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    3711 results match your criteria Boletin de la Asociacion Medica de Puerto Rico[Journal]

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    Factors Associated to Invasive Fungal Infection in Hispanic Patients with Hematological Malignancies.
    Bol Asoc Med P R 2017 ;109(1):43-48
    Division of Infectious Diseases, Department of Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
    Fungal infections represent a serious complication for immunosuppressed patients resulting in an increased morbidity and mortality. A non-concurrent prospective study was performed to evaluate the factors associated to invasive fungal infection (IFI) in patients with hematological malignancies admitted to the University Hospital in San Juan, Puerto Rico from January 1, 2011 through June 15, 2014. The medical records of 84 patients were evaluated. Read More

    Difficult Diagnosis between B Cell Lymphoma and Classical Hodgkin's Lymphoma.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):98-101
    Although primary mediastinal large B-cell lymphoma and classic Hodgkin lymphoma of nodular sclerosis type are distinct disease, they share several clinical characteristics and biologic features. However, there are mediastinal lymphomas that not fit in either category. These types of lymphomas are recognized as mediastinal gray zone lymphomas. Read More

    Screening for Peripheral Arterial Disease.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):95-7
    Lower extremity peripheral artery disease is a manifestation of systemic atherosclerotic disease, which affects over 8 million Americans and conveys a significant health burden globally. Although PAD can be asymptomatic and subclinical, it is associated with a reduction in functional capacity and quality of life when symptomatic, and, in its most severe form, is a major cause of limb amputation. Peripheral arterial disease (PAD) commonly results from progressive narrowing of arteries in the lower extremities. Read More

    The Prevalence Of Sexually Transmitted Infections On Teen Pregnancies And Their Association To Adverse Pregnancy Outcomes.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):89-94
    Introduction: Based on our population data, the teen pregnancy rate and the prevalence of sexually transmitted infections (STIs) reported during pregnancy are worrisome. STIs appear to pose a threat to pregnancy outcomes including preterm birth (PTB), neonatal low birth weight (NLBW) and premature rupture of membranes (PROM). The objective of this study is to determine the prevalence of STIs in pregnant teens and the association of this variable to adverse pregnancy outcomes. Read More

    POEMS Syndrome: A Rare Disease With A Challenging Diagnosis.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):85-8
    A complex conglomerate of symptoms, signs, and abnormalities are present with POEMS syndrome, making the diagnosis, management and follow-up a challenge. Recognizing the disease early on may be difficult. Many patients are initially misdiagnosed as having others disorders, for example: multiple myeloma. Read More

    Epidemiology of Traumatic Peripheral Nerve Injuries Evaluated by Electrodiagnostic Studies in a Tertiary Care Hospital Clinic.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):79-84
    Objectives: Describe the etiology and frequency of traumatic peripheral nerve injuries (TPNI) in the electrodiagnostic laboratory of a tertiary care hospital.

    Methods: The charts of patients who underwent an electrodiagnostic study for a TPNI were revised. The main outcome measure was the frequency of each injury by anatomic location, involved nerve, mechanism, and severity. Read More

    Peripheral Arterial Disease: Surgical Treatment.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):75-8
    Peripheral arterial disease is a frequent under-diagnosed and poorly recognized clinical entity that can affect a great number of patients. Recognition of risk factors is crucial and a through evaluation of symptoms and use of diagnostic tools to better decide when an intervention is warranted. Lower extremity bypass surgery is one alternative method for treatment of PAD. Read More

    Obesity and premature coronary artery disease with myocardial infarction in Puerto Rican young adults.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):70-4
    A cross-sectional study examined adults aged 21 to 35 years who underwent left cardiac catheterization in the Cardiovascular Center for Puerto Rico and the Caribbean during 2008-2012 due to myocardial infarction. Demographic characteristics, clinical risk factors, and the extent of CAD were documented. Chi-square statistic or Fisher's exact test was used to compare the distribution of demographic, clinical, and lifestyle characteristics across CAD extent. Read More

    Metabolic Changes After Roux-N-Y Bariatric Surgery In Hispanics.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):66-9
    The objective was to describe the metabolic outcomes 12 months after bariatric surgery (Roux-N-Y) in morbidly obese Hispanic patients, and evaluate the correlation between weight loss and the observed changes. Medical records from a hundred-and-two Hispanic obese patients who underwent bariatric surgery were identified at the University of Puerto Rico (UPR) Hospital. The following variables were obtained before and 12 months after surgery: Body Mass Index (BMI), body weight, total cholesterol (TC), triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL), and fasting blood sugar (FBS). Read More

