Puerto Rico Health Sciences Journal最新文献

The elimination of HIV and syphilis from Puerto Rico as per metrics of the World Health Organization has been achieved despite continued HIV risk and high background prevalence. Excellence in antenatal services and screening, deployment of antiretroviral and penicillin syphilis therapies, and proper follow-through with mothers and infants has yielded success even as control of infection overall remains elusive. We highlight the context of this achievement in our editorial to accompany the article: "Elimination of the Perinatal Transmission of HIV and Syphilis in Puerto Rico and Sustained Success since 2007: Convergence of Science, Women-Centered Care, and Policy".

Objective: To determine the prevalence of obesity and hypertension and the association of hypertension with obesity in an island-wide sample of school children in Puerto Rico.

Methods: The quantitative descriptive study included 3,145 children, 5 to 17 years of age, from Puerto Rico; they were examined once during a 3-year (2014-2017) period for weight (lbs) and height (cm) to calculate their body mass index (BMI) based on their age and sex. Children with BMIs in or above the 95th percentile were considered obese. The systolic and diastolic blood pressures (mm Hg) were measured once to determine the prevalence of hypertension based on age, height, and sex. Children with blood pressures in or above the 95th percentile were considered hypertensive. The blood pressures of obese and non-obese children were compared using the independent samples t-test. The association between obesity status (obese/non-obese) and hypertensive status (hypertensive/non hypertensive) was analyzed using the chi-square test.

Results: A total of 25.7% of the children were obese. Boys were 1.38 times as likely to be obese as girls were. 9.9% of the children were hypertensive. Obese children were 2.82 times as likely to be hypertensive as non-obese children were.

Conclusion: About 1 of every 4 children in the sample was obese; about 1 of 10 was hypertensive. Obese children were at a significantly higher risk for hypertension than non-obese children were. The study indicates the need for public health strategies that promote prevention and parental education to reduce the prevalence of obesity and the sequelae of hypertension.

Objective: Milk is the first and continued source of ingested Vitamin D. Extensive studies have been carried out in humans measuring Vitamin D in lactating mothers but to date few values have been obtained for milk of non-human primates and none for rhesus monkeys. Consequently. we have determined Vitamin D and antirachitic activity (ARA) in milk samples obtained from 21 rhesus monkeys.

Methods: Lactating dams were sampled by hand-stripping. 25(OH)D2, Vitamin D2, 25(OH)D3, Vitamin D3 and ARA were assessed in foremilk using LC-MS/MS techniques.

Results: 25(OH)D2 and Vitamin D2 were below detectible limits (<0.5 ng/g), 25(OH) D3 =4.2 ± 1.8 ng/ml, Vitamin D3 = 6.1 ± 3.1 ng/ml and ARA = 1080 ± 480 IU/L.

Conclusion: This is the first report of content of Vitamin D and ARA activity in foremilk of the rhesus monkey and can serve as a reference for future studies.

Radiotherapy treatment-induced intestinal injury and gut microbial perturbation/dysbiosis have been implicated in the pathobiology of cancer-related fatigue. The objective of this brief review was to explore the available evidence of the relationship between intestinal injury and self-reported fatigue, especially among cancer patients. The scientific evidence-including our own-linking gut mucosal barrier dysfunction and gut microbial perturbation/dysbiosis induced by cancer treatment with worsening of cancer related fatigue (perhaps through the gut-brain axis) is limited but promising. Emerging data suggest that lifestyle interventions and the administration of specific probiotics may favorably modulate the gut microbiota and potentially mediate beneficial effects leading to improvements in fatigue.

Objective: Irritable bowel syndrome (IBS) is characterized by chronic abdominal pain and altered bowel habits. A high prevalence has been reported in medical students around the globe. This study aimed to investigate the prevalence of IBS and associated risk factors in medical students in Puerto Rico (PR).

Methods: A cross sectional study was conducted in a sample of medical students from first to fourth year currently enrolled at the University of PR School of Medicine. Participants completed a self-administered, anonymous questionnaire that contained questions about general socio-demographic data, lifestyle habits, degree of subjective psychological stress and the Rome III criteria: IBS Module.

Results: 314 medical students were included for analysis. The mean age was 24.8±3.25; 48.1% were females. The prevalence of IBS was 36.3%. Among the IBS subjects, 78 (24.8%) were classified as IBS mixed. Family history of IBS and psychological stress were significantly associated to IBS (p<0.05), whereas cigarette smoking was found to be protective for IBS (OR = 0.26 + .17, P=.04).

