Boletin de la Asociacion Medica de Puerto Rico最新文献

Chest pain is a common complaint in the emergency department (ED). Besidesa careful history and physical exam; electrocardiogram, laboratorytests and imaging studies are widely available diagnostic tests that are usedfor patient assessment. When ST elevation and elevated cardiac enzymesare present the most likely diagnosis are ST elevation myocardial infarction(STEMI) or myocarditis. In this case report we present two low risk patientsfor major adverse cardiac event with ST elevation and elevated cardiac enzymesand how a careful risk assessment and detailed electrocardiogram evaluationcould help differentiating between these two diagnoses.

Dengue is an endemic disease in Puerto Rico, with three to nine thousandsuspected dengue cases reported yearly. In PR, physicians are required to maintainmedical education courses about dengue in order to recertify their medicallicenses. The purpose of this study was to describe characteristics of patientsadmitted to Bella Vista Hospital with suspected dengue and estimate thecompliance with guidelines established by the CDC documented in medical records.A total of 197 medical records of patients admitted with diagnosis of suspecteddengue during January 1, 2013 through December 31, 2013 were reviewed.The annual distribution of admitted cases showed a higher incidenceduring the months of June through September, with August having the higherincidence of all. Combined aches and pains were most commonly reported atadmission with a prevalence of 82%. In general there was a low prevalence ofsevere disease as per definition at presentation (DM, clinical fluid accumulation,hepatomegaly, pregnancy and/or renal insufficiency). Overall, compliancewith CDC established guidelines were only partially followed. The guidelinethat was followed more frequently was a daily CBC, with 95% of patientshaving this as part of their management. Prevalence of administration ofisotonic intravenous fluids was 63%, monitoring of vital signs was 48%),and administration of bolus of intravenous fluid was11%. No fatalities werereported during the period.

This is the case of a 38 year-old female patient with an intrauterine pregnancy,in which a previous incidentally identified adrenal mass proved to be apheochromocytoma during the antenatal period. The patient was started onα-and β-adrenergic blockade to maintain hemodynamic stability, and surgicalremoval of the lesion was performed during the second trimester without majorcomplications. In view of the rarity of this disorder in pregnancy, it is imperativeto have a high index of suspicion for a prompt and dedicated management,since this tumor, if unrecognized, is associated with high fetal and maternalmortality.

Prolactinomas are the most common hormone-secreting pituitary tumorsand represents approximately 40% of all pituitary adenomas. Pharmacologytherapy with dopamine agonists is the mainstay treatment for prolactinomas.Usually, patients respond to these drugs with decreased level of the serumprolactin and with time, by tumor shrinkage. Less than 10% of patientswith prolactinomas exhibit resistance to the action of dopamine agonists, asdefined by the lack of normalization of the serum prolactin levels despite long-term treatment at high doses of these drugs. However secondary resistanceto dopamine agonists therapy has also been described in patients who wereinitially responsive to treatment, either with Cabergoline or Bromocriptinebut later develop dopamine agonist resistance, with elevated prolactin levelsand sometimes an enlarging tumor volume several years afterwards. Wereport a case of a male patient with prolactinoma who developed drug resistance13 months after initial dopamine agonist therapy.

Jarcho-Levin syndrome (JLS) is a rare axial skeletal growth disorder characterized by the presence of multi-level costovertebral malformations, a short neck, a short trunk, and kyphoscoliosis at birth. Neural tube defects appear to be common findings in patients with JLS, and chest hypoplasia frequently leads to respiratory insufficiency and death in early childhood. There have been no previous studies in the literature on the anesthetic management of JLS with neural tube defects and hydrocephalus. Therefore, we have reported a case of JLS in a female full-term newborn, who underwent surgery for myelomeningocele repair and ventriculoperitoneal shunting, with the associated anesthetic challenges and their management.

Background: Background: Gender disparities in pediatric fracture events has beenwell-documented however, less is known about racial disparities. The aim of this study is to investigate the epidemiology ofpediatric bone fractures in a Hispanic population.

