Boletin de la Asociacion Medica de Puerto Rico最新文献

Fibrous dysplasia is benign developmental disorders of bone where normallamellar cancellous bone is replaced with immature fibro-osseus tissue resultingin poorly formed trabeculae of immature woven bone. It may affectone (monostotic) or multiple bones (polyostotic). Polyostotic disease is lesscommon, 20-25% of patients, mostly in children below 10 years old andtends to enlarge beyond bone maturation ration which can cause pain, progressivedamage and higher tendency of pathological fractures.(1) We reporta case of polyostotic fibrous dysplasia present on bilateral tibia diaphysis. Patientpresented with bilateral leg pain on examination and imaging showedbilateral tibia lytic lesion. Management consisted of reaming and intramedullarynailing on bilateral tibia after which patient presented without painand radiographs showing no evidence of lesion. Tibia x-rays demonstrated exuberantcortical intramedullary bone formation with disappearance of thescalloped osteolytic lesions on the inner wall of tibial cortex. Clinically the patient'ssymptoms disappeared giving the opportunity to return to contact sportswithout limitation.

Since the introduction of liver transplant as treatment for end-stage liver disease,thousands of lives have been saved. To prevent organ rejection, immunosuppressionis given chronically and hence, patients are at increased risk foropportunistic infections related to immunosuppression, especially within thefirst year after the transplant. However, opportunistic infections can occur yearsafter the transplantation. Disseminated nocardiosis is one of these infections,and although the common presentation includes involvement of skin, lungs, andcentral nervous system. We present an uncommon presentation of nocardiosisin which cholestasis and elevated liver enzymes predominate, mimicking organrejection and liver disease recurrence. Infectious etiologies, including opportunisticmicroorganisms, must always be ruled out in patients presenting elevationin liver enzymes and cholestasis after liver transplant as early diagnosis can preventcomplications such as re-transplantation and even death.

Hypothyroidism is the most common thyroid disorder in the adult population.Studies have found a higher prevalence of overt hypothyroidism in type2 diabetic population than in the general population, but the relationshipbetween subclinical hypothyroidism and diabetes mellitus 2 is still controversial.The aim of this study is to estimate the prevalence rate of hypothyroidism inthe adult population receiving services in an ambulatory clinic and to determineif there is an association between hypothyroidism and diabetes mellitus.From the database of all adult patients who attended the outpatient clinic atFamily Medicine Center Policlínica Bella Vista in Mayagüez, P.R. during2014, a random sample of 200 subjects was obtained and the medical recordswere reviewed. The prevalence rate of diabetes mellitus in this group was 22%and the prevalence rate of hypothyroidism was 17%. The prevalence rateof hypothyroidism in diabetic patients was 10/44 (22.7%). The prevalencerate of hypothyroidism in non-diabetic patients was 24/156 (15.4%). The prevalenceratio was 1.48 (95% CI: 0.77, 2.85; X2 = 1.31, p = 0.25). The resultsof this cross-sectional study showed a non-statistically significant tendencyfor a higher prevalence of hypothyroidism in diabetic patients, which suggestthat screening for hypothyroidism among patients with diabetes shouldbe considered. More studies with more patients are necessary to investigate theassociation between thyroid dysfunction and diabetic patients.

Background: Autism Spectrum Disorder (ASD) is characterized by impaired social interactionand communication, and by restricted and repetitive behavior, that beginsusually before a child is three yearsold.(1) Researchers have shown that prevalencerates in the U.S. may be as high as 1 in 68.(52) A number of studies haveexamined the effects of early exposure to anesthesia on brain development andsubsequent impairment in neurocognitive function; yet, little is known aboutthe possible effects of anesthetic agents on social-behavioral functioning. Theassociation between exposure to anesthesia either in uterus, during the firstyears of life, or later and development of Autistic Spectrum Disorder (ASD) or itsseverity was determined in a retrospective population based cohort study.

Objectives: Identify if children who had previous exposureto anesthesia either in uterus, first years of life during their developing brainyears, or later, are at risk of developing ASD and its severe form of the disease.

Methods: Data was obtained from structured interviews administered to a sample of 515parents/guardians distributed in two groups: ASD = 262 children diagnosedwith this condition and Non-ASD: 253 children (siblings of ASD group) withoutdiagnosis (95% confidence interval) that freely decided to participate and agreedto a consent form. Variables studied include: demographics, diagnosis andseverity of ASD, exposure to anesthesia, method of childbirth, and age of exposureChildren less than 2 years of age were considered into have developingbrain period. Data was analyzed using Chi-square or Fisher exact test.

