Puerto Rico health sciences journal最新文献

Objective: Screening tests are recommended to identify genetic defects, chromosomal aneuploidies, and structural birth defects. Sonographic and maternal serum-based options are available for the risk assessment of aneuploidy in the first and/or second trimester. Also, invasive diagnostic methods, such as amniocentesis, are used for prenatal diagnosis, but these methods carry a tangible risk to the fetus. However, in recent years, circulating fetal nucleic acids have a promising moleculer tool in the noninvasive prenatal diagnosis of fetal chromosomal aneuploidies. In this study, we aimed to explore the usability of microRNAs (miRNAs) in this process of prenatal diagnosis.

Methods: Fourteen pregnant patients who were found to be carrying fetuses with congenital anomalies were designated as the patient group; 16 pregnant women identified as being at risk of carrying children with such anomalies-but whose fetuses were later found to be anomaly-free-were assigned to control group 1; and 13 pregnant women who had been screened and who had not been identified as being at risk made up control group 2. An analysis of miRNA expression, isolated from maternal plasma and amniotic fluid samples, was performed by quantitative real-time polymerase chain reaction.

Results: It was found that hsa-miR-629-5p, hsa-miR-320c, hsa-miR-21-5p, hsa-let-7c-5p, hsa-miR-98-5p, hsa-miR-486-5p, hsa-miR-4732-5p, and hsa-miR-181a-5p levels increased in the patient group's maternal plasma compared to that of the control group.

Conclusion: In light of these data, we believe that miRNAs may have an important role in the noninvasive prenatal diagnosis of fetal birth defects, especially Down syndrome.

Objective: In complicated parapneumonic effusion or Empyema, approximately 25% of patients require surgical intervention which can be associated with a mortality risk of almost 20%. However, the use combination of rt-tPA and DNase in elderly patients with prohibitive surgical risk has improved outcomes. The main goal of our study is to highlight the utility of intrapleural thrombolysis in patients with prohibitive risk for surgery.

Methods: A retrospective record review study of patients (n=23) with complicated parapneumonic pleural effusion or empyema treated with tPA and DNase from January 1st of 2015 to March 18th, 2019 at VACHCS. Data collected to describe the outcome of intrapleural thrombolytics included demographic, pleural fluid analysis, surgical risk assessment, diagnosis and initiation treatment day, doses, chest imaging, drainage rate, chest tube size and average days in place, inflammatory markers, microbiology, antibiotics, and complications.

Results: Only 21.7% of patients were considered surgical candidates. Seventy-four percent had a 30-day post-surgical mortality risk of > 2.5% using the National Surgery Office (NSO) risk calculator. Post-operative inpatient stay was 99.7% and estimated post operative ICU stay average was >80%. Primary outcome (pleural drainage improvement) obtained in 73.9%. Most common serious complications included sepsis (52.2%) and nonserious was residual hydropneumothorax (47.8%).

Conclusion: This study demonstrates that administration of intrapleural thrombolytics through a percutaneous pleural catheter achieved successful drainage safely and without the need for surgical interventions in a selected group of advanced age, elderly patients with pleural infections who were deemed to be high surgical risk.

Objective: To evaluate IgG antibody levels against SARS-CoV-2 in non-infected vaccinated subjects among vaccine brand, sex, and age.

Methods: Abbott's AdviseDx SARS-CoV-2 IgG II immunoassay was used to measure IgG levels within 6-9 months after the second dose vaccination; level >50 AU/mL was classified as a positive test.

Results: Data of 183 non-infected vaccinated subjects was analyzed according to the vaccine brand, time after second vaccination, sex, and age. Bivariate analysis showed that receiving the Moderna brand vaccine, being female, and younger were associated with higher antibody levels, p<.001. Conversely, no differences were observed between the IgG antibody levels against SARS-CoV-2 and time after second vaccination (6-7 months as compared to 8-9 months), p=.49.

Conclusion: After six to nine months post-vaccination, receiving the Moderna vaccine, being female, and being younger were significantly associated to higher IgG antibody levels to SARS-CoV-2 in non-infected vaccinated subjects.

Objective: Hansen's disease (HD) is a chronic granulomatous infection endemic in the tropics. Its main clinical manifestations involve the cutaneous, nervous, and musculoskeletal systems. Leprosy reactions (LR) are systemic inflammatory and immune-mediated complications of HD. These include reversal reactions (RR), erythema nodosum leprosum (ENL), and Lucio phenomenon. These reactions significantly increase disease-related morbidity and disability. We aimed to determine the number and type of LR, their association to hosts' immune responses (Ridley Jopling classification), timing of development, and treatment of HD patients in Puerto Rico.

Methods: A retrospective medical record review was performed on 291 HD patients containing LR status data available from the Dermatology Service at the Hispanic Alliance for Clinical & Translational Research.

Results: Our data revealed that 83 (29%) patients developed LR, of which 31% had RR and 69% had ENL. Most LR were observed in patients in the lepromatous border (97%): Borderline lepromatous leprosy (BL) and Lepromatous Leprosy (LL). Most patients with RR and ENL had a single episode (83% and 62%, respectively), and those that received multi-drug therapy (MDT) had a reaction onset occurring most frequently within the first year of MDT and after the first year of MDT, respectively. Prednisone was the first line treatment used to manage both types of LR.

