Boletin de la Asociacion Medica de Puerto Rico最新文献

{"title":"ST Elevations and Elevated Cardiac Enzymes Not Always a STEMI: Two Case Reports.","authors":"Juan Fernández Fernández,&nbsp;Claudia Deliz-Guzmán,&nbsp;César Andino-Colón,&nbsp;Héctor Claudio-Hernández,&nbsp;Nannette Lugo-Amador","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Chest pain is a common complaint in the emergency department (ED). Besides\u0000a careful history and physical exam; electrocardiogram, laboratory\u0000tests and imaging studies are widely available diagnostic tests that are used\u0000for patient assessment. When ST elevation and elevated cardiac enzymes\u0000are present the most likely diagnosis are ST elevation myocardial infarction\u0000(STEMI) or myocarditis. In this case report we present two low risk patients\u0000for major adverse cardiac event with ST elevation and elevated cardiac enzymes\u0000and how a careful risk assessment and detailed electrocardiogram evaluation\u0000could help differentiating between these two diagnoses.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 2","pages":"47-50"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35276773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Síndrome de Wünderlich Secundario a Fistula Arteriovenosa Postraumática: Reporte de caso.","authors":"Willem Calderon-Miranda,&nbsp;Erick Villa-Mejia,&nbsp;Luis Rafael Moscote-Salazar,&nbsp;Nidia Escobar","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 2","pages":"85-7"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35282401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compliance with management guidelines in patients with suspected dengue.","authors":"Tamara López-Díaz,&nbsp;Felipe Lugo,&nbsp;Jorge M Rodríguez,&nbsp;Elbio Sabao,&nbsp;Karen Sierra,&nbsp;Yoan Valdés,&nbsp;Jorge Vera","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Dengue is an endemic disease in Puerto Rico, with three to nine thousand\u0000suspected dengue cases reported yearly. In PR, physicians are required to maintain\u0000medical education courses about dengue in order to recertify their medical\u0000licenses. The purpose of this study was to describe characteristics of patients\u0000admitted to Bella Vista Hospital with suspected dengue and estimate the\u0000compliance with guidelines established by the CDC documented in medical records.\u0000A total of 197 medical records of patients admitted with diagnosis of suspected\u0000dengue during January 1, 2013 through December 31, 2013 were reviewed.\u0000The annual distribution of admitted cases showed a higher incidence\u0000during the months of June through September, with August having the higher\u0000incidence of all. Combined aches and pains were most commonly reported at\u0000admission with a prevalence of 82%. In general there was a low prevalence of\u0000severe disease as per definition at presentation (DM, clinical fluid accumulation,\u0000hepatomegaly, pregnancy and/or renal insufficiency). Overall, compliance\u0000with CDC established guidelines were only partially followed. The guideline\u0000that was followed more frequently was a daily CBC, with 95% of patients\u0000having this as part of their management. Prevalence of administration of\u0000isotonic intravenous fluids was 63%, monitoring of vital signs was 48%),\u0000and administration of bolus of intravenous fluid was11%. No fatalities were\u0000reported during the period.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 1","pages":"53-56"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35211921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pheochromocytoma in pregnancy: A case Report.","authors":"Milliette Alvarado,&nbsp;Margarita Ramirez-Vick,&nbsp;Myriam Allende-Vigo,&nbsp;William Mendez-Latalladi,&nbsp;Marielba Agosto,&nbsp;Rafael Gonzalez,&nbsp;Meliza Martinez,&nbsp;Monica Vega,&nbsp;Mara Fernandez,&nbsp;Roman Velez,&nbsp;Keimari Méndez","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This is the case of a 38 year-old female patient with an intrauterine pregnancy,\u0000in which a previous incidentally identified adrenal mass proved to be a\u0000pheochromocytoma during the antenatal period. The patient was started on\u0000α-and β-adrenergic blockade to maintain hemodynamic stability, and surgical\u0000removal of the lesion was performed during the second trimester without major\u0000complications. In view of the rarity of this disorder in pregnancy, it is imperative\u0000to have a high index of suspicion for a prompt and dedicated management,\u0000since this tumor, if unrecognized, is associated with high fetal and maternal\u0000mortality.