Methods: This is a retrospective cross-sectional analysis of patient’s records from aPediatric Orthopeadic outpatient clinic in the Southwest region of Puerto Ricoduring a 1-year span (August 2014 – August 2015). Differences in sex, BMI,health insurance coverage, parental educational level and employment status,mechanism of fracture, fracture site, and seasonality were investigated amongthree age classes (pre-school children, school children and adolescents).

Results: The sample consited of 243 subjects (0-21 y/o) sustaining a fracture ofany extremity within the study period. Boys were at a higher risk of having afracture event and as age increased, the male/female ratio also increased. Themean BMI was 18.0 kg/m2, with the highest in the school children age group(20.3 kg/m2). Slighlty more than half of the subjects (55.7%) benefitted frompublic health insurance coverage. The typical father was a laborer with a highschool diploma, while the mother had a high school diploma but was unemployedThere was a tendency for the children to suffer a bone fracture whileat school (49.4%), followed by fractures at home (34.6%). In both the pre-schooland school children groups, the upper extremity was more frequently involved(66.7% and 63.9%, respectively) in fracture events. Finally, there was very littlevariation in the seasonality of fracture events.

Conclusion: This study provided valuable epidemiological information aboutpediatric bone fractures within a Hispanic population. It may contribute tothe development and implementation of educational and preventive strategiesappropriate to age and sex-differences.

Eighty year old male patient with heart failure preserved ejection fraction (EF),Obstructive sleep apnea, peripherovascular disease admitted with increasingshortness of breath and found with pulmonary emboli. Baseline 2D-echocardiogramperformed demonstrated preserved ejection fraction and a rightthrombus in transit. Anticoagulation with weight based-low molecularweight heparin was given for six days. Follow-up echo performed demonstratedcomplete dissolution of right heart thrombi. Since there was complete dissolutionof thrombi seen on right atrium, anticoagulation with Rivaroxaban was given instead.

The discourse about health in Puerto Rico has been constructed using thephysician and hospital’s perspective or a particular disease or epidemic. Thusfar, this approach has not addressed the health library as an object of study. Theorigins and development of the Conrado F. Asenjo Library (CFAL) will be discussed. Before 1912, there were no medical libraries in Puerto Rico, onlyprivate collections. In 1914, the act that created the Institute of Tropical Medicinewas amended to allocate funds for the purchase of books to supportresearch in tropical diseases in Puerto Rico. The history of the CFA Libraryreflects its contribution to issues, concerns, development of research, and to theevolving paradigms in the health field in the Island. Historical documents,such as Bailey K. Ashford’s personal papers located at the CFAL and GeorgetownUniversity Archives (GU) were evaluated. Institutional reports fromthe School of Tropical Medicine (STM) and articles published by Puerto Ricanphysicians such as Dr. Pedro Gutiérrez Igaravídez and Dr. Isaac GonzálezMartínez, affiliated to the Institute of Tropical Medicine, were also studied.Finally, references and bibliographies in articles published between 1912 and1924 were evaluated and consulted to find additional sources.

We report clinical and molecular mechanisms relating the process ofinflammation involved in the progression of obesity and the metabolic syndrome,emphasizing the cardiovascular problems developed in Hispanic populations.Namely, the incidence, component characteristics and complications of obesityand metabolic syndrome in island Puerto Ricans are described and evidence ispresented supporting the fact that the metabolic syndrome may be milder inPuerto Rico than in the mainland United States because it is characterized byless aggressive coronary artery disease and a relatively normal lipid profile.Moreover, data supports the fact that increased serum cholesterol levels produceless myocardial infarctions in Puerto Rico than in mainland Hispanics andCaucasians. In addition, the incidence of ventricular tachycardia, a complicationcaused by remodeling and ischemia of the heart, may be lower in Puerto Ricothan in the United States, although the prevalence of the metabolic syndrome ishigher in the island. On the other hand, there is evidence of a rising epidemic ofobesity and vascular inflammation in Puerto Rico that suggests that cardiovascularmorbidity and mortality in the island will continue to increase in thefuture decades.