Conclusion: Most lepromatous reactions occur within the lepromatous border. ENL was the most common LR. Prompt recognition and management of these immunologic reactions is essential to prevent long term nerve function impairment.

Objective: Influenza affects 5-15% of the worldwide population and is responsible for 4-5 million cases and 250,000-500,000 deaths. Despite established recommendations, vaccination rates continue to be low. Our study aimed to identify barriers to influenza immunization and attitudes toward the vaccine among respiratory health care (HC) professionals in Puerto Rico.

Methods: We conducted an anonymous written survey that was handed out to 130 HC professionals, including physicians, nurses and respiratory therapists, who attended the Annual Respiratory Disease Congress held in San Juan, Puerto Rico, on August 2018.

Results: A total of 68 health care professionals participated in the study. Nearly 34% of participants reported never receiving influenza immunization themselves, 13% reported intermittent immunization, and 53% received immunizations yearly. Approximately 82% and 87% of the participants believed the influenza vaccine to be safe and effective, respectively. Sixty- five percent of respiratory therapists considered the vaccine effective, as compared to 94% of physicians and 100% of nurses and other HC professionals (p=0.023). Most of the participants (87%) recommended influenza immunization, although 38% of participants indicated being concerned about potential side effects of the vaccine. Knowledge of current clinical indications for influenza immunization for medical conditions varied from 59% for patients on systemic steroids to 94% for patients with diabetes mellitus.

Conclusion: This survey among respiratory HC professionals in Puerto Rico demonstrated barriers in knowledge about vaccination, its indications, and its safety. Addressing these barriers provides us with opportunities to improve influenza immunizations rates among HC workers and their patients.

Objective: Past studies have demonstrated that women with inflammatory bowel disease (IBD) have a higher risk of gynecological conditions than do women without it. We aimed to characterize the gynecological histories of Hispanic Women living in Puerto Rico with IBD.

Methods: We identified women, aged 21 to 55 years, with a confirmed IBD diagnosis and receiving follow-up care from the University of Puerto Rico IBD clinics from 2017 through 2020. A questionnaire was administered to acquire sociodemographics, family history, past medical history, IBD diagnosis, and gynecologic aspects.

Results: One hundred eighty-six women were recruited. Fifty-three (28%) patients had ulcerative colitis, while 133 (72%) had Crohn's disease. Fifty-six percent of all the participants had a chronic illness in addition to than their IBD. Seventy-four out of 186 patients reported having had at least 1 late period within the last 12 months. Fifty-three (28%) described their period patterns as irregular. Thirty-nine (21%) of the patients reported having been vaccinated against human papillomavirus (HPV), and 8 (4%) had been infected by it. Nine out of 186 (5%) patients reported suffering from infertility.

Conclusion: The results showed that our Hispanic patients (living in Puerto Rico) had a prevalence of irregular menstrual cycles that was similar to that observed in other populations. On the other hand, the presence of HPV, infertility, and cervical cancer were lower and the frequency of Papanicolaou smears performed higher than what has been seen in the continental United States, suggesting that this topic should be investigated in future studies.

Objective: To evaluate how the COVID-19 pandemic (declared in March 2020) affected our surgical workload.

Methods: Using the University of Puerto Rico Department of Surgery database, we evaluated the number of surgical cases and their characteristics for the years 2019 through 2021. The variables examined included age, sex, American Society of Anesthesiology classification, type of surgery (elective/emergency), whether the patient had been admitted or was an outpatient, and outcome.

Results: The total number of surgical cases decreased 30%, falling from 5,040 in 2019 to 3,564 in 2020, but then increasing about 10% to 3,935 in 2021. The number of elective surgery cases dropped 33%, going from 4,383 in 2019 to 2,924 in 2020. The number of emergency surgeries had a minor decrease of 16%, diminishing from 650 to 546 between 2019 and 2020, inclusive. Patients undergoing elective surgery during 2020 were found to be older, were more frequently men, and required inpatient admission more often. Three significant periods were identified and correlated to the number of surgical cases, the first being the COVID-19 lockdown (March 2020) and the second and third being the increases in infections caused by the Delta and Omicron variants of the virus (July 2021 and December 2021, respectively).

Conclusion: The COVID-19 pandemic resulted in a significant decrease in the number of surgical cases. Two years after the pandemic, we have not recovered and continue to have fewer surgical cases than we did in 2019.

Over the last years, pembrolizumab has been one of the checkpoint inhibitors that have revolutionized the management of unresectable malignancies given its successful rate of disease control. This drug has become part of the standard of care in several types of cancers, however, the side effects are an emerging concern for physicians managing patients with cancer. Immune mediated injury of these drugs can target virtually any organ. Liver injury is an important side effect of these drugs that can be life threatening and needs to be well recognized. Here we report a case of an 85-year-old male with medical history of stage 3 laryngeal carcinoma who presented with severe liver injury secondary to pembrolizumab.