Boletin de la Asociacion Medica de Puerto Rico最新文献

Fungal infections represent a serious complication for immunosuppressed patients resulting in an increased morbidity and mortality. A non-concurrent prospective study was performed to evaluate the factors associated to invasive fungal infection (IFI) in patients with hematological malignancies admitted to the University Hospital in San Juan, Puerto Rico from January 1^st, 2011 through June 15^th, 2014. The medical records of 84 patients were evaluated. Fifty-nine patients with IFI and twenty-five without IFI. The majority were men between 35 to 55 years old. The main hematological diagnosis was acute myelogenous leukemia (AML) followed by acute lymphoblastic leukemia (ALL). Seventy-percent developed IFI. The most common fungi were C. albicans followed by non-albicans species, Fusarium and, Aspergillus species, respectively. About 63% of the patients with AML and 81% without AML had IFI. Those who received steroids were more likely to develop IFI. After adjusting for AML and age, the odds of IFI among patients using steroids were 3.33 higher than those not using steroids. Patients who were exposed to different antifungal medication had 72% lower odds to develop IFI.

Cerebrospinal fluid leaks of the cranial vault, constitute one of the most commoncomplications after neurosurgical procedures. In this paper we introduce toyou an observational study, in which a series of patients with this complicationwhere managed by using elastic compression hat during 18 hours per day,for two weeks to four months. Every one of them presented complete resolutionof the leak, without any recurrence until actual controls. After that we perform areview of the literature, demonstrating this is a new therapeutic management,being us the first group on reporting it. According to the observed results, it wasconcluded that despite more studies are required, the use of elastic compressionhats for this kind of patients could be effective and safe.

End Stage Renal Disease patients undergo profound hemodynamic changesduring hemodialysis treatments which are now recognized as a marker forincreased risk of morbidity and mortality. Development of intradialytichypotension or hypertension are a common clinical problem in this populationwith an incidence of up to 20%. We performed a retrospective review of49 Hispanic patients receiving ambulatory hemodialysis during a period of6 months to ascertain the development of aforementioned intradialytic events.Clinical data examined the association of these events to mortality and theirrelationship to antihypertensive medications and cardiomegaly. The prevalenceof intradialytic hypotension was 38.78%, hypertension 16.33% individuallyand both taking place 16.33%. Taken together, the prevalence of theseintradialytic events was 71.43% in our Hispanic population. A significant association was found between mortality and Beta blockers (BB)(P=0.044),Calcium channel blockers (CCB) (P=0.023), cardiomegaly (P=0.044),and intradialytic events (P=0.035). Odds ratio of multiple variables dis-closed that dependent variable death decreased in probability with the useof BB by an estimate of 73% and with the use of CCB by 74.8%. On the otherhand, odds of developing the dependent variable death increased by 74.5% if thepatients developed intradialytic events. Similarly, the odds of developing cardiomegaly in the living group increased by 70%. A logistic regression of multiplevariables found that the probability of developing the dependent condition ofdeath increases by almost 2.896 times if intradialytic events are present andthat there is a 58.9% inferred causality. It is concluded that intradialytic hyper-tension and hypotension are major risk factors for mortality in dialysis patients.The use of BB and CCB may be protetive to avoid the risk of mortality inthese patients.

Stress fractures and muscle strains are common in marathon runners. Moststress fractures occur in lower extremities and tibia stress fractures comprisealmost half. Iliac wing stress fractures are not commonly found in runners andare usually related to osteoporosis. There have been 4 previous reports of iliac stressfractures in marathon runners none reported an associated isolated gluteusminimus tendon tears. We will report a case of a female marathon runner withiliac wing stress fracture with associated isolated gluteus minimus tendon tear.

Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of S. aureus thatshows resistance to multiple antibiotics. Up to 30% of S. aureus strains isolatedfrom nosocomial infections are MRSA, and it has become a growing problemfor public health. The cost of MRSA infection is also having a huge impactfinancially and results in considerable resource utilization. Puerto Rico’sLegislature passed Law # 298 on October 19, 2012 for the control and preventionof MRSA infections in medical installations in Puerto Rico. In order to complywith the law we conducted a pilot study to identify possible setbacks of theimplementation of the MRSA decolonization protocol as standard of care therapy inour institution while contributing to the process of quality improvement andpatient safety. Nasal swabs were taken at the Pre-admission Department andprocessed through a PCR-based MRSA detection assay. A protocol of decolonizationin patients with positive results was implemented. The study showedthat patients without apparent risk factors could be colonized either withMRSA or Methicillin-sensitive S. aureus (MSSA). The time between pre-admission and surgery was less than the indicated for a proper decolonizationprocedure. Therefore, 50% of the scheduled surgeries could have beenpostponed in case of positive MRSA or MSSA. In our experience patient’s educationwas crucial to guarantee compliance and adherence to treatment. Inorder to decrease risk of wound infection we recommend that both, screeningprocess and decolonization if required, be performed before the preadmissionappointment for elective surgery. This study provided a framework for MRSApre-admission screening and decolonization in our Institution.