Puerto Rico Health Sciences Journal最新文献

Objective: To test the hypothesis that fermentable fiber prevents Salmonella typhimurium infection-associated symptoms by enhancing innate and adaptive immune system in neonatal pigs.

Methods: Two-d-old piglets (n=120) were randomized to receive either a nutritionally complete sow milk replacer formula (CON), or supplemented with methylcellulose (MCEL-non-fermentable), soy polysaccharides (SPS-moderately fermentable), or fructooligosaccharides (FOS-highly fermentable). On d7, piglets received an oral gavage of S. typhimurium-798, and continued receiving the same diets up to 48h post-infection. Ileal mucosal samples were obtained for further analyses.

Results: A reduction in chloride secretion was observed in FOS when compared to other diets (p<0.0003). The number of ileal sulfo-acidomucins was higher (p<0.05) in FOS before infection compared with other diets. NFkB was inhibited in FOS following infection (p<0.05), when compared with CON. IL-1β expression was increased at 4h post-infection (p<0.05) in CON; however, this response was attenuated in the fiber groups. IL-6 expression was higher (p<0.05) in CON post- infection, higher in SPS at 24h (p<0.05), but unchanged in MCEL and FOS when compared to pre-infection values. FOS had a higher expression of neutrophil-chemoattractant IL-8 before infection (p<0.05) compared to other groups.

Conclusion: The reduction in chloride secretion, proinflammatory cytokines expression and NFkB activation, and increased number of sulfo-acidomucins, and IL-8 expression in the fiber groups, indicates that the degree of fermentability impacts the innate and adaptive immune system, and could be the mechanisms by which dietary fibers reduce S. typhimurium infection-associated-symptoms in neonatal pigs and apply these results to infants.

Objective: Microvascular free-tissue transfer (M-FTT) is a surgical technique for traumatic injuries that allows tissue reconstruction based on donor tissue composition. The aim of this study is to describe the surgical experiences of M-FTT for reconstruction of complex soft tissue injuries in the lower extremities of a Hispanic population.

Methods: This is a descriptive study of all M-FTT procedures performed by a single plastic surgeon from 2012 to 2016 at Puerto Rico Medical Center. Demographics, admission diagnosis, mechanism of trauma, type of free flap, co-morbidities, length of stay, donor site and complications were evaluated.

Results: Eight patients who underwent single M-FTT procedures at lower extremity were enrolled in the study. The average age at time of surgical reconstruction was 36.9+13.2 years with six males and two females. The transfer procedures were performed using donor sites of six rectus abdominis flaps and 2 radial forearm flaps. Posterior tibial artery was used in 62.5% and popliteal artery were used in 37.5% as recipient arteries. Average surgical time was 4.4+0.7 hours with an average length of hospital stay of 22.9+20.1 days. Post-operative complications were reported in three M-FTT procedures: two cases who suffered venous thrombosis and one case who suffered partial necrosis.

Conclusion: The M-FTT offers an adequate surgical option for patients who present with complex soft tissue traumatic injuries at the lower extremities.

Objective: To describe the epidemiological manifestations and assess major risk factors in children under the age of three years presenting with non-accidental injury (NAI) fractures in a level two trauma center in Puerto Rico.

Methods: An IRB approved retrospective descriptive study was performed by reviewing case records of 75 patients who presented with a NAI fracture at the Pediatric University Hospital of the Puerto Rico Medical Center. The study time period was from October 1996 to October 2014. The inclusion criteria for our population consisted of: (1) patients between the ages of zero to three years, (2) suffered a long bone fracture, and (3) had a history of suspected child abuse at our academic institution. The exclusion criteria were: (1) patients older than three years, (2) no history of NAI, or (3) had a congenital bone disorder.

Results: A total of 117 long bone fractures were observed in our population. Similar distribution was seen between sex,, with 52% being male and 48% being female. The mean age was 10.8 months. The group with the highest frequency of NAI fractures were children under the age of one year (57.3 %). The most commonly involved fractured bone for all age groups was the femur (48.0 %). No statistical significance was observed when comparing sex, age, associated injuries or multiple fractures.

Conclusion: Children younger than one year of age who present with long bone fracture, multiple fractures, low household income and parental unemployment are associated with an increased risk of NAI fractures.

