questions were used for data collection. Logistic regression analyses were used to determine the association of PHQ-9 scores and the risk factors linked to depression symptoms.

Results: A total of 173 (83.2%) out of 208 enrolled students participated in the study. Of the participants, 75.7% were medical students and 24.3% were nursing students. Of the risk factors studied, feelings of regret and lack of sleep were associated with a higher frequency of depression symptoms in medical students. For the nursing student population, suffering from a chronic disease was associated with a higher frequency of depression symptoms.

Conclusion: Due to the increased risk of depression in healthcare professionals, identifying risk factors that can be addressed through early changes in behavior, or in institutional policies, is important in terms of working to mitigate the risk of mental health problems in this vulnerable population.

Objective: Evidence supports the local application of non-steroidal antiinflammatory drugs such as dexketoprofen trometamol (DXT) for pain management, but little is known about the potential antinociceptive effect of chlorhexidine gluconate (CHX) and its possible synergistic effect when combined with DXT. The aim of this study was to evaluate the local effect of a DXT-CHX combination using isobolographic analysis in a formalin pain model in rats.

Materials and methods: Briefly, 60 female Wistar rats were used for the formalin test. Individual dose effect curves were obtained using linear regression. For each drug, the percentage of antinociception and median effective dose (ED50; 50% of antinociception) were calculated, and drug combinations were prepared using the ED50s for DXT (phase 2) and CHX (phase 1). The ED50 of the DXT-CHX combination was determined, and an isobolographic analysis was performed for both phases.

Results: The ED50 of local DXT was 5.3867 mg/mL in phase 2 and for CHX was 3.9233 mg/mL in phase 1. When the combination was evaluated, phase 1 showed an interaction index (II) of less than 1, indicating synergism but without statistical significance. For phase 2, the II was 0.3112, with a reduction of 68.88% in the amounts of both drugs to obtain the ED50; this interaction was statistically significant (P < .05).

Conclusion: DXT and CHX had a local antinociceptive effect and exhibited synergistic behavior when combined in phase 2 of the formalin model.

Objective: To assess the receipt of health care services among live-born infants of women with and without evidence of Zika virus (ZIKV) infection while pregnant during the 2016-2017 ZIKV outbreak in Puerto Rico.

Methods: We used data from the Pregnancy Risk Assessment Monitoring System-Zika Postpartum Emergency Response study telephone surveys to examine maternal reports of the receipt of health care services by infants born in Puerto Rico from August through December 2016 and November through December 2017. Evidence of ZIKV infection was ascertained from the infant's birth certificate or was self-reported in the survey.

Results: Fourteen percent of women in 2016 and 9% in 2017 had evidence of ZIKV infection during pregnancy. Most infants of women with evidence of ZIKV received the recommended health care services in 2016 and 2017, respectively, including a hearing test (91% vs. 92%), developmental assessment (90% vs. 92%), and an eye exam (74% vs. 70%); fewer received a head scan (45% vs. 36%) and evaluation for physical therapy (17% vs. 10%). From 2016 to 2017, the proportion of infants having a personal doctor increased for all infants; for infants of women without evidence of ZIKV infection, receiving hearing, developmental, and eye assessments increased.

Conclusion: Most infants of women with evidence of ZIKV infection during pregnancy received the recommended hearing and developmental assessments during the ZIKV outbreak. Experiences with increasing service capacity during the ZIKV outbreak can be evaluated to inform the response to future emergencies that affect maternal and child health.

Objective: To evaluate how the proportion of elderly patients aged 65 and above has increased in our surgical services over a 5-year period.

Methods: We compared the ages and characteristics of the surgical cases in 2014 with those in 2019, a 5-year interval, using the information from the University of Puerto Rico (UPR) General Surgery Database. The variables examined included age, gender, American Society of Anesthesiology (ASA) classification and outcome.

Results: In the UPR General Surgery Database information was available for 4,906 surgical cases performed in 2014 and for 4,954 such cases performed in 2019. The mean age of the patients increased from 48 (±23) years to 50 (±22) years in the 5-year interval. The gender distribution indicated that 56% were women and 44% were men, with no significant difference between the 2 periods evaluated. A statistically significant (P<0.001) increase in patients, 65 years of age and older occurred from 2014 (27%) to 2019 (31%). Patients aged 65 years and older were sicker, as indicated by more frequent ASA classifications of 3 or greater (in 2014: 13% vs. 32% and in 2019: 31% vs. 59%; P<0.001). Postoperative morbidity and/or mortality were slightly higher in the older group (5%, 3%) when compared to the younger group (3%, 2%).

Conclusion: Elderly patients represent about one-third of the surgical workload, a proportion that is expected to grow as the general population ages. The rapid aging of the population presents important challenges, such as shifting disease burden and increased expenditures on health and the long-term care of the elderly, for which we will have to prepare.

Leiomyomas are the most common mesenchymal tumors of the urinary bladder. They account for 0.43% of all bladder tumors. Their incidence is 3 times higher in women than in men. There are approximately 250 cases described in the scientific literature, but none are of Caribbean males. The intramural location of the neoplasm described in this article was uncommon; only 7% of all the leiomyomas of the urinary bladder are found in this location. We present a case of a 65-year-old male with an intramural leiomyoma that was found incidentally during the evaluation of left lower-quadrant abdominal pain. The histopathological specimen that was taken at the time at the time of surgery showed a tumor with atypical smooth muscle cells indicative of a leiomyoma. The clinical presentation, radiographic imaging, and surgical management of this rare tumor are presented herein.