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 1","pages":"95-98"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35300060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary Resistance to dopamine agonist after thirteen months of successful treatment in a 42 years old man.","authors":"Iván E Laboy-Ortiz,&nbsp;Sharon Velez-Maymí,&nbsp;José Hernán Martínez,&nbsp;Rafael Trinidad,&nbsp;Michelle Mangual,&nbsp;Alfredo Sanchez,&nbsp;Madeline Gutierrez,&nbsp;Paola Mansilla,&nbsp;Carmen Rivera,&nbsp;Coromoto Palermo,&nbsp;María de Lourdes Miranda,&nbsp;Ricardo Brau","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Prolactinomas are the most common hormone-secreting pituitary tumors\u0000and represents approximately 40% of all pituitary adenomas. Pharmacology\u0000therapy with dopamine agonists is the mainstay treatment for prolactinomas.\u0000Usually, patients respond to these drugs with decreased level of the serum\u0000prolactin and with time, by tumor shrinkage. Less than 10% of patients\u0000with prolactinomas exhibit resistance to the action of dopamine agonists, as\u0000defined by the lack of normalization of the serum prolactin levels despite long-\u0000term treatment at high doses of these drugs. However secondary resistance\u0000to dopamine agonists therapy has also been described in patients who were\u0000initially responsive to treatment, either with Cabergoline or Bromocriptine\u0000but later develop dopamine agonist resistance, with elevated prolactin levels\u0000and sometimes an enlarging tumor volume several years afterwards. We\u0000report a case of a male patient with prolactinoma who developed drug resistance\u000013 months after initial dopamine agonist therapy.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 1","pages":"31-36"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35300061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Challenges and Management in a case of Jarcho-Levin Syndrome with a Neural Tube Defect in a Newborn.","authors":"Cengiz Kaya,&nbsp;Halil Cebeci","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Jarcho-Levin syndrome (JLS) is a rare axial skeletal growth disorder characterized by the presence of multi-level costovertebral malformations, a short neck, a short trunk, and kyphoscoliosis at birth. Neural tube defects appear to be common findings in patients with JLS, and chest hypoplasia frequently leads to respiratory insufficiency and death in early childhood. There have been no previous studies in the literature on the anesthetic management of JLS with neural tube defects and hydrocephalus. Therefore, we have reported a case of JLS in a female full-term newborn, who underwent surgery for myelomeningocele repair and ventriculoperitoneal shunting, with the associated anesthetic challenges and their management.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 2","pages":"17-20"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35629779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of pediatric bone fractures across age groups: Analysis of a pediatric population at an outpatient clinic in the Southwest region of Puerto Rico.","authors":"Jose Ortiz-Fullana,&nbsp;Pablo Valentín,&nbsp;Norman Ramírez","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Background: Gender disparities in pediatric fracture events has been\u0000well-documented however, less is known about \u0000racial disparities. The aim of this study is to investigate the epidemiology of\u0000pediatric bone fractures in a Hispanic population.</p><p><strong>Methods: </strong>This is a retrospective cross-sectional analysis of patient’s records from a\u0000Pediatric Orthopeadic outpatient clinic in the Southwest region of Puerto Rico\u0000during a 1-year span (August 2014 – August 2015). Differences in sex, BMI,\u0000health insurance coverage, parental educational level and employment status,\u0000mechanism of fracture, fracture site, and seasonality were investigated among\u0000three age classes (pre-school children, school children and adolescents).</p><p><strong>Results: </strong>The sample consited of 243 subjects (0-21 y/o) sustaining a fracture of\u0000any extremity within the study period. Boys were at a higher risk of having a\u0000fracture event and as age increased, the male/female ratio also increased. The\u0000mean BMI was 18.0 kg/m2, with the highest in the school children age group\u0000(20.3 kg/m2). Slighlty more than half of the subjects (55.7%) benefitted from\u0000public health insurance coverage. The typical father was a laborer with a high\u0000school diploma, while the mother had a high school diploma but was unemployed\u0000There was a tendency for the children to suffer a bone fracture while\u0000at school (49.4%), followed by fractures at home (34.6%). In both the pre-school\u0000and school children groups, the upper extremity was more frequently involved\u0000(66.7% and 63.9%, respectively) in fracture events. Finally, there was very little\u0000variation in the seasonality of fracture events.</p><p><strong>Conclusion: </strong>This study provided valuable epidemiological information about\u0000pediatric bone fractures within a Hispanic population. It may contribute to\u0000the development and implementation of educational and preventive strategies\u0000appropriate to age and sex-differences.