    [Achondroplasia: a pilot study on the psychosocial and medical features of a sample in Puerto Rico].
    Bol Asoc Med P R 2015 Jul-Sep;107(3):58-65
    This study explores the psychological wellbeing of twenty-two (n = 22) adults with achondroplasia. The sample was composed of seven (n = 7) males and fifteen (n = 15) females between the ages of 21 and 75 (mean age = 39.6). Read More

    Non-Invasive Therapy of Peripheral Arterial Disease.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):52-7
    Peripheral arterial disease (PAD) is a significant cause of morbidity and mortality worldwide. Lifestyle changes, like the cessation of the use of tobacco as well as a modification of dietary and exercise habits, can be the most cost-effective interventions in patients with PAD. Smocking cessation is the most important intervention, since it increases survival in these patients. Read More

    Endovascular Intervention in the Treatment of Peripheral Artery Disease.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):47-51
    Endovascular therapy has emerged as an essential part of the management we can offer patients suffering from peripheral arterial disease. The AHA/ACCF guidelines deemed ballon angioplasty as a reasonable alternative for patients with limb threatening lower extremity ischemia who are not candidates for an autologus venous graft. Endovascular treatment is most useful for the treatment of critical limb ischemia and should ensure adequate proximal flow before engaging in interventions of distal disease. Read More

    Diagnostic Studies for the Evaluation of Peripheral Artery Disease.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):42-5
    Atherosclerosis is a systemic disease that may affect multiple vascular territories including the coronary, cerebral and peripheral circulation. Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis and has an important impact on quality of life as well as morbidity in affected individuals. The diagnosis of PAD can be challenging and the clinician must know the different methods available and the limitations of each of them. Read More

    Metastatic Ovarian Tumor Masquerading as Atypical Pneumonia.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):38-41
    Krukenberg tumor is a malignancy in the ovary from a primary lesion in the gastrointestinal tract and a metastatic signet ring cell adenocarcinoma to the ovary. Stomach is the most common primary site, but other organs can serve as a primary site. The lymphatic system is the most likely route for metastasis. Read More

    Previous Exposure to Anesthesia and Autism Spectrum Disorder (ASD): A Puerto Rican Population-Based Sibling Cohort Study.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):29-37
    Background: Autism Spectrum Disorder (ASD) is characterized by impaired social interaction and communication, and by restricted and repetitive behavior, that begins usually before a child is three years old.1 Researchers have shown that prevalence rates in the U.S. Read More

    Usefulness Of Glucocorticoids In The Management Of Foreign Body Aspiration.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):24-7
    Foreign body aspiration can be a life-threatening emergency. An aspirated solid or semi-solid object may lodge in the larynx, trachea or other breathing airways. If the object is large enough to cause nearly complete obstruction of the airway, asphyxia may rapidly cause death. Read More

    The Racial, Cultural and Social Makeup of Hispanics as a potential Profile Risk for Intensifying the Need for Including this Ethnic Group in Clinical Trials.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):17-23
    Hypertension not only is the most frequently listed cause of death worldwide; but also a well-recognized major risk factor for cardiovascular disease and stroke. Based on the latest published statistics published by the American Heart Association, hypertension is very prevalent and found in one of every 3 US adults. Furthermore, data from NHANES 2007 to 2010 claims that almost 6% of US adults have undiagnosed hypertension. Read More

    Pleural Effusion In A Patient With Primary Sjögren's Syndrome Successfully Treated With Corticosteroids.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):13-6
    Sjögren's syndrome is a systemic autoimmune disorder characterized by salivary insufficiency and lymphocytic infiltration of the exocrine glands. Bronchiolitis and bronchiectasis are common airway manifestations but interstitial pneumonitis, and lymphocytic interstitial pneumonitis may also occur. It rarely presents with pleuritis. Read More

