Scientific Representations at the UPR School of Tropical Medicine. I: Images of Science.
This article on the STM's scientific endeavors is the first in a historical serial collection about the images and evolution of sciences at the institution. It reviews faculty's principal investigations (by disciplines and research problems), development of research programs, and concomitant scientific productivity and research outcomes. The essay focuses on the emerged scientific representations and the nature of sciences, and has been divided into four sections: 1) images of science, 2) the evolution of science in the first two eras (1926-40), 3) the third and last era unfolding (1941-49), and 4) special studies. This fi...
Source: Puerto Rico Health Sciences Journal - September 20, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Historical Migration revealed through a Case of Autosomal Dominant Alzheimer's Disease.
We report a case that illustrates a migration pattern seen a century ago that is currently in the process of repeating itself. Using information from a neuropathological examination, genetic analyses, and historical sources, we linked a patient with autosomal dominant Alzheimer's disease in Hawai'i with her ancestors in Puerto Rico. In this patient we identified the G206A PSEN1 mutation, previously identified as being linked to a founder effect from Puerto Rico. At the turn of the twentieth century, due to devastating hurricanes in Puerto Rico and the island's new status as a possession of the United States, over 5,000 Pue...
Source: Puerto Rico Health Sciences Journal - September 20, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Pancreatic Cancer Incidence, Mortality, and Survival in Puerto Rico, 2001-2015.
Authors: Castañeda-Avila M, Torres-Cintrón CR, Cruz-Benítez A, Fuentes-Payán W, Maldonado-Albertorio A, Nieves-Ferrer L, Padró-Juarbe P, Soto-Abreu R, Perez-Ríos N, Ortiz-Ortiz KJ, Magno P, Ortiz AP Abstract OBJECTIVE: To perform an epidemiologic profile of pancreatic cancer (PC) in Puerto Rico (PR) with data gathered from 2001 to 2015. METHODS: Using data from the PR Central Cancer Registry we estimated incidence and mortality rates and trends of PC in PR, and performed survival analyses. We also compared the age-standardized incidence and mortality rates of PC in peop...
Source: Puerto Rico Health Sciences Journal - September 20, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Occurrence and Practices for Pain, Agitation, and Delirium in Intensive Care Unit Patients.
CONCLUSION: Although pain, agitation, and delirium occurrence were similar to other studies, patients continue to suffer. A gap exists between clinical practices in these ICUs and current guidelines. Strategies that contribute to integrating guidelines into these ICUs should be developed, studied, and implemented. PMID: 31536628 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - September 20, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Relationship between Caregiver Health Literacy and Caregiver Burden.
CONCLUSION: It is important for individuals who are caring for chronic patients and need assistance in this tough process to stay healthy in terms of decreasing the care burden. Caregivers must be adequately health literate so that they will be able to understand basic health information and develop the proper self-care behavior that will enable them to maintain and even improve their own health status. PMID: 31536629 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - September 20, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Comparison of Skin Biomechanics and Skin Color in Puerto Rican and Non-Puerto Rican Women.
Authors: Regueira Y, Fargo JD, Tiller D, Brown K, Clements C, Beachman B, Brignone E, Sommers MS Abstract OBJECTIVE: Skin biomechanics are physical properties that protect the body from injury. Little is known about differences in skin biomechanics in racial/ethnic groups and the role of skin color in these differences. The purpose of this study was to determine the relationship between skin biomechanics (viscoelasticity, hydration) and skin color, when controlling for demographic and health-related variables in a sample of Puerto Rican and non-Puerto Rican women. METHODS: We performed a secondary analysis of d...
Source: Puerto Rico Health Sciences Journal - September 20, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Improvement in Hispanics' CRC Knowledge and Awareness using the Inflatable Caribe Colon.
This study evaluated the effectiveness of the Caribe Colon inflatable colon model in two community events as an educational tool to increase CRC knowledge, awareness, and intention to undergo CRC screening. METHODS: Participants (aged ≥ 40 years and with no previous CRC history) completed a pre- and post- questionnaire, and took the tour of the Caribe Colon. RESULTS: After completing the tour, survey responses (n=154) revealed a significant increase in CRC knowledge and awareness (p
Source: Puerto Rico Health Sciences Journal - September 20, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Prevalence of Recurrent Stroke among a Rehabilitation Cohort in Nigeria.