Conclusion: This is the first study to describe the prevalence of IBS in medical students in PR. A higher prevalence of IBS was found as compared to that reported for medical students in other countries. Additional studies aimed at estimating the impact of IBS on quality of life and academic performance of the medical students are essential.

Small-bowel bleeding is a relatively uncommon event of gastrointestinal bleeding. Some causes of small-bowel bleeding, such as vascular lesions, are still challenging to confirm, despite the use of various diagnostic modalities (e.g., capsule endoscopy, deep enteroscopy, and radiographic imaging). Vascular lesion-induced bleeding tends to be insidious and intermittent, but sometimes it can be massive and fatal, so that the timing of an endoscopy is critical. We describe herein the case of an elderly female patient with Dieulafoy's lesion-induced small-bowel bleeding presenting with recurrent melena. In this article, we describe how the cause of her bleeding was found and how the bleeding was stopped endoscopically. Finally, we discuss the characteristics of a small-bowel Dieulafoy's lesion and its endoscopic treatment.

Objective: The objective of this study was to investigate the impact of kidney stones (KSs) on critically ill older adults (CIOA) staying longer than 24 hours in the ICU. Sepsis is one of the leading causes of mortality for ICU patients. KS disease is a well-known risk factor for bacteriuria and urinary tract infection.

Methods: A total of 256 CIOA were initially evaluated from April 2017 through February 2019. Patients who had urinary ultrasonography and computed tomography within 12 months prior to ICU admission were included. Patients with an additional urological pathology, under the age of 65 years, and with ICU stays of 24 hours or less were excluded. Consequently, 151 patients were eligible and constituted the study group. These patients were divided into 2 subgroups, according to the presence or absence of KSs. These 2 groups were compared with regard to urine culture (UC) results, presence of urosepsis, and septic shock.

Results: The mean age was 80.66 (±7.76) years. There were 18 patients with KSs and 133 without KSs. A total of 71 patients had a positive UC. Repeat UC positivity (p = 0.002) and resistant microorganisms (p = 0.034) were significantly more frequent in the KS group. The incidences of both urosepsis (p<0.001) and septic shock (p<0.001) were also significantly higher in patients with KSs.

Conclusion: The presence of KSs in CIOA is frequently associated with urosepsis and septic shock. Large prospective trials are required to evaluate the impact of KSs on the prognosis of patients in the ICU.

Objective: Heterosexual intercourse is the main mode of HIV transmission among heterosexual women in Puerto Rico and the third for men. We conducted an Internetbased study of heterosexual young adults in Puerto Rico to explore their sexual practices, beliefs and decision-making skills for HIV prevention. Data presented in this study will help to understand the factors that contribute to the sexual transmission of HIV among heterosexuals within the Puerto Rican context.

Methods: We administered an online-based survey to a sample of 618 young adult heterosexual men and women. Data were collected using Perseus Survey Solutions software.

Results: Overall, most participants expressed they had the same sexual partner in the previous six months, never or almost never used male condoms with their main partner and did not perceive themselves at-risk of contracting HIV (have a low HIV risk perception). Men reported using male condoms more frequently than women (e.g. male condom on their male partner) during vaginal sex, in particular single and younger men. Women expressed more positive attitudes toward male condoms than men.

Conclusion: Results confirm the need to implement interventions that increases the sense of vulnerability among heterosexuals, as well as skills and use of male condoms. This study contributes additional data on sexual practices and attitudes to encourage the identification of new or current changes in HIV protective or risk factors, specifically for an understudied population of Heterosexuals in Puerto Rico.

The early diagnosis of in utero congenital diaphragmatic hernia (CDH) allows a thorough evaluation for other morbidities that may be associated with CDH. Our patient was referred to us with a fetus at 13 weeks gestational age with a thick nuchal translucency. Our team performed a transvaginal ultrasound that revealed a large ystic hygroma, a heart displaced to the right, and a heterogeneous mass with peristalsis in the left chest. The fetus was diagnosed with CDH. The patient received genetic counseling after which she requested and underwent chorionic villus sampling. The early diagnosis of CDH allows for a timely intervention with the improved management of pre-natal and post-natal care. Better neonatal management is pivotal in providing a multidisciplinary consultation approach in order to furnish accurate counseling and prognostic information for the patient.