    A Hispanic female patient with heartburn: A rare presentation of Paroxysmal Nocturnal Hemoglobinuria.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):9-12
    Paroxysmal nocturnal hemoglobinuria (PNH) is a non-malignant, acquired clonal hematopoietic stem cell disease that can present with bone marrow failure, hemolytic anemia, smooth muscle dystonias, and thrombosis. We present a case of a 32 year-old-female, G2P2A0 with no past medical history of any systemic illnesses who refers approximately 2 months of progressively worsening constant heartburn with associated abdominal discomfort. CBC showed leukopenia (WBC 2. Read More

    Prevalence of Diabetes Mellitus in Human Immunodeficency Virus positive Patients in Puerto Rico--San Juan City Hospital Experience.
    Bol Asoc Med P R 2015 Jul-Sep;107(3):5-8
    Introduction: The total number of patients with Human Immunodeficiency Virus (HIV) is 33 million, with 2.7 million new infections in 2007(1). Puerto Rico has an increasing prevalence trend of Diabetes Mellitus of 12. Read More

    Secondary Resistance to dopamine agonist after thirteen months of successful treatment in a 42 years old man.
    Bol Asoc Med P R 2016 ;108(1):31-36
    Prolactinomas are the most common hormone-secreting pituitary tumors and represents approximately 40% of all pituitary adenomas. Pharmacology therapy with dopamine agonists is the mainstay treatment for prolactinomas. Usually, patients respond to these drugs with decreased level of the serum prolactin and with time, by tumor shrinkage. Read More

    Pheochromocytoma in pregnancy: A case Report.
    Bol Asoc Med P R 2016 ;108(1):95-98
    This is the case of a 38 year-old female patient with an intrauterine pregnancy, in which a previous incidentally identified adrenal mass proved to be a pheochromocytoma during the antenatal period. The patient was started on α-and β-adrenergic blockade to maintain hemodynamic stability, and surgical removal of the lesion was performed during the second trimester without major complications. In view of the rarity of this disorder in pregnancy, it is imperative to have a high index of suspicion for a prompt and dedicated management, since this tumor, if unrecognized, is associated with high fetal and maternal mortality. Read More

    Acute Shortening and re-lengthening in the management of open tibia fractures with severe bone of 14 CMS or more and extensive soft tissue loss.
    Bol Asoc Med P R 2016 ;108(1):91-94
    Introduction: A traumatic event to the tibia with more than 14 cm of bone and soft tissue loss represents a challenge to most orthopedic surgeons and is considered a limb-threatening condition. Few solutions are available in such clinical situations and among them is the acute shortening and re-lengthening of bone and soft tissue.

    Materials And Methods: Our study presents the management of 7 patients with grade III B open fractures (according to the Gustillo-Anderson classification) of the tibia who underwent resection of all the devitalized tissues, acute limb shortening to close the defect, application of an external fixator, and metaphyseal osteotomy for re-lengthening. Read More

    Klinefelter Syndrome (49, XXXXY/48, XXXY) associated with narrow angle glaucoma: A case report.
    Bol Asoc Med P R 2016 ;108(1):85-90
    Introduction: Previous studies have described Klinefelter syndrome as a genetic disorder characterized by at least one extra X chromosome and at least 47 chromosomes. It is the most common sex chromosome aneuploidy among men. Patients may present with large height, gynecomastia, low testosterone levels, infertility, hypogonadism and diseases usually more common in females such as osteoporosis, breast cancer and auto-immune disorders. Read More

    Isolated Rectus Femoris Muscle Tear in a Non-Athletic Patient: A Case Report.
    Bol Asoc Med P R 2016 ;108(1):81-83
    Quadriceps muscle injuries are common in athletes and middle age patients. Strains and tears of the distal portion of the muscle is the most common presentation of these injuries. Isolated rectus femoris tears are rare and few reports are published that evaluate outcomes in of nonsurgical treatment of these injuries. Read More

    Intradialytic Hypertension / Hypotension and Mortality in San Juan, Puerto Rico.
    Bol Asoc Med P R 2016 ;108(1):77-80
    End Stage Renal Disease patients undergo profound hemodynamic changes during hemodialysis treatments which are now recognized as a marker for increased risk of morbidity and mortality. Development of intradialytic hypotension or hypertension are a common clinical problem in this population with an incidence of up to 20%. We performed a retrospective review of 49 Hispanic patients receiving ambulatory hemodialysis during a period of 6 months to ascertain the development of aforementioned intradialytic events. Read More


