Boletín de la Asociación Médica de Puerto Rico (Bol Asoc Med Puert Rico)

Publications in this journal

• Article: [In Process Citation].

  Luis A Cruz
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  ABSTRACT: The invention of Dr. Willem Kolff revolutionized the treatment of the patients with end-stage renal disease in the sixties. This milestone coincided with the beginning of nephrology as a medical subspecialty. A group of professionals that included physicians, technicians and nurses took the task of initiating the first dialysis programs in the hospitals of Puerto Rico. The Veterans Hospital served as a research and training center during the first years of hemodialysis in the island. This article summarizes the challenges and genuine efforts of the professionals that built the foundation of what we know today as renal replacement therapy.
  Boletín de la Asociación Médica de Puerto Rico 10/2012; 103(3):63-9.
• Article: [In Process Citation].

  Gabriel Alcalá-Cerra, Juan José Gutiérrez-Paternina, Lucía Mercedes Niño-Hernández, Luis Rafael Moscote-Salazar, Carolina Polo Torres, Rubén Sabogal Barrios
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  ABSTRACT: We described a patient who had left trigeminal neuralgia by vertebro-basilar dolichoectasia, who underwent microvascular decompression separating the basilar artery of the trigeminal nerve by interposing a vascular graft piece. Symptoms resolved completely after surgery. Nine years later, he has a recurrence of facial pain associated with rapidly progressive brainstem compressive symptoms. The brain MRI showed the vertebro-basilar dolichoectasia exerting compression on the ventral-lateral aspect of the pons and the medulla. In cerebral angiography confirmed the presence of dilated tortuous vertebral arteries, basilar, and of both internal carotid. To our knowledge this is the first case of brain stem compression syndrome preceded by NT in patients with vertebro-basilar dolichoectasia and one of the few cases with coexistence of vertebro-basilar and bilateral carotid dolichoectasia.
  Boletín de la Asociación Médica de Puerto Rico 01/2008; 103(3):34-7.
• Article: [In Process Citation].

  Ylene D Rodríguez Ortiz, Glenda Miranda, Rafael Burgos Calderón, Santos Depine, Otegbola Ojo
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  ABSTRACT: End-Stage Renal Disease (ESRD) is a global public health problem. Although there are strategies for its prevention, the number of cases has increased. In order to understand current situation in Puerto Rico (PR) we review available data, which is presented in a descriptive report of the incidence, prevalence and mortality of ESRD during the period 2000-2008. In addition, we compare the incidence and prevalence rates with regard to other countries. We used 2000-2008 USRDS statistics and the QIRN3 for patients on dialysis. Transplanted patients were excluded. Crude rates of incidence and prevalence in PR were calculated for comparison with the United States and other countries. Percentages were calculated to describe the demographic characteristics and primary diagnosis in 2008. During the period 2000-2008 the incidence rate increased by 21.6 percent; from 286.8 to 348.7 pmp. The prevalence rate increased by 27.3 percent; from 861.2 to 1096.2 pmp. The average annual growth in the incidence and prevalence was 2.4 percent and 3.0 percent respectively. During the same period, diabetes mellitus was the leading cause of ESRD reaching 67.4 percent of total new cases in 2008, while in the U.S. was 44.4 percent. Unadjusted mortality decreased slightly in 2008 to 18.5 percent. PR is the fifth country with the highest incidence of patient on dialysis and the first with ESRD due to diabetes mellitus. ESRD is becoming more common and prevalent in PR. We should be more aggressive in establishing public health strategies to reduce ESRD.
  Boletín de la Asociación Médica de Puerto Rico 09/2000; 103(3):4-9.
• Article: [Prevalence of obesity and associated conditions in a center for family medicine].

  M Román Díaz
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  ABSTRACT: Obesity is the most prevalent nutritional problem in North America and is associated with multiple chronic diseases. A sample, stratified by age and sex (N = 193), was taken from all the patients that visited Dr. Pila Hospital's Family Practice Center during a two month period. From the medical records, data was obtained about age, sex, body mass index, and the presence of diabetes mellitus, arterial hypertension, hypercholesterolemia or hyperlipidemia. The mean age was 44.8 years. The prevalence rates for obesity, hyperlipidemia, arterial hypertension, and diabetes were 53.4%, 69.5%, 26.0% and 17.2% respectively. The prevalence rates for hypertension and diabetes were twice in obese subjects than in non obese subjects. No statistical association was found between obesity and hyperlipidemia. Although this sample is not representative of the general population, this study sheds light on the impact of obesity and associated conditions among users of health services.
  Boletín de la Asociación Médica de Puerto Rico 12/1992; 84(11):302-4.
• Article: Attitudes and knowledge toward bicycle helmet by school age children.

