Puerto Rico health sciences journal最新文献

Objective: The abrupt decline in the Total Fertility Rate (TFR) of Puerto Rico to 0.9 children per woman, well below the replacement level of 2.1 children per woman, makes the prospect of a sustained population decline a real possibility. Population projections produced by the United States Census Bureau and the United Nations Population Division show that the island population may decline from 3.8 millions in 2000 to slightly above 2 million by 2050, a dramatic population decline of 47% in 50 years. Both population projections assume that all countries with a TFR below replacement level could eventually increase toward or oscillate to 2.1 children per woman and have Puerto Rico's TFR approaching 1.5 by 2050. This assumption has been widely criticized as unrealistic and not supported by evidence. The main objective of our research is to provide an alternative fertility projection for Puerto Rico by 2050 that has more realistic assumptions.

Methods: Our methodology is based on the Bayesian Hierarchical Probabilistic Theory used by the United Nations to incorporate a way to measure the uncertainty and to estimate the projection parameters. We modified the assumptions used by the United Nations by considering 17 countries with TFR similar to Puerto Rico.

Results: By 2050, Puerto Rico may have a TFR of 1.1 bounded by a 95% credibility interval (0.56,1.77).

Conclusion: Under this scenario Puerto Rico can expect to have a larger population decline than that projected by the Census Bureau and the United Nations.

Objective: Monkeypox is a viral zoonotic disease endemic to West and Central Africa; it has been reported in more countries during the last decade than in the previous 40 years. In 2022 a multinational outbreak occurred. This change in the epidemiology of the virus may represent an evolutionary adaptation. The purpose of this study is to analyze the molecular aspects of Monkeypox virus (MPXV) disease that may explain the latter's change in epidemiology during the 2022 outbreak.

Methods: From July 2022 through December 2022, the period of the outbreak, a narrative review was conducted on the available literature, with a total of 271 articles published in the MEDLINE/PubMed and LILACS databases being examined. The chosen articles were organized using the search and reference manager Mendeley Desktop 1.19.4. Duplicates and articles that did not meet the study's objective were eliminated, resulting in the selection of 49 articles for the present review.

Discussion: MPXV resurgence poses challenges due to waning immunity and changing epidemiological patterns. Recent outbreaks show different transmission routes, affecting new demographics. Genomic evolution, vaccination history, and potential new animal reservoirs complicate containment efforts. Continued surveillance and vaccination are crucial for control.

Conclusions: It seems possible that MPXV has (re-)emerged to occupy the ecological niche left by the smallpox virus. Mutations of the apolipoprotein B mRNA editing enzyme, catalytic subunit 3G motif, in MPXV clade IIb since 2017 may explain the epidemiological change that has occurred in recent years. This pattern could be due to sustained transmission in a new host or a new route of infection.

Objective: Primary ciliary dyskinesia (PCD) is a respiratory disorder that impairs mucociliary clearance, leading to decreased lung function. Conventional chest physiotherapy (CCP) is the traditional airway clearance technique (ACT) and is considered a standard treatment for PCD patients. This systematic review investigated whether device supported ACTs are better alternatives for improving lung function and/or quality of life in PCD, compared with CCP.

Methods: The OVID Medline, PubMed, CINAHL, and Cochrane databases were searched. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the Grading of Recommendations, Assessment, Development, and Evaluation approach was used to aggregate the data. This systematic review has been registered on the International Prospective Register of Systematic Reviews website.

Results: Of the 389 citations that resulted from our literature search, 2 randomized crossover trials that included a total of 54 patients were analyzed. The certainty of the aggregated study evidence was very low. No difference was identified between device-supported ACTs and CCP in terms of forced vital capacity and forced expiratory volume in 1 second in PCD patients aged 6 to 20 years.

Conclusion: Device-supported ACTs could be considered alternative treatment options to replace CCP. High quality research is required to confirm this result.