Authors: Vincent-Onabajo G, Adamu A Abstract OBJECTIVE: A recurrent stroke increases the rates of mortality and morbidity after an initial stroke. There is, however, a dearth of data on the prevalence of recurrent stroke in Nigeria. METHODS: A secondary analysis of the data obtained from 100 stroke survivors undergoing physiotherapy at 2 health facilities in Nigeria was carried out to document the prevalence of recurrent stroke. The association between recurrent stroke and selected socio-demographic and clinical factors of the participants was explored using logistic regression analysis. RESULTS: Thirty-two...
Source: Puerto Rico Health Sciences Journal - September 20, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Nonmedical use of d-Amphetamines and Methylphenidate in Medical Students.
CONCLUSION: This study suggests a higher prevalence of ADHD medication use amongst the PR medical student sample compared to findings reported of US medical students, as well as a high prevalence related to nonmedical use as a means for medical students to cope with their training. The nonmedical use of stimulants in the medical school setting remains of utmost public health and clinical concern. The results of this study could help develop proper workshops and non-pharmacological techniques to help medical students cope with their workload. PMID: 31536633 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - September 20, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Variation between Point-of-care and Laboratory HbA1c testing in Clinical Practice.
CONCLUSION: Point-of-care HbA1c testing should not be used in solidarity to diagnosis pre-diabetes and diabetes. When using HbA1c results to guide therapy, self-monitoring of blood glucose and symptoms of both hypo- and hyperglycemia should be correlated to help determine appropriate therapy. PMID: 31536634 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - September 20, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Carcinoma Showing Thymus-Like Elements: A Rare Malignant Tumor of the Thyroid Gland.
We present the first CASTLE case from Turkey. A 51-year-old male was admitted with a complaint of a neck mass and hoarseness. A laryngoscopic examination revealed left vocal cord paralysis. Neck ultrasonography showed a tumor which was compressing the esophagus and had invaded the left recurrent laryngeal nerve (RLN). The patient underwent a total thyroidectomy, a unilateral central-compartment neck dissection, and following adjuvant radiotherapy. Intraoperative nerve monitoring was performed during the operation to preserve the contralateral nerve. He completed a 3-year follow-up period after the completion radiotherapy, ...
Source: Puerto Rico Health Sciences Journal - September 20, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

R on T Phenomenon and Long QTc Syndrome due to Moxifloxacin in a Healthy Female.
Authors: Anyfantakis D, Makrakis G Abstract Long QT syndrome is characterized by prolongation of the corrected QT interval and is associated with fatal arrhythmias. R on T phenomenon is the coincidence of a premature ventricular complex with a T wave and may result to syncope and sudden cardiac death. Here we present a case of a 59-year-old woman with no previous history of medication, receiving moxifloxacin for community-acquired pneumonia. She was admitted complaining for thoracic pain and shortness of breath. Electrocardiogram showed both R on T phenomenon and QT prolongation. After discontinuation of the antibi...
Source: Puerto Rico Health Sciences Journal - September 20, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Multimodal Endovascular approach in a Case of Multiple Dural Arteriovenous Fistulae.
We describe a rare presentation of DAVF in a patient with multiple DAVF, at 3 separate sites within the cranial cavity; associated with a medical history of two traumatic motor-vehicle accidents, total anomalous pulmonary venous return (TAPVR), and acquired aplastic anemia. We describe our approach in the treatment of this complex condition. PMID: 31536637 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - September 20, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Identifying Robust Autism Indicators for Latino Children.
CONCLUSION: These data are used to recommend a simplified Latino ASD screening procedure that can be managed by pediatricians and other primary care givers (with a limited time and skills to screen children from Latino families) during routine care visits; this will assist them in making referrals for an ASD diagnostic evaluation, based on this screening. PMID: 31260548 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - July 3, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Longitudinal Associations between Dietary Patterns and Weight Status in Puerto Rican Infants and Toddlers' Participants of the WIC Program.