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 2","pages":"51-6"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35634541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Heart Thrombus in Transit: Unusual Echocardiographic Finding in a patient with Acute Pulmonary Embolism.","authors":"Sonia I Vicenty-Rivera,&nbsp;Ricardo Perez-Feliciano,&nbsp;Carla P Rodriguez-Monserrate,&nbsp;Gabriela Montes-Rivera,,&nbsp;Oscar Nevarez-Pomales","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Eighty year old male patient with heart failure preserved ejection fraction (EF),\u0000Obstructive sleep apnea, peripherovascular disease admitted with increasing\u0000shortness of breath and found with pulmonary emboli. Baseline 2D-echocardiogram\u0000performed demonstrated preserved ejection fraction and a right\u0000thrombus in transit. Anticoagulation with weight based-low molecular\u0000weight heparin was given for six days. Follow-up echo performed demonstrated\u0000complete dissolution of right heart thrombi. Since there was complete dissolution\u0000of thrombi seen on right atrium, anticoagulation with Rivaroxaban was given instead.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 2","pages":"43-6"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35636285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Institutionalization and Professionalization of the\u0000Medical Library in Puerto Rico: The Conrad F. Asenjo \u0000Library’s Legacy.","authors":"C M Santos-Corrada","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The discourse about health in Puerto Rico has been constructed using the\u0000physician and hospital’s perspective or a particular disease or epidemic. Thus\u0000far, this approach has not addressed the health library as an object of study. The\u0000origins and development of the Conrado F. Asenjo Library (CFAL) will be \u0000discussed. Before 1912, there were no medical libraries in Puerto Rico, only\u0000private collections. In 1914, the act that created the Institute of Tropical Medicine\u0000was amended to allocate funds for the purchase of books to support\u0000research in tropical diseases in Puerto Rico. The history of the CFA Library\u0000reflects its contribution to issues, concerns, development of research, and to the\u0000evolving paradigms in the health field in the Island. Historical documents,\u0000such as Bailey K. Ashford’s personal papers located at the CFAL and Georgetown\u0000University Archives (GU) were evaluated. Institutional reports from\u0000the School of Tropical Medicine (STM) and articles published by Puerto Rican\u0000physicians such as Dr. Pedro Gutiérrez Igaravídez and Dr. Isaac González\u0000Martínez, affiliated to the Institute of Tropical Medicine, were also studied.\u0000Finally, references and bibliographies in articles published between 1912 and\u00001924 were evaluated and consulted to find additional sources.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 2","pages":"5-10"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35274981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammation, Obesity and the Metabolic Syndrome. Implications in Hispanics.","authors":"José Marcial,&nbsp;Pablo I Altieri,&nbsp;Héctor L Banchs","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We report clinical and molecular mechanisms relating the process of\u0000inflammation involved in the progression of obesity and the metabolic syndrome,\u0000emphasizing the cardiovascular problems developed in Hispanic populations.\u0000Namely, the incidence, component characteristics and complications of obesity\u0000and metabolic syndrome in island Puerto Ricans are described and evidence is\u0000presented supporting the fact that the metabolic syndrome may be milder in\u0000Puerto Rico than in the mainland United States because it is characterized by\u0000less aggressive coronary artery disease and a relatively normal lipid profile.\u0000Moreover, data supports the fact that increased serum cholesterol levels produce\u0000less myocardial infarctions in Puerto Rico than in mainland Hispanics and\u0000Caucasians. In addition, the incidence of ventricular tachycardia, a complication\u0000caused by remodeling and ischemia of the heart, may be lower in Puerto Rico\u0000than in the United States, although the prevalence of the metabolic syndrome is\u0000higher in the island. On the other hand, there is evidence of a rising epidemic of\u0000obesity and vascular inflammation in Puerto Rico that suggests that cardiovascular\u0000morbidity and mortality in the island will continue to increase in the\u0000future decades.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 2","pages":"21-9"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35629780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}