Boletin de la Asociacion Medica de Puerto Rico最新文献_第6页

Endoscopic- Assisted Trephination approach for repair of Frontal Sinus posterior wall fracture in a Child. 内镜辅助下入路修复儿童额窦后壁骨折1例。

Boletin de la Asociacion Medica de Puerto Rico Pub Date : 2015-04-01

Luis A Tarrats, Carlos Torre-León, Gustavo Almodóvar, Juan C Portela

引用次数: 0

President's Message. 总统的消息。

Boletin de la Asociacion Medica de Puerto Rico Pub Date : 2015-04-01

Wanda G Velez Andújar

引用次数: 0

Knee avascular necrosis in HIV patient. HIV患者膝关节缺血性坏死。

Boletin de la Asociacion Medica de Puerto Rico Pub Date : 2015-04-01

Victor R Ortiz Declet, Antonio Soler Salas

引用次数: 0

Isolated Xanthoma Of The Sphenoid Sinus: A Rare Presentation. 孤立的蝶窦黄色瘤:一种罕见的表现。

Boletin de la Asociacion Medica de Puerto Rico Pub Date : 2015-04-01

引用次数: 0

Manatí Medical Center Sepsis Management Epidemiological Study. Manatí医疗中心败血症管理流行病学研究。

Boletin de la Asociacion Medica de Puerto Rico Pub Date : 2015-04-01

Tamara Morales Serrano, Shirley Ramos, Yanira Lara Gonzalez, Heileene Torres Colberg, Alexis Vera Quiñones, Roberto Miranda Santiago, Samuel Amill, Marielys Otero, Vielka Cintron, Martha Lissete Villarreal Morales

{"title":"Manatí Medical Center Sepsis Management Epidemiological Study.","authors":"Tamara Morales Serrano, Shirley Ramos, Yanira Lara Gonzalez, Heileene Torres Colberg, Alexis Vera Quiñones, Roberto Miranda Santiago, Samuel Amill, Marielys Otero, Vielka Cintron, Martha Lissete Villarreal Morales","doi":"","DOIUrl":"","url":null,"abstract":"Sepsis is the combination of infection and physiological changes known as the systemic inflammatory response syndrome. There have been improvements in mortality rates and outcomes of septic patients based on \"Surviving Sepsis Campaign\" guidelines. Current management of sepsis at our Institution follows no specific mandatory protocols. This study aimed to verify the incidence and outcome of sepsis in Manati Medical Center, Puerto Rico. An observational retrospective study was conducted. All the Emergency Department admissions from May 1/ to October 31/ 2013 were screened for sepsis per ICD-9 code. For all included patients, demographic and clinical data at ED admission were collected. During this period 8931 patients were admitted and 148 met criteria for sepsis and related conditions. The overall mortality rate was 43.91%. Mortality increased with age, from 10.52% among ≤ 44 years old to 68.75% in those ≥ 85 years old. The main infection sources were respiratory (32.66%) and urinary tract (24.62%). Mean age among non-survivors was 10.8 years higher than the survivor group (95% Cl 5.2-1 6.5, p < 0.05). Multivariate analysis showed an increased fatality rate associated to severity of sepsis (HR 1.33; 95% Cl; 1.03-1.72, p = 0.02) and the APACHE2 score (HR 1.05; 95% Cl, 1.01-1.09 p = 0.03). Our data suggests that sepsis is an important problem to consider. We strongly encourage an institutional standardized protocol to diminish the mortality impact. Our results will allow adequate preventive strategies to improve early diagnosis, mortality rates and outcomes of septic patients.","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"107 2","pages":"34-9"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34229702","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}

引用次数: 0

Case Report: Prothesis-patient mismatch after aortic valve replacement. 病例报告:主动脉瓣置换术后假体与患者不匹配。

Boletin de la Asociacion Medica de Puerto Rico Pub Date : 2015-04-01

Luis Rodriguez-Ospina, Juan Garcia-Morell, Carla P Rodriguez-Monserrate, Julio Valentin-Nieves