The recent COVID-19 global emergency may have ripple effects on mental health of many people worldwide. This is especially true for populations like birthing and postpartum women where many changes to daily routines, access to medical care, work-related routines and socialization were experienced. This brief report presents data from an ongoing cohort study aiming to describe maternal mental health during the pandemic T12 (March 2020 to April 2021) with post-pandemic T2 (May 2022 to May 2023) of mothers followed in Puerto Rico. 47 out of 100 mothers have been recalled and assessed with psychosocial interviews (COPE-IUS) and assessments of anxiety (GAD-7) and depression (PHQ-9). Paired t-test revealed mean scores of depressions (PHQ-9) were significantly higher for T2 with a mean of 6.35 and a range of 4.4+/- than for T1 where mean was 5.15 (+/- 2.9), t=-1.954, df=45, p < .05. Similarly, anxiety scores (GAD-7) were significantly higher in T2 6.67 (4.2) than for T1 5.35 (3.7), t=-1.8, df=45, p < .05. Also, COPE-IUS Post-pandemic psychosocial interview results evidence that 80% of mothers do not feel the COVID-19 pandemic is a significant stressor at T2 and are able to maintain routine activities with no social distancing measures. However, reports of loneliness, sadness, worry, and fear continue to be present. Our findings point to the need to further identify other contributing factors to the deterioration of maternal mental health during the perinatal/peripartum period (pregnancy, birth, and postpartum) in Puerto Rico. Possibly the effects of repeated adversity that has been present in the island (multiple environmental stressors, history of traumatic experiences, and constant hardships) may all have cumulative impact over maternal mental health during the perinatal/peripartum period.

Objective: Childbirth is considered to be both beautiful and traumatic. Following a vaginal delivery, some women express discontent with the appearance of their genitalia on social media and/or websites. This study explored how some women perceived their genitalia, post childbirth. Three groups were compared: women with a vaginal delivery, those with a cesarean-section, and those who had never given birth.

Methods: After the study received approval from the institutional review board, 224 female participants living in Puerto Rico and aged 21 to 42 years completed a questionnaire about their genital self-image.

Results: Approximately 51% (n = 115) of the participants had never given birth; the others had given birth via C-section 23% (n = 51) or vaginally 26% (n = 58). In all 3 groups, 84% felt positive about their genitals, 79% expressed their satisfaction with the appearance of their genitals and 84%, with their size; 81% were not ashamed of their genitals.

Conclusion: Logistic regression found no significant difference in genital self-perception between delivery groups or nulliparous women. The adjusted odds ratios for positive genital image varied slightly between delivery methods but were not statistically significant (ranging from 0.65 to 1.11 for vaginal deliveries, and 0.42 to 1.00 for C-sections; P > .05). This suggests that the method of delivery does not have a significant impact on women's genital self-perception. However, for the 21% with negative perceptions, targeted support is essential; for those struggling with their self-image after childbirth, our results can inform support services to address concerns.

Objective: The current study aimed to explore changes in health-related behaviors and social practices in Hispanic cancer patients during a government-mandated lockdown and their relationship to sociodemographic and clinical characteristics.

Methods: Secondary analyses were conducted on data gathered by a longitudinal cohort study to describe the unmet needs of Hispanic cancer patients living in Puerto Rico exposed to Hurricane Maria in 2017, earthquakes in 2020, and COVID-19. However, our study solely focuses on the data from the COVID-19 pandemic period.

Results: Most participants were women (n = 72) with breast cancer (81.2%). Participants exhibited changes in religious practices (60%), physical activity (58.4%), and sedentary behavior (50%); 31.4% experienced changes in eating habits and sleeping patterns. Responses to the study questionnaire involved staying connected with family (85.5%) through phone calls (78.2%); 69.9% of the participants reported observing shifts in the family dynamics. A strong majority endorsed the government-imposed isolation measures (95.6%). Patients not undergoing treatment were likelier (r = -0.324; P = .010) to support the measures. Finally, younger patients experienced more work-related changes (r = -0.288; P = .017) and were less inclined (r = -0.293; P = .011) to find the isolation measures appropriate.

Conclusion: This paper describes the lockdown related changes in health and social behaviors sustained by cancer patients, changes which could potentially impact their overall health and health-related quality of life. Our results fill an existing gap in our findings and contribute to understanding the experiences of cancer patients (in particular, Hispanic patients) during the COVID-19 pandemic.