Results: In contrast to non-ASD group, most of the children within ASD group weremale, 76% (p=0.0001). With regards to methods of childbirth, 64% of the ASDpopulation were vaginal delivery (VD; Non-anesthesia exposure group) and36% cesarean delivery (CD) compared to non-autistic population with 71%VD and 29% CD, which demonstrates no statistical difference between bothgroups (p=0.1113). Out of the 36% of ASD population that underwent CD,7% were performed using general anesthesia and 93% regional anesthesia,while the 29% of the CD of non-ASD, 5% were performed using general anesthesiaand 95% regional anesthesia. This reveals no statistical significance(p=0.7569) with the development of ASD and the type of anesthesia usedwhen comparing ASD with non-ASD patients. In view of severity of autism, inVD, 56% of ASD population had mild form of the disorder, 34% moderate, and10% severe; while CD had a 54% mild form of the disorder, 33% moderate, and13% severe. This shows no statistical association (p=0.8069) when comparingexposure to anesthesia in uterus to subsequent severe form of ASD.Of the 262 ASD patients, 99 had exposure to anesthetics before their diagnosis,while in Non-ASD population, 110 had exposure to anesthesia, demonstratingno statist

Objectives: The incidence and prevalence of Chronic Kidney Disease (CKD)patients treated with dialysis has continued to increase worldwide. These patientsare at the highest risk of developing cardiovascular complications whichcontribute to their demise. The objective of this study was to describe the clinicaland demographic characteristics of the patients on maintenance hemodialysisat the University Hospital, in San Juan Puerto Rico.

Methods: We reviewed a total of 55 active patients. Data was collected toidentify the demographic and clinical characteristics. Co-morbid conditionssuch as diabetes mellitus, hypertension, and coronary artery disease (CAD)were noted as well as age, dialysis vintage and social and educational profiles.

Results: Patients were divided into two groups according to age (group 1 wereless than 60 years and group 2 were more than 60 years). Average age was 42 yearsin group 1 with 17 females and 24 males and 78 years in group 2 with 6 femalesand 8 males. Diabetes mellitus was present in 17 (41%) of group 1 and 5 patients(35%) of group 2. Likewise hypertension was present in 26 (63%) of group 1 patientsand 11(78%) of group 2 patients. CAD was present in 15 (36%) of group 1patients and 7 (50%) of group 2 patients. There was an association between lowannual income in both groups but not in the level of education.

Conclusion: A relatively young population was identified in our descriptiveanalysis of hemodialysis patients at the University Hospital. The expected highincidence of diabetes mellitus observed in the general population of hemodialysispatients in our country was not present. Hypertension and CAD weremajor risk factors in these patients. In view of these findings we recommendbetter control of blood pressure, prevention and early detection of CAD inCKD patients before initiating dialysis.

This case illustrates the unusual presentation of Takotsubo cardiomyopathy inan elderly male patient with characteristic chest pain and dyspnea associatedwith electrocardiographic changes of biphasic T wave inversions and QT-intervalprolongation on anterior segment, mimicking acute coronary syndrome.Takotsubo cardiomyopathy is a transient systolic dysfunction of the apicaland/or mid and anterior segments of left ventricle most frequently seen in post-menopausal women, up to 80 to 100% of cases. Often there is a history of a recent(within the previous two months) episode of severe emotional or physicalstress associated with the event.

In this case report a patient presents with high-output cardiac failure in the clinicalsetting of acute leukemia and leukostasis. Case particulars are presented, literatureis reviewed and a potential mechanistic explanation is proposed to describepresentation and clinical findings.

Introduction: Previous studies have described Klinefelter syndrome as a geneticdisorder characterized by at least one extra X chromosome and at least 47chromosomes. It is the most common sex chromosome aneuploidy among men.Patients may present with large height, gynecomastia, low testosterone levels,infertility, hypogonadism and diseases usually more common in females suchas osteoporosis, breast cancer and auto-immune disorders. Other rare ophthalmicassociations have been described, such as diffuse choroidal atrophy, microphtalmia,cataracts, juvenile glaucoma, choroid colobomas and goniodysgenesis.

Objectives: To report on the ocular findings in a Puerto Rican patient withKlinefelter syndrome (XXXXY/XXXY). PATIENTS AND METHODS: A patient with Klinefelter syndrome with revious history of elevated intraocularpressure underwent a comprehensive ocular examination, Humphrey visualfields and Stratus optical coherence tomography (OCT) tests. Patient had inreased intraocular pressure, visual field loss and OCT findings compatible withglaucoma. After laser YAG laser iridotomies, high IOP persisted. Brimonidine0.2 % drops three times a day drops were prescribed to lower IOP.

Conclusions: A patient with Klinefelter syndrome had poor visual acuity, high intraocular pressure, visual fields and OCT results, all compatible with angle closureglaucoma as part of the syndrome.