    An Isolated Gluteus Minimus Tendon Tear with Stress Fracture of the Iliac Wing in a Marathon Runner: A case report.
    Bol Asoc Med P R 2016 ;108(1):67-70
    Stress fractures and muscle strains are common in marathon runners. Most stress fractures occur in lower extremities and tibia stress fractures comprise almost half. Iliac wing stress fractures are not commonly found in runners and are usually related to osteoporosis. Read More

    High Output Cardiac Failure in a Patient Presenting with Acute Myeloid Leukemia and Leukostasis.
    Bol Asoc Med P R 2016 ;108(1):63-65
    In this case report a patient presents with high-output cardiac failure in the clinical setting of acute leukemia and leukostasis. Case particulars are presented, literature is reviewed and a potential mechanistic explanation is proposed to describe presentation and clinical findings. Read More

    Diabetes Treatment Satisfaction Questionnaire (DTSQ) of in non-ambulatory type 2 diabetic patients.
    Bol Asoc Med P R 2016 ;108(1):57-62
    Objectives: The aim of this work is to determine the diabetes treatment satisfaction in a group of hospitalized patients with type 2 diabetes.

    Methods: observational cross research. Patients over the age of 18 with diagnosed type 2 diabetes of at least one year until the present study were included. Read More

    Compliance with management guidelines in patients with suspected dengue.
    Bol Asoc Med P R 2016 ;108(1):53-56
    Dengue is an endemic disease in Puerto Rico, with three to nine thousand suspected dengue cases reported yearly. In PR, physicians are required to maintain medical education courses about dengue in order to recertify their medical licenses. The purpose of this study was to describe characteristics of patients admitted to Bella Vista Hospital with suspected dengue and estimate the compliance with guidelines established by the CDC documented in medical records. Read More

    Choledochal Cyst: Hepaticoduodenostomy or hepaticojejunostomy?
    Bol Asoc Med P R 2016 ;108(1):41-46
    Choledochal cysts are cystic dilatation of the common bile duct managed by excision and hepatico-intestinal reconstruction. The gold standard after choledochal cyst excision is reconstruction using the jejunum. With the advent of laparoscopy the pendulum has changed toward hepaticoduodenostomy reconstruction. Read More

    Secondary Resistance to dopamine agonist after thirteen months of successful treatment in a 42 years old man.
    Bol Asoc Med P R 2016 ;108(10066):29-34
    Prolactinomas are the most common hormone-secreting pituitary tumors and represents approximately 40% of all pituitary adenomas. Pharmacology therapy with dopamine agonists is the mainstay treatment for prolactinomas Usually, patients respond to these drugs with decreased level of the serum prolactin and with time, by tumor shrinkage. Less than 10% of patients with prolactinomas exhibit resistance to the action of dopamine agonists, as defined by the lack of normalization of the serum prolactin levels despite long- term treatment at high doses of these drugs. Read More

    A Broken Heart: Takotsubo Cardiomyopathy.
    Bol Asoc Med P R 2016 ;108(1):27-30
    This case illustrates the unusual presentation of Takotsubo cardiomyopathy in an elderly male patient with characteristic chest pain and dyspnea associated with electrocardiographic changes of biphasic T wave inversions and QT-interval prolongation on anterior segment, mimicking acute coronary syndrome. Takotsubo cardiomyopathy is a transient systolic dysfunction of the apical and/or mid and anterior segments of left ventricle most frequently seen in post- menopausal women, up to 80 to 100% of cases. Often there is a history of a recent (within the previous two months) episode of severe emotional or physical stress associated with the event. Read More

    Bilateral Tibia Fibrous Dysplasia in a Pediatric Patient Treated with Intramedullary Nailing: A Case Report.
    Bol Asoc Med P R 2016 ;108(1):23-25
    Fibrous dysplasia is benign developmental disorders of bone where normal lamellar cancellous bone is replaced with immature fibro-osseus tissue resulting in poorly formed trabeculae of immature woven bone. It may affect one (monostotic) or multiple bones (polyostotic). Polyostotic disease is less common, 20-25% of patients, mostly in children below 10 years old and tends to enlarge beyond bone maturation ration which can cause pain, progressive damage and higher tendency of pathological fractures. Read More