A 6-year-old Hispanic patient presented with a 1-month history of pruritic patches on her scalp, characterized by hair loss, black dots, and dandruff-like scales. The patient was seen by her primary care physician, who prescribed ketoconazole 2% shampoo. This provided little relief for her symptoms, which prompted her admission to nearby hospital, where fluconazole was administered intravenously and mometasone lotion applied. The patient was discharged and instructed to use the ketoconazole shampoo and mometasone lotion. The previously prescribed medications failed to improve her now enlarged, inflamed, scaly, pustule-speckled lesions. Given her condition, she was admitted to the University Pediatric Hospital in San Juan, where the Dermatology Department was consulted. Cultures were taken from the lesions, revealing the presence of Trichophyton tonsurans, which led to the diagnosis of tinea capitis (ringworm of the scalp) with kerion formation. In addition, multiple nits and adult lice characteristic of Pediculus humanus capitis were observed. A 6-week course of griseofulvin, a 1-week course of permethrin solution, and a 5-day course of oral prednisolone were started, effectively cleared the patient's inflammation and fungal infection. This case highlights how there exist areas of improvement in terms of interprofessional communication between physicians, as well a need to increase awareness of the proper treatment for this common pediatric skin condition. We postulate that in doing so, similar cases could be spared the unfortunate results of untreated tinea capitis, that is, kerion formation and the possible scarring this lesion can produce.

Objective: Direct-acting antiviral (DAA) drugs have resulted in high rates of virological cure in chronic hepatitis C (CHC)-infected patients. We used noninvasive tests to assess fibrosis in subjects who had been cured with DAA.

Methods: Retrospective data collection (2014-2019) from the medical record of CHC patients at the hepatology clinic was performed. Subjects co-infected with HIV and hepatitis B, post-liver transplant, and lost to follow-up were excluded. We evaluated fibrosis at baseline and 1 year after completing therapy using vibration-controlled transient elastography (VCTE), fibrosis-4 (FIB-4), and aspartate aminotransferase-toplatelet ratio index (APRI) scores.

Results: With 210 medical records reviewed, 41 were included. The mean age was 62.8 years; 61% were men. Significant fibrosis regression was observed 1-year post-treatment using 3 noninvasive methods: VCTE, APRI, and FIB-4 score. Prior to treatment, 46% of the patients had advanced fibrosis compared to 25% 1 year after treatment. The VCTE scores of 4 subjects (with body mass indices [BMIs] > 30) indicated a worsening of fibrosis. We did not find a statistically significant association between BMI and VCTE, FIB-4, or APRI score.

Conclusion: In most CHC patients, DAA therapy leads to liver fibrosis regression. Obesity may play an important role in the worsening of hepatic fibrosis or the absence of fibrosis regression.

Mevalonate kinase deficiency is a rare autosomal recessive disease caused by mutations in the mevalonate kinase gene (MVK). Depending on the mutations, a patient with this deficiency can exhibit any one of a spectrum of rare autoinflammatory diseases, such as hypergammaglobulinemia D (hyper-IgD) with periodic fever syndrome and mevalonic aciduria. To date, approximately 300 cases with mutations in the MVK gene have been reported worldwide. Herein, we present a 3-year-old female from Puerto Rico with a history of fever, arthralgia, and skin lesions since her first month of age and who, upon genetic workup, was confirmed to have compound heterozygous mutations in the MVK gene. Given her medical history and the results of her genetic testing, she was diagnosed with hyper-IgD with periodic fever syndrome. She will be treated with canakinumab, an interleukin-1ß antagonist, after receiving the varicella and measles-mumps-rubella (MMR) vaccines.

Objective: Vitiligo is a dermatological autoimmune condition characterized by areas of progressive skin depigmentation. Vitiligo lesions are cosmetically disfiguring and associated with significant psychological conditions such as depression and anxiety and comorbidities such as thyroid disease and diabetes. All races, ethnicities, ages, and regions of the world are impacted by vitiligo, with a global prevalence of about 0.5-2%. Currently, there is no published information available on the prevalence of vitiligo in Puerto Rico. Our study's aim was to estimate the prevalence of vitiligo among patients attending the specialized clinic of dermatology at UPR School of Medicine in Puerto Rico and describe the distribution of cases by age and sex.

Methods: We performed a descriptive study to evaluate the patients attending the University of Puerto Rico School of Medicine Clinics from January 2017 to May 2022. Using ICD-10 code L80 and medical records, we identified 581 patients with vitiligo and their respective demographic data distributed by sex and age.

Results: Of the 581 vitiligo patients, 350 (60.2%) were women, and 231 (39.8%) were men. The median age in the vitiligo population was 33.5 years. Out of the studied sample, 30.2% were under the age of 18. Overall, there was an estimated prevalence of 5.2%.

Conclusion: We report a vitiligo prevalence of 5.2% in a specialized clinic in Puerto Rico, suggesting further studies are necessary to discover possible underlying factors contributing to this increased prevalence.