CONCLUSION: Diet quality significantly decreased over time in our sample. Breastfeeding for less than one month and formula-based diets significantly increased the odds of overweight/obesity at follow-up, but no significant associations were found with DQIS or its components. PMID: 31260549 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - July 3, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Exploring the Relationship between Diarrhea and Fatigue that can occur during Cancer Treatment: Using Structural Equation Modeling.
Authors: Gonzalez VJ, Beckstead J, Groer M, McMillan S, Ortiz D, Marrero S, Saligan LN Abstract OBJECTIVE: To examine the relationship of the symptoms of diarrhea and fatigue by testing a model that included multiple dimensions of the cancer related-symptom experience. METHODS: A secondary data analysis was conducted on data from the self-reports of 102 cancer patients co experiencing diarrhea and fatigue during treatment at a comprehensive cancer center in the Southeastern United States. Structural equational modeling was employed to examine the relationship between the 2variables. Fatigue and diarrhea were as...
Source: Puerto Rico Health Sciences Journal - July 3, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Age-Specific Reference Ranges for Serum Prostate-Specific Antigen in Puerto Rican Men with Proven Prostate Cancer.
Authors: Esteban EP, Rivera A, Rivera-Rodriguez J Abstract OBJECTIVE: The purpose of this research was to carry out a statistical study (the first such) of prostate-specific antigen (PSA) levels in Puerto Rican men (including residents of Puerto Rico not born on the island) with proven prostate cancer (PC). We also sought to propose new age-specific PSA reference ranges to improve the diagnosis and prognosis of PC. METHODS: In order to address our objectives, a PSA statistical analysis of 16,305 Puerto Rican men (from 2004-2012) with proven PC was carried out. RESULTS: For all Puerto Rican PC patients, PSA ...
Source: Puerto Rico Health Sciences Journal - July 3, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

A Clinical Study on Cadaveric Kidney Donors in Puerto Rico and the Survival outcome of the grafts: a retrospective study of 187 kidneys from 2009-2011.
CONCLUSION: Our study evidences the role of various characteristics in the distribution of KDRI values in the Puerto Rican population, suggesting that the identification of variables specific to a geographically distinct group may result in better donor categorization for predicting transplant outcomes. In addition, our graft-survival results, despite the elevated rates of BKV and anti-donor antibodies, highlight the increasing need to monitor the presence of antibodies in a prospective and an anticipatory manner to identify and manage patients at risk for antibodymediated rejection. PMID: 31260552 [PubMed - in process...
Source: Puerto Rico Health Sciences Journal - July 3, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Urinary Tract Infections in College and Non-College Women from Colombia.
CONCLUSION: The frequencies of urinary tract infection were similar in both groups. These individuals might have been taking non-prescribed antibiotics or failing to comply with a prescribed treatment or bacteria are of hospital origin. PMID: 31260553 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - July 3, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Which Factors may reduce the Health-Related Quality of Life of Ecuadorian Patients with Diabetes?
CONCLUSION: Older age, longer disease duration, hypertension, and nephropathy are associated with having a lower HRQoL, in patients with type 2 DM in Quito, Ecuador. PMID: 31260554 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - July 3, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Time of Surgery in the Outcome of Cervical Spinal Cord Injury: the University of Puerto Rico Experience.
CONCLUSION: Traumatic cervical spinal cord injury is associated with high mortality and morbidity. Early surgery was not associated with an improved neurological outcome at long-term follow-up. The benefit of early surgery was seen only in terms of decreasing each patient's length of hospital stay. PMID: 31260555 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - July 3, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

The Protective Effect of Rosewater against DNA Damages and Oxidant and Antioxidant Parameters of Rats Exposed to Chlorpyrifos Ethyl.
Authors: Ögüt S, Asgarpour H, Sekkin S Abstract OBJECTIVE: The aim of this study was to determine both the protective effect of rose water (RW) against DNA damage in the tissues of rats exposed to chlorpyrifos-ethyl (CPE) and RW's effect on the oxidant and antioxidant levels in the blood serum and brain tissues of those same rats. METHODS: In this experimental study, 32 mature male wistar albino rats were divided into 4 groups: group I, control; group II, CPE; group III, RW; and group IV, CPE+RW. The parameters of DNA tail intensity and DNA tail moment were analysed in blood samples by comet assay. Gl...
