Boletin de la Asociacion Medica de Puerto Rico最新文献

{"title":"Bilateral Tibia Fibrous Dysplasia in a Pediatric Patient Treated with Intramedullary Nailing: A Case Report.","authors":"Emanuel Rivera Rosado,&nbsp;Eric Hernandez Ortiz,&nbsp;Christian Lopez Aponte,&nbsp;Pablo V Marrero Ortiz","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Fibrous dysplasia is benign developmental disorders of bone where normal\u0000lamellar cancellous bone is replaced with immature fibro-osseus tissue resulting\u0000in poorly formed trabeculae of immature woven bone. It may affect\u0000one (monostotic) or multiple bones (polyostotic). Polyostotic disease is less\u0000common, 20-25% of patients, mostly in children below 10 years old and\u0000tends to enlarge beyond bone maturation ration which can cause pain, progressive\u0000damage and higher tendency of pathological fractures.(1) We report\u0000a case of polyostotic fibrous dysplasia present on bilateral tibia diaphysis. Patient\u0000presented with bilateral leg pain on examination and imaging showed\u0000bilateral tibia lytic lesion. Management consisted of reaming and intramedullary\u0000nailing on bilateral tibia after which patient presented without pain\u0000and radiographs showing no evidence of lesion. Tibia x-rays demonstrated exuberant\u0000cortical intramedullary bone formation with disappearance of the\u0000scalloped osteolytic lesions on the inner wall of tibial cortex. Clinically the patient's\u0000symptoms disappeared giving the opportunity to return to contact sports\u0000without limitation.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 1","pages":"23-25"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35211104","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":"Rejection, Recurrence, or Something Else?","authors":"Felipe Vélez-González,&nbsp;Veroushka Ballester,&nbsp;Iván Antúnez,&nbsp;Rafael Pastranal,&nbsp;Esther A Torres,&nbsp;Carmen González-Keelan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Since the introduction of liver transplant as treatment for end-stage liver disease,\u0000thousands of lives have been saved. To prevent organ rejection, immunosuppression\u0000is given chronically and hence, patients are at increased risk for\u0000opportunistic infections related to immunosuppression, especially within the\u0000first year after the transplant. However, opportunistic infections can occur years\u0000after the transplantation. Disseminated nocardiosis is one of these infections,\u0000and although the common presentation includes involvement of skin, lungs, and\u0000central nervous system. We present an uncommon presentation of nocardiosis\u0000in which cholestasis and elevated liver enzymes predominate, mimicking organ\u0000rejection and liver disease recurrence. Infectious etiologies, including opportunistic\u0000microorganisms, must always be ruled out in patients presenting elevation\u0000in liver enzymes and cholestasis after liver transplant as early diagnosis can prevent\u0000complications such as re-transplantation and even death.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 2","pages":"39-41"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35276769","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":"Prevalence of Hypothyroidism and Its Association with Diabetes Mellitus in Patients of an Ambulatory Clinic.","authors":"Mariela Bernal,&nbsp;Eddy Escobar,&nbsp;Carmen E Rodríguez González","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Hypothyroidism is the most common thyroid disorder in the adult population.\u0000Studies have found a higher prevalence of overt hypothyroidism in type\u00002 diabetic population than in the general population, but the relationship\u0000between subclinical hypothyroidism and diabetes mellitus 2 is still controversial.\u0000The aim of this study is to estimate the prevalence rate of hypothyroidism in\u0000the adult population receiving services in an ambulatory clinic and to determine\u0000if there is an association between hypothyroidism and diabetes mellitus.\u0000From the database of all adult patients who attended the outpatient clinic at\u0000Family Medicine Center Policlínica Bella Vista in Mayagüez, P.R. during\u00002014, a random sample of 200 subjects was obtained and the medical records\u0000were reviewed. The prevalence rate of diabetes mellitus in this group was 22%\u0000and the prevalence rate of hypothyroidism was 17%. The prevalence rate\u0000of hypothyroidism in diabetic patients was 10/44 (22.7%). The prevalence\u0000rate of hypothyroidism in non-diabetic patients was 24/156 (15.4%). The prevalence\u0000ratio was 1.48 (95% CI: 0.77, 2.85; X2 = 1.31, p = 0.25). The results\u0000of this cross-sectional study showed a non-statistically significant tendency\u0000for a higher prevalence of hypothyroidism in diabetic patients, which suggest\u0000that screening for hypothyroidism among patients with diabetes should\u0000be considered. More studies with more patients are necessary to investigate the\u0000association between thyroid dysfunction and diabetic patients.