Puerto Rico health sciences journal最新文献

Objective: Puerto Rico has had an alarming increase in opioid distribution, overdose, and opioid-related deaths in the last 2 decades. It is crucial to analyze both the effects of naloxone on mortality in opioidoverdose cases and the current trends in naloxone administration to implement strategies to reduce deaths from opioid-related overdoses.

Methods: This retrospective study analyzed opioid overdoses and naloxone administration in Puerto Rico from 2019 to 2023. The data was obtained from the Puerto Rico Mental Health and Anti-Addiction Services Administration and included findings on the spatial and temporal patterns of naloxone administration and a demographic description of the affected populations. Additionally, the study provided an overview of naloxone's role in fatality reduction in cases of opioid overdose.

Results: The key findings indicate a higher prevalence of naloxone administration in public spaces, with peaks occurring during afternoon hours; middle-aged men were the predominant group experiencing opioid overdoses. Additionally, the results demonstrated significantly higher mortality among individuals who did not receive naloxone. Those who received a single dose had a survival rate of 76%, compared to 56% for those who received no naloxone. Furthermore, individuals who received multiple doses of naloxone had an even higher probability of survival.

Conclusion: The findings present an effective approach to enhance the targeted geographic distribution of naloxone. Our findings indicated that increasing access to naloxone and strengthening overall community engagement could contribute to mitigating the ongoing public health crisis in Puerto Rico.

Objective: To estimate the prevalence of skeletal anteroposterior malocclusions and their associated components in orthodontic patients living in Puerto Rico.

Methods: A cross-sectional study was conducted with 50 normodivergent patients (cervical vertebral maturation stages 4-6) from the Orthodontic Graduate Program (2012-2014) of the University of Puerto Rico, Medical Sciences Campus. A calibrated examiner obtained five measurements (Frankfort Horizontal-Sella-Nasion, Sella-Nasion-Gonion-Gnathion, Sella-Nasion-A point, Sella-Nasion-B point, and A point-Nasion-B point) from patients' initial cephalometric x-rays using Dolphin Imaging software, version 11.7, to determine the presence and distribution of skeletal jaw discrepancies. Sex-based differences were explored using the Mann-Whitney and Fisher's exact tests. P < .05 was considered statistically significant.

Results: The prevalence of skeletal discrepancies was 78%. The most common skeletal malocclusion was Class II (54%), followed by Class I (34%) and Class III (12%). Class II malocclusions were associated with maxillary prognathism (59%), whereas Class III malocclusions were attributed to mandibular prognathism (83%). Most Class I patients did not present a discrepancy (65%); however, we observed bimaxillary prognathism in 24% of Class I patients, and a low position of Sella was detected in 54% of the sample. No significant sex-based differences were observed in the five cephalometric x-ray measurements (P > .05).

Conclusion: A high percentage of patients presented with a skeletal malocclusion. Class II skeletal malocclusions due to maxillary prognathism predominated; no sex-based differences were found for skeletal jaw discrepancies; a low Sella position was frequently observed.

This report presents the case of an 86-year-old man with chronic obstructive pulmonary disease (COPD) managed since 2018 with inhaled corticosteroids, long-acting muscarinic antagonists, long-acting beta-agonists, and roflumilast. He was admitted to the medical intensive-care unit with acute respiratory failure due to severe pneumonia. Imaging revealed left lower lobe consolidation. Despite treatment with piperacillin/tazobactam and methylprednisolone, his condition worsened, necessitating bronchoscopy. Sputum samples identified Nocardia species, confirming pulmonary nocardiosis, and he was started on trimethoprim-sulfamethoxazole (TMP-SMX) therapy. The case highlights the risks associated with long-term corticosteroid use in COPD patients, which may predispose them to opportunistic infections such as nocardiosis. The patient's severe COPD and potential macrophage dysfunction likely contributed to the development of nocardiosis This case underscores the importance of the early recognition and appropriate treatment of pulmonary nocardiosis to reduce associated morbidity. Bronchoscopy is crucial for diagnosing difficult-to-culture organisms in patients unresponsive to standard treatment, and gene sequencing offers promise for rapid, accurate detection. The patient showed clinical improvement with TMP-SMX therapy, with follow-up imaging indicating partial resolution. Continued outpatient care is scheduled, emphasizing vigilance in managing high-risk COPD patients, particularly in tropical regions such as Puerto Rico.