Source: Puerto Rico Health Sciences Journal - July 3, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

An Unexpected Cause of Sepsis: Keep Pursuing the Source of Infection.
Authors: Ramos-Rossy J, Otero-Domínguez Y, Axtmayer J, Torres-Palacios J, Cantres O, Rodríguez-Cintrón W Abstract An 86-year-old man was found with altered mental status, fever and aphasia. His physical exam revealed nuchal rigidity but no other meningeal signs. Because the patient's mental status was declining, he was intubated and placed in mechanical ventilation. His head CT scan was unremarkable, without evidence of mass effect. A lumbar puncture yielded cerebrospinal fluid that was remarkable for the presence of gram-positive cocci in pairs. His blood cultures showed gram-negative bacilli....
Source: Puerto Rico Health Sciences Journal - July 3, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Life-threatening Misdiagnosis of Bulbar Type Onset Myasthenia Gravis as a Subacute Thyroiditis.
We report the case of 48 year-old woman, in whom initial presentation of MG with predominance of bulbar symptoms was mistaken for thyroid disease complications. Subsequently, correct diagnosis and optimal management resulted on significant improvement of her functional state. We discuss the importance of considering MG as one of the potential differential diagnoses among cases of new onset or recurrent unexplained bulbar symptoms. PMID: 31260558 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - July 3, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Small Bowel Bleeding: A Challenging Diagnosis.
We present a case of SBB in which multiple imaging and endoscopic procedures were required to identify the culprit lesion. Additionally, we review the most common etiologies, radiologic modalities, and endoscopic procedures available. PMID: 31260559 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - July 3, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Dying in the Intensive Care Unit.
CONCLUSION: A small percentage of the patients who died in the ICU had advance directives at the time of admission, this though all were of advanced age, had recently been discharged after a prior hospital stay, suffered from 1 or more chronic illnesses, or had a history of mental or physical disease. Our findings underscore the need for the early referral of patients of the type previously mentioned to a PS. PMID: 30924908 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - March 30, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Resuscitation Strategies in Early Septic Shock: A Survey of Puerto Rico Intensive Care Physicians.
CONCLUSION: Significant variability exists in the management of ESS among physicians in the ICU in PR. Compared to other studies, fewer physicians in PR use invasive monitoring techniques. These results highlight the need for quality education and training in CCM as well as continuing education in the field. PMID: 30924909 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - March 30, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Polymyxin B for Gram Negative Multidrug Resistant Bacteria in a Hispanic Population.
CONCLUSION: The use of polymyxin B was associated with an ICU mortality reduction. Unexpectedly we found a significantly improved survival in patients who received polymyxin B in combination with daptomycin, which awaits prospective confirmation. PMID: 30924910 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - March 30, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Evaluation of Serum Circulating Levels of ICAM-1 as Tuberculosis Risk-assessment Factor in Type 2 Diabetes Patients.
CONCLUSION: In conclusion, the present study demonstrated that elevated levels of ICAM-1 in patients with type 2 diabetes mellitus are likely associated with the development of tuberculosis. PMID: 30924911 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - March 30, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Novel Molecular Signatures of Chikungunya Virus in Puerto Rico.
CONCLUSION: Our analysis of the E1 gene revealed new molecular signatures in PR CHIKV sequences, 1 of which was also found in Colombia. While studies have shown possible relationships between T98A and A226V with viral adaptation and spread, no other PR sequence contained these vector-adaptive mutations. Thus, constant monitoring of the virus remains an essential factor in the establishment of control strategies to track viral spread. PMID: 30924912 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - March 30, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

New Diagnoses among HIV+ Men and Women in Puerto Rico: Data from the HIV Surveillance System 2003-2014.