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 2","pages":"31-4"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35275530","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":"Previous Exposure to Anesthesia and Autism Spectrum Disorder (ASD): A Puerto Rican Population-Based Sibling Cohort Study.","authors":"O Creagh,&nbsp;H Torres,&nbsp;K Rivera,&nbsp;M Morales-Franqui,&nbsp;G Altieri-Acevedo,&nbsp;D Warner","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Autism Spectrum Disorder (ASD) is characterized by impaired social interaction\u0000and communication, and by restricted and repetitive behavior, that begins\u0000usually before a child is three years\u0000old.(1) Researchers have shown that prevalence\u0000rates in the U.S. may be as high as 1 in 68.(52) A number of studies have\u0000examined the effects of early exposure to anesthesia on brain development and\u0000subsequent impairment in neurocognitive function; yet, little is known about\u0000the possible effects of anesthetic agents on social-behavioral functioning. The\u0000association between exposure to anesthesia either in uterus, during the first\u0000years of life, or later and development of Autistic Spectrum Disorder (ASD) or its\u0000severity was determined in a retrospective population based cohort study.</p><p><strong>Objectives: </strong>Identify if children who had previous exposure\u0000to anesthesia either in uterus, first years of life during their developing brain\u0000years, or later, are at risk of developing ASD and its severe form of the disease.</p><p><strong>Methods: </strong>Data was obtained from structured interviews administered to a sample of 515\u0000parents/guardians distributed in two groups: ASD = 262 children diagnosed\u0000with this condition and Non-ASD: 253 children (siblings of ASD group) without\u0000diagnosis (95% confidence interval) that freely decided to participate and agreed\u0000to a consent form. Variables studied include: demographics, diagnosis and\u0000severity of ASD, exposure to anesthesia, method of childbirth, and age of exposure\u0000Children less than 2 years of age were considered into have developing\u0000brain period. Data was analyzed using Chi-square or Fisher exact test.</p><p><strong>Results: </strong>In contrast to non-ASD group, most of the children within ASD group were\u0000male, 76% (p=0.0001). With regards to methods of childbirth, 64% of the ASD\u0000population were vaginal delivery (VD; Non-anesthesia exposure group) and\u000036% cesarean delivery (CD) compared to non-autistic population with 71%\u0000VD and 29% CD, which demonstrates no statistical difference between both\u0000groups (p=0.1113). Out of the 36% of ASD population that underwent CD,\u00007% were performed using general anesthesia and 93% regional anesthesia,\u0000while the 29% of the CD of non-ASD, 5% were performed using general anesthesia\u0000and 95% regional anesthesia. This reveals no statistical significance\u0000(p=0.7569) with the development of ASD and the type of anesthesia used\u0000when comparing ASD with non-ASD patients. In view of severity of autism, in\u0000VD, 56% of ASD population had mild form of the disorder, 34% moderate, and\u000010% severe; while CD had a 54% mild form of the disorder, 33% moderate, and\u000013% severe. This shows no statistical association (p=0.8069) when comparing\u0000exposure to anesthesia in uterus to subsequent severe form of ASD.\u0000Of the 262 ASD patients, 99 had exposure to anesthetics before their diagnosis,\u0000while in Non-ASD population, 110 had exposure to anesthesia, demonstrating\u0000no statist","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 2","pages":"73-80"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35282398","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":"Analysis of clinical characteristics of dialysis patients at the University Hospital.","authors":"Fátima B Cintrón Rosa,&nbsp;Elvin Soto Hernández,&nbsp;Anmelys Rivera Valentín,&nbsp;Héctor J Díaz Rodríguez,&nbsp;Jannice M Arroyo Soto,&nbsp;Ángel F Delgado Garrastegui,&nbsp;Ileana E Ocasio Meléndez,&nbsp;Enrique Ortiz Kidd,&nbsp;José L Cangiano","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>The incidence and prevalence of Chronic Kidney Disease (CKD)\u0000patients treated with dialysis has continued to increase worldwide. These patients\u0000are at the highest risk of developing cardiovascular complications which\u0000contribute to their demise. The objective of this study was to describe the clinical\u0000and demographic characteristics of the patients on maintenance hemodialysis\u0000at the University Hospital, in San Juan Puerto Rico.</p><p><strong>Methods: </strong>We reviewed a total of 55 active patients. Data was collected to\u0000identify the demographic and clinical characteristics. Co-morbid conditions\u0000such as diabetes mellitus, hypertension, and coronary artery disease (CAD)\u0000were noted as well as age, dialysis vintage and social and educational profiles.</p><p><strong>Results: </strong>Patients were divided into two groups according to age (group 1 were\u0000less than 60 years and group 2 were more than 60 years). Average age was 42 years\u0000in group 1 with 17 females and 24 males and 78 years in group 2 with 6 females\u0000and 8 males. Diabetes mellitus was present in 17 (41%) of group 1 and 5 patients\u0000(35%) of group 2. Likewise hypertension was present in 26 (63%) of group 1 patients\u0000and 11(78%) of group 2 patients. CAD was present in 15 (36%) of group 1\u0000patients and 7 (50%) of group 2 patients. There was an association between low\u0000annual income in both groups but not in the level of education.