Boletin de la Asociacion Medica de Puerto Rico最新文献

Quadriceps muscle injuries are common in athletes and middle age patients.Strains and tears of the distal portion of the muscle is the most commonpresentation of these injuries. Isolated rectus femoris tears are rare andfew reports are published that evaluate outcomes in of nonsurgical treatmentof these injuries. This article will described an unusual case of isolated distalrectus femoris tear in a patient with no associated risk factors, who initiallypresented with extensor mechanism weakness and limping, treated conservativelywith range of motion therapy and strengthening.

Psoriasis is an immune disorder characterized by chronic activation of systemicinflammation. Morbidity and mortality in patients with psoriasis is attributedmainly to cardiovascular disease. There are studies in Caucasians and African-Americans, but little is known about how psoriasis is associated to coronaryartery disease (CAD) in Hispanics. We intend to describe the angiographic findingsof a group of Puerto Rican patients with psoriasis. Retrospective cohort studyof 46 patients with psoriasis were studied. Coronary angiographic reports werereviewed, and collected data was statistically analized. Population median agewas 56, and 72% were males. Of the 46 patients, 27 had CAD by angiographiccriteria (58.7%). Twelve patients were referred to bypass graft surgery, 8 underwentcoronary stent placement, and 7 were treated medically. Whether psoriasiscan be considered a risk factor for developing CAD is still on debate. Morethan 50% of our patients with psoriasis had angiographic evidence of CAD. Adjustingfor traditional cardiovascular risk factors, we found no significant association(p>0.05) with CAD. We believe that inflammation plays a contributing rolein the increased risk of CAD in these patients. The importance of this study relieson being the first retrospective analysis in a group of Hispanics trying to determinean association between coronary artery disease and psoriasis when in PuertoRico, coronary artery disease is 30% less than in the United States.

The subclavian artery pseudoaneurysm is a rare entity with only few cases re-ported in the literature. Most injuries were related to iatrogenic manipulationwith catheters for canalization of central lines in the hospital setting. In rare cases,this injury has been described secondary to a blunt trauma and motor vehicleaccidents with traumatic injury to the subclavian artery caused by seatbelt use.We report an unusual case presentation of subclavian artery pseudoaneurysm.

Objectives: The aim of this work is to determine the diabetes treatment satisfactionin a group of hospitalized patients with type 2 diabetes.

Methods: observational cross research. Patients over the age of 18with diagnosed type 2 diabetes of at least one year until the present studywere included. Those presenting pathologies attributed to diabetes wereexcluded. Patients should have responded to the DTSQ questionnaireupon admission. r Pearson regression, multivariate linear regressionand U Mann-Whitney tests were analyzed.

Results: A total of 102 patients were included with an average age of 63.1years. Average value of the DTSQs was 14.5.A significant statistic correlation was observed between the score of thequestionnaires and good diabetes control showed by the levels of HbAc1and fasting blood glucose, among other parameters. Indeed there wasno correlation between satisfaction and age and BMI. Women had lowersatisfaction score than men.

Conclusions: levels of diabetes treatment satisfaction in the study populationcorrelated well with diabetic status. That is, the lower diabeticcompromise, the better satisfaction score. The degree of satisfaction inpatients with type 2 diabetes was lower than the observed on patients withthe same pathology but from primary levels of health care.

Autoimmune hepatitis (AIH) may present with clinical, laboratory abnormalitiesand histological features suggestive of primary biliary cirrhosis(PBC) or primary sclerosing cholangitis (PSC). These variants of AIHare known as overlap syndromes. We present a case of a 62 year-old-malewho presented with altered liver function tests, anemia and unintentionalweight loss. Initial laboratories revealed anemia and a cholestatic pattern. Diagnosticwork-up was remarkable for a positive antinuclear antibodies (ANA)test and a liver biopsy suggestive of an AIH-PBC overlap syndrome. This caseillustrates the complexity of establishing the diagnosis and effective therapy inthis condition.