Objective: Compare maxillary anterior dentition measurements, using Chu's proportion gauge with a T-bar tip (PG-TT) and a Two-Tip Compass (T-TC), in a group of Puerto Ricans, to determine the reliability of the PG-TT.

Methods: This cross-sectional study was conducted at the University of Puerto Rico, School of Dental Medicine, Medical Sciences Campus. The participants (18-35 years old) were dental students or employees of the university. Previously, the examiner had been trained and calibrated in instrument usage. Calibration participants (n = 16) received an oral exam, prophylaxis, and a chlorhexidine mouthwash for home use. After 3 days, the upper-anterior teeth were measured using the 2 instruments. The agreement was determined using weighted kappa statistics (Kw), and 0.80 was the minimum acceptable level. The examiner achieved almost perfect agreement (inter-examiner KwT-TC = 0.95 [0.96-0.93]; KwPG-TT = 0.82 [0.81-0.87]) with a reference examiner.

Results: Fifty participants (25 women and 25 men) were evaluated. Length: The teeth of the men presented an unacceptable level of agreement, except for in the right central incisors. For the women, a strong level of agreement was observed only in the lateral incisors and left canines. When the teeth of both sexes were considered, a strong level of agreement was detected, except for in the right canines and left central incisors. Width: The level of agreement was unacceptable, except for in the right canines (distal).

Conclusion: T-TC is a more reliable instrument to measure tooth dimensions as compared to the PG-TT.

Objective: Postpartum depression (PPD) has negative effects on the mothers who experience it. The aims of the study described herein were to determine the prevalence of PPD and to determine the correlations between PPD and perceived social support, quality of life, and the risk factors for PPD.

Methods: Data were collected using a questionnaire prepared by the researchers and that included the Edinburgh Postnatal Depression Scale, the Beck Depression Scale, the Quality of Life scale, the Multidimensional Scale of Perceived Social Support, and questions regarding the sociodemographic characteristics and PPD risk factors of the mother.

Results: The prevalences of PPD were found to be 3.9% in the 4th week postpartum and 5.9% in the 6th week postpartum. Being a primary school (and no higher) graduate, being stressed in daily life, experiencing health problems during the delivery and the postpartum period, and not thinking of oneself as a good mother were all determined to be risk factors for PPD. Although the mean score for social support was higher in women with low PPD risks, this difference was not significant. According to a linear regression model, PPD negatively affected the social and psychological qualities of life of the mothers in the 4th week postpartum.

Conclusion: Along with a trend suggesting a correlation between high social support and low PPD risk in women, a correlation between low PPD risk and high quality of life was also found.

Objective: We conducted a study in a tertiary hospital to investigate complementary and alternative medicine (CAM) prevalence in a Puerto Rican population. The study also evaluated demographic and clinical factors in order to correlate them with CAM use.

Methods: Spanish speaking residents with a known diagnosis of cancer being followed in the outpatient facilities at Auxilio Mutuo Cancer Center were invited to participate in the study. Patients who read and signed a consent form were given a questionnaire inquiring, among various things, on their use of any CAM treatment, education level, gender, place of residence and whether they had consulted their oncologist. The questionnaire also asked about their expectations for use of CAM.

Results: 215 patients were approached to participate out of which 200 signed the consent and accepted to participate. A total of 95 of 200 patients (47.5%) mentioned that they utilized at least one CAM treatment. Six factors were then analyzed for their correlation with CAM usage and three yielded statistically significant results at p<.05: age group, education level, and area of residence. After multivariate analysis all of these three factors behaved as independent variables. Gender, tumor type and stage were not significantly associated with use of CAM.

Conclusion: Our data show that CAM use is significantly more common in those with higher education, younger age, and those living in non-metropolitan areas. Vitamin C and soursop (Graviola or guanábana) proved to be the two most common CAM treatments, respectively.