</p><p><strong>Conclusion: </strong>A relatively young population was identified in our descriptive\u0000analysis of hemodialysis patients at the University Hospital. The expected high\u0000incidence of diabetes mellitus observed in the general population of hemodialysis\u0000patients in our country was not present. Hypertension and CAD were\u0000major risk factors in these patients. In view of these findings we recommend\u0000better control of blood pressure, prevention and early detection of CAD in\u0000CKD patients before initiating dialysis.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 2","pages":"81-3"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35282400","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":"A Broken Heart: Takotsubo Cardiomyopathy.","authors":"Sonia Vicenty,&nbsp;Francés Aulet,&nbsp;Julio Valentín,&nbsp;Carla P Rodríguez,&nbsp;Viviana M Ortiz,&nbsp;Yvonne M Figueroa,&nbsp;María del M Ortega","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This case illustrates the unusual presentation of Takotsubo cardiomyopathy in\u0000an elderly male patient with characteristic chest pain and dyspnea associated\u0000with electrocardiographic changes of biphasic T wave inversions and QT-interval\u0000prolongation on anterior segment, mimicking acute coronary syndrome.\u0000Takotsubo cardiomyopathy is a transient systolic dysfunction of the apical\u0000and/or mid and anterior segments of left ventricle most frequently seen in post-\u0000menopausal women, up to 80 to 100% of cases. Often there is a history of a recent\u0000(within the previous two months) episode of severe emotional or physical\u0000stress associated with the event.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 1","pages":"27-30"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35211105","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":"Construcción y Validación de una Escala para Tamizar Ortorexia: Primer estudio piloto en Puerto Rico.","authors":"Teresa Carrero,&nbsp;Lymaries Padilla Cotto,&nbsp;José Rodríguez-Gómez","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 2","pages":"89-95"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35282403","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":"Clinical profile, bacterial isolates, and antibiotic resistance of corneal ulcers in Puerto Rico.","authors":"Pedro J Dávila,&nbsp;Maria Pilar-Fernandez,&nbsp;Jan P Ulloa-Padilla,&nbsp;Victor M Villegas,&nbsp;Vanessa Lopez,&nbsp;Lilia Rivera,&nbsp;Carmen A Santos,&nbsp;Luis A Santiago-Cabán","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 1","pages":"47-51"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35209483","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":"High Output Cardiac Failure in a Patient Presenting with Acute Myeloid Leukemia and Leukostasis.","authors":"Jeffrey Maldonado,&nbsp;Angel Lopez Candales","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In this case report a patient presents with high-output cardiac failure in the clinical\u0000setting of acute leukemia and leukostasis. Case particulars are presented, literature\u0000is reviewed and a potential mechanistic explanation is proposed to describe\u0000presentation and clinical findings.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 1","pages":"63-65"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35211923","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":"Klinefelter Syndrome (49, XXXXY/48, XXXY) associated with narrow angle glaucoma:\u0000A case report.","authors":"Ejan P Ulloa-Padilla,&nbsp;Pedro J Dávila,&nbsp;Natalio J Izquierdo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies have described Klinefelter syndrome as a genetic\u0000disorder characterized by at least one extra X chromosome and at least 47\u0000chromosomes. It is the most common sex chromosome aneuploidy among men.\u0000Patients may present with large height, gynecomastia, low testosterone levels,\u0000infertility, hypogonadism and diseases usually more common in females such\u0000as osteoporosis, breast cancer and auto-immune disorders. Other rare ophthalmic\u0000associations have been described, such as diffuse choroidal atrophy, microphtalmia,\u0000cataracts, juvenile glaucoma, choroid colobomas and goniodysgenesis.</p><p><strong>Objectives: </strong>To report on the ocular findings in a Puerto Rican patient with\u0000Klinefelter syndrome (XXXXY/XXXY). PATIENTS AND METHODS: A \u0000patient with Klinefelter syndrome with revious history of elevated intraocular\u0000pressure underwent a comprehensive ocular examination, Humphrey visual\u0000fields and Stratus optical coherence tomography (OCT) tests. Patient had \u0000inreased intraocular pressure, visual field loss and OCT findings compatible with\u0000glaucoma. After laser YAG laser iridotomies, high IOP persisted. Brimonidine\u00000.2 % drops three times a day drops were prescribed to lower IOP.</p><p><strong>Conclusions: </strong>A patient with Klinefelter syndrome had poor visual acuity, high \u0000intraocular pressure, visual fields and OCT results, all compatible with angle closure\u0000glaucoma as part of the syndrome.</p>","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"108 1","pages":"85-90"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35211928","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}