    Association between fine needle aspiration cytology and final pathology in the diagnosis of thyroid nodules with surgical indications.
    Bol Asoc Med P R 2016 ;108(1):13-18
    Fine needle aspiration of thyroid (FNA) is broadly used as the preferred preoperatory test to evaluate thyroid nodules. The clinical importance of this procedure is primarily related the need to exclude Thyroid Cancer. There are few studies investigating the association between FNA and final pathology in patients with thyroid nodules with surgical indications. Read More

    Adequate Administration of Perioperative Antibiotics in Orthopedic Patients: Quality Assessment Study.
    Bol Asoc Med P R 2016 ;108(1):9-11
    The Centers for Disease Control and Prevention (CDC) estimate that nearly 500,000 surgical site infections (SSIs) occur annually.[3] SSIs remain a substantial cause of morbidity and mortality among hospitalized patients. For this reason, we developed a quality assessment study with a perioperative antibiotic protocol that included antibiotic type, weight dependent dose, and intraoperative re-dosing regime for the proper administration of prophylaxis antibiotics prior to orthopedic surgery. Read More

    A middle aged woman with isolated ACTH deficiency associated with transient growth hormone deficiency.
    Bol Asoc Med P R 2016 ;108(1):5-8
    Isolated ACTH deficiency (IAD) is a rare entity characterized by secondary adrenal insufficiency with low levels of serum cortisol, decreased production of ACTH, adequate secretion of other pituitary hormones and normal pituitary structure on radioimaging. The prevalence of IAD as a cause of secondary adrenal insufficiency has not been determined. Impairment of growth hormone (GH) secretion has been noted in 20 to 30% of patients with IAD which is normalized after glucocorticoid replacement. Read More

    Analysis of clinical characteristics of dialysis patients at the University Hospital.
    Bol Asoc Med P R 2016 ;108(2):81-3
    Objectives: The incidence and prevalence of Chronic Kidney Disease (CKD) patients treated with dialysis has continued to increase worldwide. These patients are at the highest risk of developing cardiovascular complications which contribute to their demise. The objective of this study was to describe the clinical and demographic characteristics of the patients on maintenance hemodialysis at the University Hospital, in San Juan Puerto Rico. Read More

    Previous Exposure to Anesthesia and Autism Spectrum Disorder (ASD): A Puerto Rican Population-Based Sibling Cohort Study.
    Bol Asoc Med P R 2016 ;108(2):73-80
    Background: Autism Spectrum Disorder (ASD) is characterized by impaired social interaction and communication, and by restricted and repetitive behavior, that begins usually before a child is three years old.(1) Researchers have shown that prevalence rates in the U.S. Read More

    Cerebrospinal Fluids Leaks of the Cranial Vault Management with Compression Cap: Case Series.
    Bol Asoc Med P R 2016 ;108(2):69-72
    Cerebrospinal fluid leaks of the cranial vault, constitute one of the most common complications after neurosurgical procedures. In this paper we introduce to you an observational study, in which a series of patients with this complication where managed by using elastic compression hat during 18 hours per day, for two weeks to four months. Every one of them presented complete resolution of the leak, without any recurrence until actual controls. Read More

    Psoriasis and Coronary Artery Disease in Hispanics.
    Bol Asoc Med P R 2016 ;108(2):65-7
    Psoriasis is an immune disorder characterized by chronic activation of systemic inflammation. Morbidity and mortality in patients with psoriasis is attributed mainly to cardiovascular disease. There are studies in Caucasians and African- Americans, but little is known about how psoriasis is associated to coronary artery disease (CAD) in Hispanics. Read More

    The Role of Fibrinolytic Therapy in the Emergency Department.
    Bol Asoc Med P R 2016 ;108(2):61-4
    Emergency physicians are many times the first-line practitioners to encounter circulatory emergencies. Amongst these many diseases we face, of importance are acute myocardial infarction, ischemic cerebrovascular accidents and pulmonary embolism. Familiarity with fibrinolytic agents and regimens, as well as indications and contraindications, are crucial to the emergency department physician. Read More

    The Perils of Diagnosing and Treating Overlap Syndrome.
    Bol Asoc Med P R 2016 ;108(2):57-9
    Autoimmune hepatitis (AIH) may present with clinical, laboratory abnormalities and histological features suggestive of primary biliary cirrhosis (PBC) or primary sclerosing cholangitis (PSC). These variants of AIH are known as overlap syndromes. We present a case of a 62 year-old-male who presented with altered liver function tests, anemia and unintentional weight loss. Read More

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