  G Rodríguez, A Quintero
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  ABSTRACT: Approximately 600 children under the age of 15 years, die each year in bicycle-related accidents. Over 80% of these deaths involve trauma to the head. Almost one fourth of all significant brain injuries in children are bicycle related. In spite of these significant statistics, bicycle helmet use in Puerto Rico has not received the necessary publicity to increase their use. Pediatricians should encourage helmet use and counsel parents about the important of this device. A case control study of accidents among bicycle riders experiencing a crash demonstrates that safety helmets reduce the risk of head injury by 85% and brain injury by 88%. The recommendation of current safety counseling practices should be incorporated as part of the routine pediatrician visit. Educational campaigns targeted at parents and children focusing on the incidence of consequences of bicycle crashes should be the primary goal for all primary practitioners, since the effectiveness of helmets in preventing head injuries might substantially increase helmet ownership among children. To assess the prevalence of bicycle helmet ownership and the associated factors with this, we surveyed 146 school age children evaluated at the Pediatrics Clinics of the University Hospital Dr. Ramón Ruiz Arnau from January to March 1991. We concluded that only 7.5% of our sample use the helmets.
  Boletín de la Asociación Médica de Puerto Rico 12/1992; 84(11):305-8.
• Article: [Management of fever in children: study and practice in a center for family medicine].

  M Collazo
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  ABSTRACT: For three consecutive weeks a questionnaire was administered to 149 parents that took children under age 13 to Dr. Pila Hospital Family Practice Center. Information was obtained about their understanding of fever and its management. In our study we found parents who had no knowledge about what temperature is considered fever. As a result, there may be children who have been unnecessarily treated for temperatures that are normal. Others failed to recognize high fever and delayed treatment. The findings of this study are consistent with the idea that, in general, there is little knowledge about the definition of fever and its treatment, which suggests the need of an educational program.
  Boletín de la Asociación Médica de Puerto Rico 12/1992; 84(11):294-7.
• Article: [Effectiveness of short-term corticosteroid therapy in patients with acute bronchial asthma in Puerto Rico].

  J L Vicéns, M Quiñones, R M Díaz
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  ABSTRACT: This is a pilot study realized in the San Juan City Hospital Pediatric Emergency Room to determine the efficacy of the short-term use of corticosteroids in pediatric patients (5 to 6 years old) with the diagnosis of acute bronchial asthma during the months of March to June 1992. Twenty three (23) cases were evaluated, of which, 8 cases were excluded because they did not comply with the eligibility criterias. The treatment was implemented in a random fashion, which consisted of one control group of treatment with different corticosteroids in combination with albuterol. The patients were evaluated at 0, 2, 6, 12 and 24 hr of therapy a pulmonary index, peak expiratory flow rate (PEFR) and pulse oximeter saturation. On admission to the study the average pulmonary index was 6 and PEFR of less than -3sd. When the patients achieved a pulmonary index of < 4, PEFR > 70% and pulse oxygen saturation of > 95% they were discharged. They were reevaluated at 5 to 7 days and 10 to 14 days after discharge. Using the same objective parameters patients that used corticosteroids had a tendency to improve or maintain the pulmonary index, PEFR and oxygen saturation between normal values. In this study it was possible to identify a tendency in the patients who used corticosteroids: the hospitalizations and exacerbations were less. The extension of the study in terms of population sample offers a better statistical representation to determine the real tendency or conclusions.
  Boletín de la Asociación Médica de Puerto Rico 11/1992; 84(11):298-301.
• Article: [Salamanca University: a historic outline].

  J Alvarez Villar
  Boletín de la Asociación Médica de Puerto Rico 03/1992; 84(2):44-7.
• Article: [Exercise, physical activity and diabetes mellitus].