Authors: Colón-López V, Miranda-De León S, Machin-Rivera M, Soto-Abreu R, Marrero-Cajigas EL, Rolón-Colón Y, Valencia-Torres IM, Suárez-Pérez EL Abstract OBJECTIVE: Describe the age-standardized rates of new HIV diagnoses and compare sex and time disparities using data from the HIV/AIDS Surveillance System in Puerto Rico (PR). METHODS: The study comprises data of new HIV diagnoses of persons 13 years of age and older in PR reported from 2003-2014. Other variables included were age, sex, and health regions. We computed male to female ratio of new HIV diagnoses and...
Source: Puerto Rico Health Sciences Journal - March 30, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Non-Melanoma Skin Cancer Tumor's Characteristics and Histologic Subtype as a Predictor for Subclinical Spread and Number of Mohs Stages required to Achieve Tumor-Free Margins.
CONCLUSION: Subclinical spread was seen in morpheaform/infiltrative and micronodular BCC histologic subtypes, recurrent tumors, and tumors in high-risk locations. These could help predict aggressive tumor behavior and optimize surgical planning. PMID: 30924914 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - March 30, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Tobacco Use and Associated Health Conditions and Risk Factors in the Lesbian, Gay, Bisexual, Transgender, and Transsexual Populations of Puerto Rico, 2013-2015.
CONCLUSION: The results of this research demonstrate that tobacco use is one of the most critical public health issues affecting the LGBTT populations in Puerto Rico. For that reason, specific interventions and treatments directed to LGBTT populations are needed to help to reduce the impact of this addiction on the health of their members. PMID: 30924915 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - March 30, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Prevalence and Risk Factors associated with Homelessness among Drug Users in Puerto Rico.
CONCLUSION: In rural Puerto Rico, the prevalence of current homelessness in IDUs was 21.7%. In the sample, 6.0% were HIV positive and 78.4% were HCV positive. Our results highlight the necessity of increasing accessibility to substance abuse treatment and establishing additional needle-exchange programs (currently, there is only 1) in rural Puerto Rico. PMID: 30924916 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - March 30, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Neutrophil to Lymphocyte Ratio is Useful in Differentiation of Malign and Benign Thyroid Nodules.
CONCLUSION: We suggest that elevated NLR in patients with thyroid nodules in preoperative period may be an indicator of underlying malign nodular disease. Increased NLR in such patients should encourage physician to perform cancer screening in thyroid gland. PMID: 30924917 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - March 30, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Leptomeningeal Carcinomatosis as the Initial Manifestation of Metastatic Disease diagnosed in Postmortem Examination: A Case Series.
We report 3 cases with distinct neurological presentations, negative cerebrospinal fluid (CSF) examinations and neurological imaging. A 52 year old woman with history of breast cancer on remission, a 2 year old male with left ear rhabdomyosarcoma status post resection, and a 59 year old woman with communicating hydrocephalus of unknown etiology. LMC was diagnosed at autopsy and confirmed by immunohistochemistry. LMC is a complication requiring a high level of clinical suspicion. Postmortem examination is an invaluable tool to confirm LMC as part of the multidisciplinary approach aiming towards the improvement of clinical d...
Source: Puerto Rico Health Sciences Journal - March 30, 2019 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

ZIKA VIRUS - The Puerto Rican Experience.
Authors: Wojna V Abstract Zika has been one of the most devastating new emerging viruses epidemic due to its effects on the nervous system mostly newborns. It was an unexpected epidemic that jeopardized our population and those with the appropriate environment for the virus to replicate, the tropics. It took us by surprise and challenged our health system. When it arrived in Puerto Rico in December 2015 many questions were raised regarding how the clinical manifestations of the infection will affect our population. Although most of infections go on asymptomatic it was not clear how our population heavily infected w...
Source: Puerto Rico Health Sciences Journal - December 24, 2018 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Zika Virus in the Americas: An Environmental Health Perspective.
Authors: Bonilla-Soto LA Abstract Phylogenetic studies suggest that ZIKV may have been introduced to Brazil, and therefore to the Americas, in 2014 during the World Spring Canoe Championship held in the city of Rio de Janeiro. Since then the virus has spread across Latin America, Caribbean, and North America. It seems clear that Aedes aegypti and, to a lesser extent, Aedes albopictus are the main vectors of the pathogen. ZIKV infection symptoms are similar to other flaviviruses such as a dengue infection and therefore can be easily confounded. Currently, the ZIKV maintains two life cycles. The first, and the origin...