Objective: The fecal immunochemical test (FIT) is indicated for colon cancer screening in asymptomatic average-risk patients. However, the inclusion of orders for non-indication-based FITs in medical records has led to increased inappropriate use in emergency department (ED) and inpatient settings. This study aimed to evaluate the clinical impact of FIT results when the test is used for purposes other than routine screening.

Methods: We conducted a single-center, retrospective chart review using electronic medical records, analyzing patients who underwent the FIT in the ED or while admitted to the VA Hospital from September 2013 through December 2016. The collected data included demographics; clinical symptoms and signs; medications; and information on digital rectal examinations, gastroenterology consultations, and endoscopic procedures.

Results: Of the 1,354 patients included, most were men. Among FIT-positive patients, the mean age was 73.7 years. The majority of FITs were done in the ED. Positive FIT results were statistically significantly associated with rectal bleeding, weakness, and diarrhea. Anticoagulants were associated with positive FIT results. Patients with positive tests often received gastroenterology consultations and were more likely to undergo endoscopic procedures.

Conclusion: None of the evaluated FITs were used for screening, confirming that they had been ordered inappropriately. This indiscriminate use can lead to unnecessary interventions and prolonged hospitalizations. Additionally, negative tests may lead to underestimate worrisome symptoms or features that require further investigation. In conclusion, our study does not support the indiscriminate use of the FIT in inpatient or ED settings.

Objective: The history of the University of Puerto Rico (UPR) Surgical Research Laboratory was reviewed from its founding in 1952, by Dr. Francisco Raffucci, to the present.

Methods: The information for this overview was obtained from the annual reports written by the surgical laboratory directors. Interviews with surgeons who worked in the early facilities, and published works, provided the early history for which no annual reports were available.

Results: The history of the laboratory begins at the former School of Tropical Medicine, under the direction of Dr. Francisco Raffucci (1952-1964). The laboratory was housed in a small building on the school grounds. Research in cardiovascular surgery, shock and transplantation was performed and published. The facility was later moved to a wooden building at the Medical Center, a medical complex in San Juan, Puerto Rico and was directed by Dr. Leovigildo Cuello (1964-1967), followed by Dr. Gerhart Ramírez Schon (1969-1972). Under Dr. Eduardo Santiago-Delpín (1972-1977) the laboratory was moved to the tenth floor of the UPR School of Medicine. Subsequent directors of the laboratory at the school of medicine were Dr. Pedro Roselló (1977-1983), Dr. Norma Cruz (1983-2004), Dr. Manuel Más (2000-2015), Dr. Aura Delgado (2015-2017), Dr. Enrique Márquez (2017-2018) and Dr. Anwar Abdul-Hadi (2018-2024), who still leads the laboratory. Currently, the facility is used in collaboration with equipment manufacturers as a surgical simulation center and on various research.

Conclusion: The Surgical Research Laboratory continues training surgeons to use new surgical devices and supporting research projects.

Clinicians have a greater impact in academia when they demonstrate mastery in both clinical and research domains. However, planning a research project and writing a manuscript are among the most intimidating and difficult activities for the clinical faculty. This manuscript aimed to provide a thoughtful and informative description of the fundamental elements of research and essential writing guidelines of a scientific paper. This document was created using personal experiences and literature guides related to research and scientific writing. The article provided stepwise guidelines and pearls to help the clinical faculty, residents, and medical students improve their research and writing skills. This manuscript outlines the essential steps of research and scientific writing. It provides an informative introduction to the fundamental elements of scientific writing guidelines. This initiative is expected to enhance the faculty's research and writing abilities. At the same time, the information should benefit the residents and medical students with their research projects.

Objective: This study aimed to understand the visual and medical characteristics and their associated social determinants of health in Hispanic older adults in Puerto Rico attending senior centers. It provides essential information on visual impairment and factors that can contribute to older adults' well-being.

Methods: A cross-sectional study of individuals attending 16 senior centers in the island's metropolitan area was performed. Information on demographic, medical, visual, and social determinants was gathered. On-site visual screening, including visual acuity and refraction, was performed. Visual impairment was defined as a best-corrected visual acuity worse than 20/40 (>0.30 logMAR) in the better-seeing eye.