  M Y Canabal Torres
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  ABSTRACT: Vigorous regular exercise is a recommended inclusion in the management of diabetes of persons with diabetes of both types, regardless of age. Benefits can be identified in the physiological (improved cardiovascular fitness, flexibility and muscle toning; in the metabolic and hormonal processes for energy production), as well as psychosocial realms (self-esteem, stress management, socialization opportunities). Considerations of the risks (hyper or hypoglicemia, ketoacidosis, neuropathies or complications os cardiac risks), and contraindications (unplanned weight training in cases with proliferative retinopathy, hypertensión, uncontrolled diabetes) must be part of the exercise prescription and implemmentation. Exercise programs must be fun, varied and comply with exercise physiology principles such as gradual progression in intensity or target heart rate, recommended frequency and duration, regular hydration, and warm-ups and cooling routines. Regular vigorous physical education, sports, regular exercise and active recreational activities can be part of a healthy lifestyle of persons with diabetes.
  Boletín de la Asociación Médica de Puerto Rico 03/1992; 84(2):78-81.
• Article: [The right of the patient to be "left alone"].

  R A Marcial-Rojas
  Boletín de la Asociación Médica de Puerto Rico 03/1992; 84(2):50-5.
• Article: [Nursing: a profession in crisis].

  E A Santiago Delpín
  Boletín de la Asociación Médica de Puerto Rico 03/1992; 84(2):48-9.
• Article: Immunocytochemical study of vasopressin-like immunoreactive material in the gastrointestinal tract of the hedgehog Erinanceus europeus.

  J L Vasallo, R Arreaza, L Muñoz-Barragán
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  ABSTRACT: A study was made of portions of the gastrointestinal tract including the stomach, duodenum, jejunum, ileum, colon and rectum, and the hypothalamus of hedgehogs using the peroxidase-antiperoxidase (PAP) method incubating paraffin embedded sections of 6-7 microns thickness in an anti-arginine-vasopressin serum at a dilution of 1:1000. Vasopressin-like immunoreactivity is present in cells of the epithelial layer of the intestinal mucosa ranging from the stomach to the rectum. In the stomach the numbers of these cells are very small although they increase in the small intestine. However, in the different portions of this latter organ no significant differences can be found. Both, in colon and rectum there are cells with vasopressin-like immunoreactive material although at higher concentrations than in the rest of the gastrointestinal (GI) tract. Immunoreactive material is present throughout the epithelial layer of the mucosa and in general the cells of the mucosa are of the open kind. Using the same antiserum and at similar dilution, both cells and nerve fibres containing vasopressin-like immunoreactivity were observed in hypothalamic sections of this animal species and were used as positive controls. It is concluded that in the gastrointestinal (GI) tract of the hedgehog there is a population of epithelial cells that contain a immunoreactivity vasopressin-like-peptide (referred to as vasopressin-like peptide (AV-LP) whose numbers increase in the distal sense.
  Boletín de la Asociación Médica de Puerto Rico 03/1992; 84(2):67-9.
• Article: Asymptomatic carcinoma of the endometrium in a patient on adjunctive tamoxifen therapy for carcinoma of the breast.

  E O'Neill, W Rodríguez Mojica
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  ABSTRACT: A case report of a 70 years old female, on tamoxifen for over five (5) years after a left mastectomy and with lymphadenectomy and radiotherapy in whom an asymptomatic adenocarcinoma of the endometrium is reported. Review of the literature suggests this association, however, definitive proof that tamoxifen causes cancer of endometrium has not been fully accepted. The best study in this regards is the one from Radiohemmet Oncologic Centre from Stockholm, Sweden. Patients with cancer of the breast that have been over two (2) years on tamoxifen should be screened with endovaginal sonograms for thickness of endometrium, thickness over 9mm and possibly over 5mm should be investigated with hysteroscopy and fractional uterine curetage.
  Boletín de la Asociación Médica de Puerto Rico 03/1992; 84(2):74-7.
• Article: [Morphologic substrates of the ventricular route of secretion and transport of substances in the tubero-infundibular region of the hypothalamus. Ultrastructural study].

  P Amat, G Amat-Peral, F E Pastor, J L Blázquez, B Peláez, A Alvarez-Morujo, D Toranzo, A Sánchez
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  ABSTRACT: Ultrastructural studies of the ependyma of the tuberoinfundibular region of the rat hypothalamus have revealed the existence of intraventricular axonal endings and of cytoplasmic blebs and bulbs that project from the apical surface of the ependymal cells to the ventricular lumen. All these structures account for the processes of ependymal apocrine secretion and the neuroventriculocrinia, and hence the release of biologically active substances into the cerebrospinal fluid (CSF). These substances contained in the CSF must act on the nervous nuclei of the tuberoinfundibular region, such as the arcuate nucleus, which is very important in the neuroendocrine regulation of the anterior pituitary gland. Dilated intercellular spaces among neighbouring ependymocytes of this region, small intraependymal cisternae and, in particular, a lateral prolongation of the infundibular recess, which courses through the nervous tissue between the arcuate nucleus and the median eminence from the vertex of the lateral angle of the infundibular recess, may be the route followed by the CSF from the third ventricle to the tissue compartment of the tuberoinfundibular region. Also studied are the cisternae of the region and the relationships of these with the lateral prolongation of the infundibular recess. Some of these cisternae may be filled by the CSF through the prolongation. In this way, the tissue compartment of CSF would be enlarged, and hence the ventricular route for the secretion and transport of biologically active substances would be potentiated.
  Boletín de la Asociación Médica de Puerto Rico 03/1992; 84(2):56-66.
• Article: [The use of silicone breast prosthesis in Puerto Rico].