Source: Puerto Rico Health Sciences Journal - December 24, 2018 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Zika in Puerto Rico, 2016-2017: I Perspectives on the Social Crisis and Health Care Concerns.
Authors: Rigau-Pérez JG Abstract The social reaction to the Zika epidemic in Puerto Rico reached a confrontational climax regarding aerial fumigation with an organophosphate insecticide. The public drama has obscured multiple simultaneous controversies. This and a companion paper, based mostly on print and digital news reports, provide a context and description of the major controversies and examine the outcomes and their lessons for the protection of the public's health. Part I describes the social and sanitary environment, the first three months of the epidemic, and the debates related to religious, demogr...
Source: Puerto Rico Health Sciences Journal - December 24, 2018 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Zika in Puerto Rico, 2016-2017: II Perspectives on Epidemic Surveillance and Control, Health Communication, Outcomes and Lessons.
Authors: Rigau-Pérez JG Abstract The social reaction to the Zika epidemic in Puerto Rico reached a confrontational climax regarding aerial fumigation with an organophosphate insecticide. The public drama has obscured multiple simultaneous controversies. This and a companion paper, based mostly on print and digital news reports, provide a context and description of the major controversies and examine the outcomes and their lessons for the protection of the public's health. Part II covers the questions on disease surveillance (what is going on?); health communication and epidemic control (what is an epidemic? ...
Source: Puerto Rico Health Sciences Journal - December 24, 2018 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

The Role of Research in Policy and Practice: The Zika Phenomena in Puerto Rico.
Authors: Nazario-Pietri G, Bonilla-Soto LA, Nazario CM Abstract On April 19, 2017, the 37th Medical Sciences Campus Annual Research and Education Forum opened with the discussion panel The role of research in policy and practice: The Zika phenomena in Puerto Rico, with Dr. Cruz M. Nazario Delgado, Dr. Carmen D. Zorrilla and Dr. Luis A. Bonilla Soto. In this article, we critically examine the public policy process of the Zika epidemic in Puerto Rico, as presented by authors Nazario and Bonilla. We argue that policymaking and the public health responses to confront the Zika epidemic in Puerto Rico took place in a pol...
Source: Puerto Rico Health Sciences Journal - December 24, 2018 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Ethical Issues during Zika Epidemic in Puerto Rico and the Americas.
Authors: Esquilín-Rivera IO, Reyes-Báez G, Pérez-Torres R Abstract The Zika virus epidemic and the possible devastating teratogenic effects of the virus represent a challenge. Health authorities have the responsibility to create programs that provide adequate preventive, medical and psychological services to the affected population. The estimated risk of microcephaly in infants of mothers infected with Zika virus is 1 to 13% when the infection occurs in the first trimester of pregnancy. There is insufficient data to estimate the risk of microcephaly when infection occurs in the second or third ...
Source: Puerto Rico Health Sciences Journal - December 24, 2018 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Pregnancy and Zika: The Quest for Quality Care and Reproductive Justice.
Authors: Rabionet SE, Zorrilla CD, Rivera-Viñas JI, Guerra-Sanchez Y Abstract On February 1, 2016, the World Health Organization (WHO) declared the ZIKV virus outbreak a Public Health Emergency of International Concern (PHEIC). Pregnant women and their infants, are vulnerable to the impact of this vector-borne illness (mosquito) and sexually transmitted viral infection. The uncertainty surrounding the possibility of congenital anomalies due to ZIKV infection during pregnancy bring a renewed debate about the rights of women to control their reproductive decisions. Current strategies, resources and services ai...
Source: Puerto Rico Health Sciences Journal - December 24, 2018 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Zika-prevention Knowledge among Hispanic Women Living in Puerto Rico: A Cross-sectional Study.
