Puerto Rico Health Sciences Journal最新文献

Objective: Alopecia areata (AA) is an autoimmune condition which affects hair follicles provoking their loss. Although the cumulative incidence of AA in the United States is estimated at 2.1%, the number of people living with this condition in Puerto Rico is unknown. In addition, little has been published about people in Puerto Rico who have this condition and its impact on health. We conducted a needs assessment study to help reduce this information gap and address the perceived needs of people living with AA in Puerto Rico.

Methods: A needs assessment study was conducted with a non-experimental, descriptive, transversal design. A 40-item questionnaire was available through the Google Forms platform. Descriptive analysis was conducted.

Results: Most of the participants were women, had AA universalis, were diagnosed (on average) at 19 years of age, and were receiving treatment at the time of the survey. Most of the participants reported having both access to information or education about alopecia and the support of their family and friends but professed needing informational support. In particular, they wanted to find out about treatment options for their alopecia.

Conclusion: Gender and time since the onset of AA appear to be important variables that must be considered when conducting future studies and interventions with this population. These future studies and interventions should address the informational support needs of people living with AA.

Objective: In 2017, the government of Puerto Rico legalized medical cannabis for several conditions including Crohn's disease (CD). There is little information about cannabis use in this population. This study aimed to develop a demographic characterization and evaluate patient perception on cannabis use for Inflammatory Bowel Disease (IBD) at the University of Puerto Rico Center for Inflammatory Bowel Diseases.

Methods: One hundred patients of ages 21 or older with a confirmed diagnosis of IBD were recruited to complete a voluntary anonymous questionnaire.

Results: 27% of the surveyed participants reported use of cannabis. Of these, 39% reported moderate knowledge and 53% reported little to no knowledge of medical cannabis. The majority did not discuss cannabis use with their physician (78%), and most saw improvement of their symptoms (68%).

Conclusion: Cannabis is frequently considered by patients as a treatment option for IBD but most have limited knowledge about its use. The low number of patients that discuss cannabis use with their physician suggests the need for physician awareness of unreported use. It should also lead to the development of strategies for patient orientation regarding the uses, properties, and expectations of cannabis as a therapy.

The prenatal diagnosis of vasa previa is essential to achieving a safe delivery in patients who suffer from the condition. Transvaginal ultrasound with color Doppler performed at the time of a routine mid-trimester ultrasound is a valuable tool in terms of achieving a timely and accurate diagnosis of vasa previa.

Objective: This study's objective was to evaluate interleukin-6 (IL-6) and C-reactive protein (CRP) responses and performance changes in obese women after 8 weeks of aerobic training with an intensity of 50 to 60% of their individual maximum oxygen uptake (VO2).

Methods: A total of 18 sedentary women with an average age of 44.3 (± 1.9) years volunteered for this study. Over a period of 8 weeks, in 4 40-minute sessions per week, the participants walked at an exercise intensity that caused their heart rates to increase to levels corresponding to 50 to 60% of their VO2 peaks. Blood samples were collected from the participants, both when they were at rest and a couple of minutes after the end of the 1st exercise session. Sampling was repeated in the 4th and 8th weeks, before and after the last training sessions.

Results: The participants' body mass indices and weights decreased significantly by the end of the 8th week, while their maximum running speeds and VO2 peaks increased significantly. There were no differences in CRP or IL- 6 concentrations between the pre- and post-training sessions, but most of the participants' IL-6 levels dropped below 10 pg/ml after 8 weeks of training.

Conclusion: Although no significant changes were observed in CRP or IL-6 concentrations, it is important to note that in response to aerobic training, the IL-6 levels of most of the participants fell to what is generally considered acceptable.

Objective: This study aims to describe the frequency of biologic therapy failure in psoriasis patients along with associated patient demographics and characteristics.

Methods: This was a retrospective medical-record review of psoriasis patients evaluated from January 1st, 2013, through May 1st, 2018, and who failed at least once to adhere to their biologic therapy.

Results: Seventy-seven patients with psoriasis who had discontinued biologic therapy at least once were included in this study. Hypertension (58.4%), diabetes (37.7%), dyslipidemia (27.3%), and psoriatic arthritis (23.4%) were the main comorbidities observed. Adalimumab (ADA, 80.5%), ustekinumab (UST, 70.1%), and etanercept (ETA, 14.2%) were the most frequently used biologics in our cohort. The biologic with the longest mean duration of use prior to its discontinuation was UST (17.0 months), followed by ADA (15.9 months) and ETA (13.6 months).

Conclusion: The most common reason for discontinuing biologic therapy was that said therapy was not effective, though for ETA and UST, the fact that biologic therapies are not universally covered by insurance company was found to be associated with their discontinuation, as well. There were no statistically significant associations found between biologic therapy discontinuation and age, gender, or comorbidities, which last included obesity, class I. Larger studies are warranted to identify risk factors associated with biologic therapy failure to help guide drug selection, decrease morbidity associated with such nonadherence and improve patient outcomes.

The surgeon's position in relation to the patient has been modified throughout the years for transsphenoidal surgery (TSS). Nowadays, if a microscopic approach is used, most centers place the surgeon at the side of the patient's head with the patient facing him. In this paper, we propose a more ergonomic and time-proven setup for this type of surgery. Since the early 1980s, our neurosurgical section has been using an approach where the surgeon stands behind the patient's head with the microscope tower on the surgeon's back. This position is rarely mentioned in the literature. We want to refresh this position for those who still use the microscope and those young neurosurgeons and residents who do most of their work endoscopically. We consider that when the surgeon is standing behind the patient's head, it is more comfortable for the surgeon. Also, it allows for the assistant to be close enough to help during the surgery. This technical note may bring new ideas for those using the microscopic TSS.