Results: A total of 304 participants were included. The mean age was 72.9 ± 9.1 years, with 37.8% being male and 62.2% female. Most of the participants lived alone, had not completed 12th grade, and lived below the poverty line. The average number of chronic conditions was 3.04 ± 1.78. Participants used an average of 4.07 ± 3.1 prescribed medications and 1.16 ± 1.45 over-the-counter. The mean presenting uncorrected visual acuity was 0.5 ± 0.46 logMAR, and the best corrected visual acuity was 0.26 ± 0.44 logMAR. The mean difference in best-corrected visual acuity showed a significant improvement of 0.03 ± 0.32 logMAR. Of the participants, 29.9% had visual impairment, with cataracts the most common self-reported cause (16.5%).

Conclusion: These findings highlight the need for interventions and prevention to reduce visual impairment in Puerto Rico's older population. Comprehensive healthcare for the elderly is critical to improving the island's overall health outcomes.

Objective: The objective of this article is to address the lack of data on self-reported postpartum depression among women in Puerto Rico with a live birth.

Methods: We examined data from the Puerto Rico Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire to evaluate self-reported postpartum depressive symptoms (SRPPDS) among women with a live birth.

Results: The prevalence of SRPPDS among women in Puerto Rico with a live birth was similar to that reported by other PRAMS sites. Overall, 9.67% of respondents reported having SRPPDS, and it did not vary by marital status, maternal age, maternal education, or income (P > .05). Risk factors that were significantly more prevalent among women who reported SRPPDS during the study period included 1) depression and anxiety before pregnancy, 2) depression and anxiety during pregnancy, and 3) smoking around the time of the interview, and 4) exposure to disaster-related stressors after Hurricane Maria.

Conclusion: Our findings show that women in Puerto Rico who had live births have similar rates of SRPPDS compared to those in other areas of the U.S.; however, specific risk factors for this population include exposure to disasters.

Objective: To describe food intake and overall diet quality during neoadjuvant concomitant chemotherapy and radiation therapy (nCRT) for rectal cancer. We also explored associations between Prime Diet Quality Score (PDQS) and short-chain fatty acid (SCFA) levels in stool at the end of nCRT in a subset of participants.

Methods: Thirty-two participants provided a 24-hour dietary recall, while 18 provided stool samples for SCFA analysis.

Results: The reported intake of 11 healthy food groups (e.g., dark green vegetables, fish) was low (<50% of participants) before treatment, while 4 unhealthy food groups (e.g., processed meat, sugar-sweetened beverages) were high (>50%), both before and after treatment. Higher propionate levels were associated with higher PDQS values.

Conclusion: Participants reported reduced dietary intake and diet quality during nCRT. Additional study is warranted to determine whether gut metabolites may mediate the impact of low diet quality.

Objective: This study aimed to investigate the leading causes of visual impairment (VI) and blindness in a low vision clinic from Puerto Rico and to assess the distribution of low-vision devices and rehabilitation approaches prescribed to patients.

Methods: A retrospective cross-sectional health record study of patients evaluated at the Low Vision Clinic from the Interamerican University of Puerto Rico School of Optometry Eye Institute between 2007 and 2024 was performed. Subjects considered had a comprehensive visual examination followed by a low vision evaluation. Ocular history, causes of visual loss, best-corrected visual acuity, and non-conventional optical devices prescribed were recorded. VI and blindness were classified according to the United States' definitions.

Results: A total of 270 records of subjects older than four years of age were included. The most prevalent causes of VI and blindness were retinal dystrophy (14.8%), diabetic retinopathy (13.7%), and albinism (13.0%). The most common causes of VI by age group were albinism in the pediatric group (42.2%), retinal dystrophy in adults (24.0%), and cataracts (25.8) in the geriatric population. The predominant VI classification was moderate VI for 37.0%. The closed caption television system was the most common low-vision device prescribed to subjects (19.3%).

Conclusion: This study provided insights into the causes of VI and blindness in Puerto Rico. These findings underscore the need for targeted interventions and public health initiatives to improve accessibility to visual rehabilitation. Further research is warranted to explore additional factors influencing access to care and evaluate the effectiveness of interventions addressing VI in Puerto Rico.