CONCLUSION: There is a need to educate the general population about the Zika virus to reduce the misconceptions about disease prevention and transmission as well as about the complications associated with Zika during pregnancy. Awareness efforts should emphasize the prevention of infections during pregnancy and the use of available contraceptive methods. PMID: 30576578 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - December 24, 2018 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

A Cross-Sectional Survey of the Zika Virus and its Prevention: The Knowledge, Thoughts, and Beliefs of a Community of Residents in Caguas, Puerto Rico.
The objective of this study was to explore the knowledge, thoughts, and beliefs regarding the Zika virus and its prevention in a community of residents in the municipality of Caguas, Puerto Rico, and elicit their concerns and perceptions of risk. METHODS: A quantitative, non experimental, descriptive, cross-sectional correlational study was conducted in a community in Caguas, Puerto Rico. A structured questionnaire was administered to a sample of 158 residents, aged 21 and older, who participated voluntarily. The data were analyzed using SPSS version 17 via univariate and bivariate analysis. RESULTS: Of 158 surveye...
Source: Puerto Rico Health Sciences Journal - December 24, 2018 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

The Zika Virus Infection in Pregnancy: Review and Implications for Research and Care of Women and Infants in Affected Areas.
Authors: Zorrilla CD, Rivera-Viñas JI, De La Vega-Pujols A, Garcia-Garcia I, Rabionet SE, Mosquera AM Abstract The world has encountered a new and serious epidemic which has disproportionately affected fetuses and infants. What makes the Zika virus (ZIKV) epidemic such a threat in our times, is that a whole generation can be affected by birth defects caused by a seemingly innocuous maternal infection, which in most cases go unnoticed and undiagnosed. Spreading to over 80 countries and affecting millions, it is associated with severe birth defects known as congenital Zika syndrome (CZS), which include fetal b...
Source: Puerto Rico Health Sciences Journal - December 24, 2018 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Congenital Zika Syndrome in Puerto Rico, Beyond Microcephaly, A Multiorgan Approach.
CONCLUSION: Among the group of infants born to mothers with Zika positive test 4% had microcephaly. Of concern to us is the fact that 31% of normo cephalic infants had ocular manifestations and 7% of them had findings on head sonogram. While microcephaly is the severest form of Congenital Zika Syndrome, ocular manifestations might characterize the spectrum of disease. These findings reiterate the importance of detailed neonatal evaluations of exposed infants. PMID: 30576581 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - December 24, 2018 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Association of Zika Virus Exposure in Utero with Ocular Phenotypes in a Group of Newborns in Puerto Rico Exposure with ocular phenotypes in newborns in Puerto Rico.
CONCLUSION: We report herein ZIKV associated ophthalmologic findings, similar to those published, in 34% of the infants with suspected/confirmed ZIKV fetal exposure. These data underline the importance of ocular examination in patients with suspected congenital Zika but without other findings on physical exam. PMID: 30576582 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - December 24, 2018 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

First Autopsy of a Newborn with Congenital Zika Syndrome in Puerto Rico.
We report on the first autopsy performed on a neonate with congenital Zika syndrome in Puerto Rico. A term male was born to a mother with confirmed Zika virus infection; he had a prenatal diagnosis of microcephaly and multiple cerebral calcifications, among other anomalies, and a normal male karyotype (determined by amniocentesis). He required neonatal resuscitation at birth and died at 2 days ofage. At autopsy, his head circumference was only 1.5 standard deviations below the mean, not fulfilling the criteria for microcephaly. He presented scissor legs, clenched and hyperflexed hands, and multiple contractures (arthrogryp...
Source: Puerto Rico Health Sciences Journal - December 24, 2018 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research

Implementation and Evaluation of Guillain-Barr é Syndrome Surveillance in Puerto Rico during the 2016 Zika Virus Epidemic.
CONCLUSION: EGBSSS provided complete, valid, and increasingly timely surveillance data, which guided public health action and supported healthcare providers during the ZIKV epidemic. This evaluation provides programmatic lessons for GBS surveillance and emergency response surveillance. PMID: 30576584 [PubMed - in process] (Source: Puerto Rico Health Sciences Journal)
Source: Puerto Rico Health Sciences Journal - December 24, 2018 Category: International Medicine & Public Health Tags: P R Health Sci J Source Type: research