  N I Cruz
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  ABSTRACT: To obtain data on the use of gel-filled silicone breast implants in Puerto Rico, a study was undertaken by the Division of Plastic Surgery of the University of Puerto Rico. Questionnaires, designed to obtain information about their breast implant patients, were mailed to the 22 plastic surgeons in Puerto Rico. Sixty-eight percent of the plastic surgeons responded. The collected data showed that 1,682 patients received gel-filled silicone breast implants, of whom breast augmentation accounted for 82%, and post-mastectomy reconstruction for 18%. Capsular contracture occurred in 16% and early complications in 2.5% of the patients. Autoimmune disease was rare (.0006%), as was breast cancer (.0002%). Very few patients in Puerto Rico received polyurethane foam covered breast implants (.005%). The risk of problems associated with breast implants in our Island appears to be very low.
  Boletín de la Asociación Médica de Puerto Rico 03/1992; 84(2):70-3.
• Article: [The social consequences of aging].

  J López Varela
  Boletín de la Asociación Médica de Puerto Rico 02/1992; 84(1):15-20.
• Article: The new macrolides: expanding the ways in antibiotic treatment.

  M L Avilés Santa, C H Ramírez-Ronda
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  ABSTRACT: After almost forty years of its introduction, erythromycin will not be the exclusive member of the macrolide group of antibiotic agents, but a new generation of its derivatives which surpass it in pharmacological properties and clinical efficacy will also be available. Clarithromycin, a 14-membered derivative, has shown acid stability, longer half-life, lower protein binding and higher lung tissue penetration. Its exceedingly high activity against erythromycin-susceptible gram-positive cocci, Mycoplasma pneumoniae, and Legionella pneumophila makes it and important alternative choice in the therapy of respiratory tract infections. Also, it has shown high activity against Chlamydia trachomatis, and high urinary clearance of this unmetabolized molecule, important properties which would render it a special role in the treatment of genitourinary tract infections. Azithromycin, a 15-membered derivative has shown enhanced basicity (due to the nitrogen atom in its lactone ring), longer half-life and lower protein bindings. Its exceptional activity against Hemophilus influenzae, Branhamella catarrhalis, Neisseria gonorrhoeae, Ureaplasma urealyticum and gram-negative bacteria, and its high concentration in tonsillar, pulmonary, prostatic and female reproductive tract tissues, assigns it an honorific place among the macrolides in the therapy against respiratory tract and genitourinary tract infections. Its role against T. gondii deserves further study, but points out this agent as a promise against this parasite.
  Boletín de la Asociación Médica de Puerto Rico 02/1992; 84(1):21-5.
• Article: [Dr. Diego Alvarez Chanca introducer of universal medicine in America].

  J M Torres-Gómez
  Boletín de la Asociación Médica de Puerto Rico 02/1992; 84(1):2-3.
• Article: Cytomegalovirus infection.

  C Climent, R Vélez, J A Capriles
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  ABSTRACT: Post-transfusion CMV infection most frequently results in asymptomatic seroconversion. Among immunocompetent patients only seronegative pregnant women require such products because of the risk of fetal CMV infection. In selected groups of immunocompromised patients, significant disease can occur. It is desirable to provide blood and blood components with reduced CMV risk to the following patients: seronegative infants weighting less than 1200 g at birth, seronegative bone marrow transplant patients who receive marrow from seronegative donors and seronegative renal transplant patients receiving kidneys from seronegative donors. Heart and liver transplantation seronegative patients may receive seronegative blood if the donor is seronegative. CMV--seronegative HIV infected cases may also be transfused with CMV--seronegative blood.
  Boletín de la Asociación Médica de Puerto Rico 02/1992; 84(1):31-3.