Malaria is considered an important health threat around the world. Travelers from non-endemic countries are at risk of contracting the parasite that causes malaria. Those traveling on humanitarian missions and military personnel are at the greatest risk. Mosquito avoidance is an important intervention, but chemoprophylaxis is the most effective method for the prevention of this infection. The selection of a specific regimen can be a difficult task. It is a decision that is not based solely on the region in which a given patient is traveling but also on that patient's comorbidities and the potential adverse effects of the medications to be used. This review is intended to be a simple guide for the primary care physician. We discuss the selection of chemoprophylaxis for patients in the general population. We also address the specifics of chemoprophylaxis during pregnancy and breast feeding and in people diagnosed with epilepsy.

Objective: To describe the patient population with mycosis fungoides (MF) in Puerto Rico in terms of demographics, disease course, and management.

Methods: We performed a retrospective chart review of patients with MF who were being followed at the University of Puerto Rico dermatology clinics from 1999 through 2016. Collected data included demographics, age at diagnosis, stage at diagnosis, follow-up time, treatment, and stage at the time of the study.

Results: A total of 53 patients were diagnosed with MF from 1999 through 2016, with a mean follow-up period of 89 months. Of those, 45% were male. At the time of diagnosis, 40% were at stage 1A, 53% were at stage 1B, and 7% were at stages 2 to 4. During data collection, 74% of the patients remained stable, 18% improved clinically, and 8% progressed in disease stage. The treatment modalities used included phototherapy, topical steroids, topical and systemic retinoids, methotrexate, topical and systemic chemotherapy, and interferon.

Conclusion: Our study reflects the chronic and indolent course of MF, which has an overall good prognosis if diagnosed at an early stage, as has been demonstrated in the recent literature. The information contained within this manuscript should contribute to the understanding and characterization of MF in patients in Puerto Rico.

Objective: The aim of this study was to examine the effects of eating dried figs on the symptoms of primary dysmenorrhea, perceived stress levels, and quality of life during all menstrual cycles.

Methods: This randomized, placebo-controlled study was performed with 99 midwifery students. Each student was randomly assigned to the placebo (n = 32), cinnamon (n = 34), or dried fig (n = 33) groups. Data were gathered through the Total Dysmenorrhea Score, a descriptive information form, the Visual Analogue Scale, a pain duration assessment form, the Menstrual Distress Questionnaire, the Perceived Stress Scale, and the short version of the World Health Organization Quality of Life Scale-TR.

Results: During the 3 menstrual cycles in which the intervention was implemented, the dried-fig group had significantly lower scores for pain severity and duration, menstrual distress, and perceived stress than did those of the cinnamon and placebo groups. In addition, during these 3 cycles, the dried-fig group had significantly higher quality-of-life scores than the cinnamon and placebo groups.

Conclusion: The results showed that eating dried figs during menstruation decreased pain severity and duration, menstrual symptoms, and perceived stress and increased quality of life.

Objective: Objectively evaluate the incidence of sciatic nerve injury after a total hip arthroplasty (THA) performed through a posterolateral approach.

Methods: Patients scheduled to undergo THA were evaluated preoperatively and postoperatively with electrophysiologic studies, the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) questionnaire and other methods described in the study. Patients older than 21 years with any of the following preoperative diagnoses: primary or secondary osteoarthritis, aseptic avascular necrosis, rheumatoid arthritis, and posttraumatic arthritis were included. Variables used for analysis were sex, age, and body mass index (BMI). The Mann-Whitney U and Wilcoxon tests and, Pearson and Spearman correlation statistics were used for analysis of categorical and continuous data respectively.

Results: Electrodiagnostic data showed alterations in 17 patients (70.8%). No signs of sciatic nerve injury. The mean preoperative and postoperative WOMAC scores were 40 and 74, respectively (p = 0.0001). Statistical differences were noted in sural sensory amplitude (SSA) and distal amplitude of the tibialis motor nerve in the female group (p=0.007; p=0.036, respectively). The SSA also demonstrated differences in the obese group (p=0.008). In terms of age, both the SSA (Pearson p=0.010 and Spearman p=0.024) and the proximal latency of the peroneal motor nerve (Pearson p=0.026 and Spearman p=0.046) demonstrated a decrease in amplitude and an increase in latency that was inversely related with age.

Conclusion: According to our subclinical electrophysiological findings, surgeons that use the posterolateral approach in THA procedures must be conscious of the sciatic nerve's vulnerability to reduce possible clinical complications.