Objective: Assess the potential value of an emergency room (ER) for the teaching of musculoskeletal (MSK) medicine to medical students and residents in training.

Methods: Data from all encounters to the ER of a teaching hospital for calendar years 2016-2019 were extracted from an electronic database. Encounters with ICD-10-CM M codes (MSK system) and S codes (injury) were selected (MSK encounters). Frequency distributions were calculated by year, sex, and age group for all encounters and MSK encounters. Annual distributions of encounters involving the shoulder, hip, knee, and ankle joints were assessed.

Results: The number of unique patients seen during the four-year period was 84,094, and the number of encounters was 187,829 (Median: 1 encounter; interquartile range: 1-2). The mean number of encounters per year was 46,957 (range: 45,311- 48,382). There was no seasonal variation. Most patients were women (45,868; 54.6%) and young (20 29 yr.) adults (15,012; 17.8%), and these groups generated the largest numbers of encounters (women: 108,799; 57.9%; young adults: 35,969; 19.1%). A total of 41,353 encounters (22.0% of all encounters) involved the MSK system. The shoulder, hip, knee, and ankle were involved in 2,768 (1.5%), 1,592 (0.8%), 3,082 (1.6%), and 1,718 (0.9%) encounters, respectively. The most common conditions for each joint were shoulder pain, femoral fracture, knee contusion, and ankle sprain.

Conclusion: Our findings suggest that ER physicians should have broad knowledge of MSK conditions and injuries. An ER is an excellent location for the teaching of MSK medicine to medical students and residents of other training programs.

Objective: The objective of this study was to determine the age-related anatomical changes that take place at the cementodentinal junction (CDJ).

Methods: Eighty-four teeth were extracted; 42 samples came from patients ranging in age from 18 to 30 years, and 42 came from patients aged from 40 to 60 years. Upper and lower and anterior and posterior teeth were included. Longitudinal slices were made, and 1% toluidine blue was used to stain all the samples prior to microscopic examination. Anatomical landmarks (apical foramen [AF], apical vertex, and cementoenamel junction) in the apical third were identified, and a pre-calibrated software package was employed to take digital measurements. Statistical analysis was performed by means of the Wilcoxon rank-sum test.

Results: The data obtained showed that there were anatomical variations in the apical third in the older patients and that these changes were related to the age of the patient. Narrower root canals and smaller CDJ diameters were found in older patients' samples.

Conclusion: The results of this study suggest that instrumentation and obturation should take place 1 mm from the AF in older patients, and not 0.5 mm, as is usually recommended.

Objective: There have been significant successes in the fight against HIV/AIDS due to the access to rapid HIV testing, interventions to reduce the mother-to-child transmission (MTCT) risk, potent and effective antiviral medications, and other biomedical prevention strategies. The purpose of this work is to demonstrate that Puerto Rico eliminated Mother-to-Child Transmission of HIV (MTCT) following the 2017 World Health Organization (WHO) criteria for validating the elimination of MTCT and Syphilis.

Methods: Existing epidemiological data from Puerto Rico was used to document the elimination of MTCT and Syphilis. Data to calculate the indicators was obtained from the various divisions of the Puerto Rico Department of Health, including vital statistics, surveillance data, and programmatic outcomes.

Results: Puerto Rico eliminated MTCT and syphilis, according to the WHO indicators, earlier than other countries. We can trace the outcomes to 1994 using the incidence rate of perinatally-acquired HIV of <50/100,000; to 2007 using HIV perinatal transmission rates for non-breastfeeding countries (<2%), to 2008 using 90% of women receiving ART at delivery, and to 2005 using the incidence rate of congenital syphilis of <50/100,000.

Conclusion: Not only have we eliminated the MTCT of HIV and syphilis, but the efforts have been sustained since 2000. The elimination of transmission of infectious diseases requires the intersection of scientific feasibility, coordinated interventions, and political will, successfully attained in Puerto Rico.

Objective: Evaluate the appropriateness of acetaminophen dosing by caregivers seeking care for their children/wards at the emergency department of a pediatric hospital.

Methods: Design: Cross-sectional descriptive study. Setting: The emergency department of the University Pediatric Hospital in San Juan, Puerto Rico. Participants: Eighty-eight caregivers who had, in the past 24 hours, administered a known quantity of acetaminophen to a pediatric patient under their care and were visiting the emergency room with that patient. Intervention: The caregivers were interviewed by the investigators, using a standardized questionnaire. Main outcome measures: The appropriateness of the acetaminophen doses administered by caregivers. The product's dosage form and strength, measurement device used (if any), and demographic data (of the caregiver and child) were also collected. Doses of 10 to 15 mg/kg of acetaminophen were considered appropriate.

Results: Overall, 45% of the caregivers had administered an inappropriate dose. Of these, 70% were subtherapeutic and 30% were supratherapeutic. Although 74% of the caregivers knew their child's/ward's weight, only 50% had used it to determine the dose. Caregivers with previous experience (as caregivers) were most likely to have administered an inappropriate dose (P = 0.03). Physicians were the source most consulted (40%) by caregivers, followed by the product's label (35%). Only 9% of the caregivers consulted a pharmacist for dosing recommendations.

Conclusion: Nearly half of all the caregivers administered an incorrect acetaminophen dose, suggesting that there is a need for better caregiver education. Due to their accessibility at the point of sale of OTC medications and pharmacotherapy knowledge, pharmacists could have an active role in promoting the safe and effective use of acetaminophen.