Sjögren's syndrome is a systemic autoimmune disorder characterized by salivary insufficiency and lymphocytic infiltration of the exocrine glands. Bronchiolitis and bronchiectasis are common airway manifestations but interstitial pneumonitis, and lymphocytic interstitial pneumonitis may also occur. It rarely presents with pleuritis. We report a woman with primary Sjögren's syndrome who developed pleuritis with moderately large effusions and antibody levels for SS-A and SS-B in the serum without evidence of infection, malignancy or other collagen diseases. After the initial treatment, daily administration of 20 mg of oral prednisone has effectively controlled the serious manifestations of the disease with minimal side effects.

Diabetes Mellitus type 2 (DM2) is a metabolic disease that develops by a decrease in sensitivity of insulin receptors as an effect of the disruption certain metabolic functions in the processing of glucose. DM2 patients have, uncontrolled glucose levels, and commonly have problems with obesity and cardiovascular disease. Patients are treated with standard diet, insulin, diabetic oral agents and antihypertensive drugs, but this approach does not completely stops tissue deterioration since it does not address the metabolic root of the disease. Metabolic correction is proposed as a suitable adjunct treatment to improve clinical outcomes. Metabolic correction is based on diet modification, proper hydration and scientific supplementation directed to improve cellular biochemistry and metabolic efficiency. In addition, other possible benefits may include reduction in medication use, disease complications and medical costs. To test the results of a metabolic correction program, 25 patients with DM2 participated in an education program about adequate food consumption that promoted control of blood glucose levels. Anthropometric measurements and blood tests were performed during a 13 week program based on a low carbohydrate diet, proper hydration and magnesium supplementation. The metabolic correction program implemented by a proprietary educational system resulted in significant reductions in glucose, triglycerides, cholesterol, weight and waist circumference. Improvements in these values could represent an important reduction of coronary heart disease risk factors as well as other chronic degenerative diseases. In addition there was medication dosage reduction in one or more medications in 21 of the 25 participating patients, which suggest that the program has the potential to improve health outcomes and reduce health care costs.

Functional brain imaging with brain single photon emission computer tomography (Brain SPECT) has been used for many years in the evaluation of multiple neuro-degenerative and neuro-developmental disorders. Brain SPECT is a nuclear medicine tomographic study performed with a lipophilic radiopharmaceutical labeled with 99mTc-pertechnetate. It is a cerebral perfusion agent that depicts the global and regional perfusion patterns in the cortical gray matter and subcortical structures. Cornelia de Lange syndrome (CdLS) is a rare neuro-developmental and genetic condition, associated to several malformations. There are a limited number of cases reported in the medical literature and few of them report neuro-radiological and/or neuro-pathologic abnormalities. We report a case of a 15 year old patient, clinically diagnosed at birth with CdLS, who presents limited anatomical findings on Computed Tomography and Magnetic Resonance Imaging. To the best of our knowledge, this is the first report of the Brain SPECT findings in this syndrome.

Background: Complaints of knee pain secondary to early osteoarthritis may account for up to 30% of visits to primary care physicians. Due to the proposed inflammatory changes in early osteoarthritis, intra-articular injections of corticosteroids (IACS) have been considered as an option for disease progression modification, pain control, and improvement of function. However, some studies have suggested poor accuracy rates of IA injections depending on the entry site chosen. It is therefore the aim of this study to evaluate the efficacy of IA knee corticosteroid injection in reducing pain and improving function in patients with early osteoarthritis and whether the low accuracy rates reported with the Anterolateral joint line injection site translate to worse functional and pain outcome measures as compared to Suprapatellar lateral injections.

Materials and methods: The study was carried out as an open-label, randomized controlled trial with 60 sequential patients recruited. Simple randomization separated groups into anterolateral joint line or suprapatellar lateral injection sites. Improvements were measured with WOMAC and VAS scores after injection of Lidocaine and steroid solution.

Results: Patients receiving IACS injections had a measurable improvement in self-reported outcomes as evidenced by standard deviation change in WOMAC and VAS scores. The majority of patients had a clinically significant improvement in VAS scores as compared to their initial measures with a notable amount of patients improving significantly as well on their WOMAC scores, irrespective of the injection site chosen.

Conclusions: We have therefore continued the use of palpation-guided intra-articular knee injections in an effort to reduce costs as compared to other injection modalities with positive results in our osteoarthritis patients.