{"title":"Case Report: Prothesis-patient mismatch after aortic valve replacement.","authors":"Luis Rodriguez-Ospina, Juan Garcia-Morell, Carla P Rodriguez-Monserrate, Julio Valentin-Nieves","doi":"","DOIUrl":"","url":null,"abstract":"Valve replacement is the standard surgical treatment of diseased valves that cannot be repaired. The main goal of replacement is to exchange the diseased valve with one that has the engineering and hemodynamics as close as possible to the disease free native valve. However due to mechanical and fluid dynamic constraints all prosthetic heart valves (PHVs) are smaller than normal and thus are inherently stenotic. This represents a challenge when it comes time to replace a valve. The correct valve with the correct and matching profile has to be selected before the procedure to avoid possible complications. It is well recognized that patients are also prone to patient-prosthesis mismatch at long term which could have consequences in the clinical outcomes (1). The evaluation of patient-prosthesis mismatch (PPM) has not been sufficiently emphasized in common practice. Failure to recognize this fact may lead to significant hemodynamic impairment and worsening of the clinical status over the time. Making efforts to identifying patients at risk may decrease the prevalence of PPM, the economic impact to our health system, the morbidity and mortality involved in these cases as well as creates efforts to standardized pre-operative protocols to minimized risk of PPM. We present a case of a 78 years old male patient who underwent aortic valve replacement due severe aortic stenosis, afterwards his clinical course got complicated with several admissions for shortness of breath and decompensated congestive heart failure (CHF).","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"107 2","pages":"40-3"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34229703","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}

引用次数: 0

Endoscopic Resection of a Posterior Nasal Septum Pleomorphic Adenoma. 内镜下后鼻中隔多形性腺瘤切除术。

Boletin de la Asociacion Medica de Puerto Rico Pub Date : 2015-04-01

Luis A Tarrats, Carlos Torre-León, Gustavo Almodóvar, Juan C Portela

引用次数: 0

Brugada Syndrome in Puerto Rico: a Case Series. 波多黎各的布鲁加达综合征:一个病例系列。

Boletin de la Asociacion Medica de Puerto Rico Pub Date : 2015-04-01

Héctor Banchs-Viñas, Norwin Rivera, Héctor Banchs-Pieretti, Pablo Altieri

引用次数: 0

23 y/o female with dysphagia--Evaluation, intervention and resolution of symptoms in the Psychiatry consultation setting. 23岁女性吞咽困难患者——精神病学咨询中症状的评估、干预和解决

Boletin de la Asociacion Medica de Puerto Rico Pub Date : 2015-04-01

Javier Santos-Cubiñá, Howard L Forman, María Fernanda Gomez, Mary Alice O'Dowd

引用次数: 0

Rapidly Progressive Seeding of a Community Acquired Pathogen in an Immune-competent Host--End Organ Damage from Head to Bone. 群落获得性病原体在具有免疫能力的宿主体内的快速渐进播种——从头部到骨骼的末端器官损伤。

Boletin de la Asociacion Medica de Puerto Rico Pub Date : 2015-04-01

Daisy Torres-Miranda, Farah Al-Saffar, Saif Ibrahim, Stephanie Font-Diaz

{"title":"Rapidly Progressive Seeding of a Community Acquired Pathogen in an Immune-competent Host--End Organ Damage from Head to Bone.","authors":"Daisy Torres-Miranda, Farah Al-Saffar, Saif Ibrahim, Stephanie Font-Diaz","doi":"","DOIUrl":"","url":null,"abstract":"This report describes a 64-years-old male patient that presented to our hospital with a chief complaint of acute worsening of his usual chronic lower back pain, progressive weakness in lower extremities and subjective fevers at home. Spine CT failed to demonstrate any infectious foci but showed partially visualized lung cavitary lesion and renal pole abnormalities. Blood cultures grew methicillin-sensitive Staphylococcus Aureus (MSSA). Transthoracic echocardiogram (TTE) showed no signs of infective endocarditis (IE). Later, the patient experienced an acute deterioration on clinical status and examination showed development of a new murmur. He also developed new hemiparesis with up-going babinski reflex. A head MRI showed multiple infarcts. MRI spine displayed osteomyelitis at T12-L1. Cerebro-spinal fluid was positive for meningitis. A transesophageal echocardiogram (TEE) was performed demonstrating new severe mitral and mild tricuspid regurgitations with a definitive 1.5 cm mobile vegetation on posterior mitral leaflet. We present is a very interesting case of a rapidly progressive MSSA infection. MSSA meningitis is a rare disease; there are only few reported cases in the literature to date. We describe a case of MSSA bacteremia, of questionable source, that resulted in MSSA endocarditis affecting right and left heart in a patient who did not have a history of intravenous drug use (IVDU) or immunosuppression. The case was complicated by septic emboli to systemic circulation involving the kidneys, vertebral spine (osteomyelitis), lungs and brain with consequent meningitis and stroke. Even when MSSA infections are well known, to our knowledge there are no previous case reports describing such an acute-simultaneous-manifestation of multi-end-organ failure, including meningitis and stroke. These latter are rarely reported, even individually.","PeriodicalId":75610,"journal":{"name":"Boletin de la Asociacion Medica de Puerto Rico","volume":"107 2","pages":"20-3"},"PeriodicalIF":0.0,"publicationDate":"2015-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34229697","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}

引用次数: 0