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RESUMENES SESIONES ORALES R-89 Pérdida auditiva en infantes prematuros Se estima que menos del uno por ciento de los recién nacidos
presentan pérdida auditiva durante la infancia. El Gobierno
de Puerto Rico instituyó recientemente la Ley de Cernimiento
Auditivo neonatal considerando que de 55,000 bebés nacidos
vivos en la isla, se identifican aproximadamente 174 casos nuevos
anualmente de pérdida auditiva. Los infantes nacidos prematuramente
presentan múltiples complicaciones médicas que tienen
un impacto significativo en el desarrollo físico, mental
y emocional así como también en el rendimiento escolar
del niño. Una de las condiciones que afecta directamente
el desarrollo del infante prematuro es la pérdida auditiva.
El Programa Preemies y Familia de la Sección de Neonatología
de la Universidad de Puerto Rico es un proyecto que identifica
factores de riesgo de deficiencias en el desarrollo y establece
un sistema de seguimiento longitudinal del infante y la familia.
Durante un periodo de un año se reclutaron 103 infantes/familias
en el programa de los cuales 14 presentaron pérdida auditiva
(18%). El 71% de los bebés que no pasaron cernimiento eran
de sexo femenino. A mayor intensidad de resucitación al
nacer, mayor el riesgo de pérdida auditiva (entubación
p 0.024, uso de epinefrína p 0.017). Dada las condiciones
y retos que estos infantes tienen que superar para sobrevivir
y adaptarse al nuevo ambiente, es necesario identificar los factores
que pueden precipitar la adquisición de pérdida
auditiva y establecer estrategias efectivas de intervención.
Auspiciado por el Consejo Estatal de Deficiencias en el Desarrollo. Management of Pediatric Cerebrovascular Lesions using Endovascular Techniques We report the safety and efficacy of endovascular embolization
techniques as part of a minimally invasive multimodal approach
in the management of pediatric cerebrovascular lesions without
the need for surgery and with dramatic resolution of neurological
deficits. The cerebrovascular lesions addressed were amenable
to embolization using liquid adhesives, particles, and microcoils.
Some patients required adjuvant radiosurgery to correct the lesions. Very early menarche, followed by incessant ovulation, as a risk
factor for carcinoma of endometrium in young nulligravidas. Incessant ovulation has been recognized as a risk factor for
carcinoma of breast for more than a century, but only recently
carcinoma of endometrium has been added to tissues which are adversely
affected by the monthly risk and fall of estrogens. No attention
has been paid to age of patients at menarche. Very early menarche,
not followed by pregnancies, might constitute an increased risk
to neoplastic transformation, because of the immaturity of the
endometrium. We are reporting two cases meeting the above criteria.
One was age 19, and the other 28, when endometrial biopsy for
metrorrhagia confirmed the diagnosis of carcinoma of endometrium.
Menarche had occured at 9 and 8 years respectively. Both patients
were overweight. Hysterectomy with preservation of ovaries was
recommended, also both patients were nulligravidas. We conclude
that very early menarche, followed by uninterrupted ovulation,
in the presence of obesity, constitute a hither unrecognized high
risk factor for carcinoma of endometrium in young (less than 30
yrs) women. LONGITUDINAL EVALUATION OF WELL DIFFERENTIATED THYROID CANCER IN ADULTS: TREATMENT OUTCOMES AND SURVIVAL. F Silva, A Olmo, R Laguna, M. Ramirez-Vick. Nuclear Medicine Section, Radiological Science Department and Endocrinology Section, Department of Medicine, School of Medicine, UPR Purpose: The purpose of the study was to evaluate the characteristics
of well differentiated thyroid cancer (WTC) in patients referred
and followed in Nuclear Medicine, assess treatment response, long
term outcome and survival rate. Method: We performed a retrospective
evaluation of the records of all WTC patients referred to our
center from 1960-2000. Clinical data and evaluations, therapies
and follow up were assessed. Patients lost to follow up for 5
year were contacted by phone. Tumors were classified using the
American Joint Committee on Cancer Classification (AJCC). Disease
free survival was calculated using the Kaplan-Meier method. Results:
A total of 106 adult patients were evaluated, 80 treated and follow
up for a mean of 12.6 years. There were 90 females, 16 males,
age range 20 to 72. Tumor histology was mainly papillary and papillary-follicular
variant, 16 tumors were multicentric. Fine needle aspiration was
done in 38%. All patients had a thyroidectomy and whole body scan.
At diagnosis, the tumor was N-1 in 35%, and M-1 in 13%. After
therapy, residual disease in the neck or lung was present in 29%.
Persistent disease was present in 17.5% after 5 years follow up.
The presence of disease did not change the quality of life. Three
patients died; all had initial metastatic follicular cancer. High
iodine doses did not change the outcome. Ninety nine percent of
the patients were alive after a mean follow up of 12 years. Conclusion:
WTC has a good long term outcome and survival if treated and followed
up effectively. USE OF BRAIN SPECT IMAGING IN PEDIATRIC PATIENTS WITH COMPLICATED
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD): IMPACT ON CLINICAL
MANAGEMENT, THERAPY AND OUTCOME. F. Silva, L. Barreras, J. Pagán,
R. Laguna, J. A. Negrón-Soto. Nuclear Medicine Section,
Radiological Sciences Department, School of Medicine, UPR Co-morbidity of Axis I Psychiatric Diagnosis in Hospitalized
Puerto Rican Adolescents Between Ages 14 and 17 years old with
a Substance Related Disorder Diagnosis Patients with substance use disorders (SUD) comorbid with other
Axis I diagnosis have been found to differ from patient with only
substance use disorders. Thus, co-morbidity has been identified
as an important factor in determining adequate assessment and
treatment parameters. In Puerto Rico, research on substance use
has only been performed in general populations where differences
have been found with populations in the United States. For these
reasons, it is considered important to assess comorbidity with
SUD in a Puerto Rican clinical sample of adolescents. Evaluation
was completed of discharge summary diagnosis from a consecutive
series of 327 adolescent patients admitted to a psychiatric inpatient
unit. Patients were evaluated and diagnosed by the same child
and adolescent psychiatrist using DSM-IV diagnostic criteria.
Co-morbidity was then identified if statistically significant
differences were found between prevalence of diagnosis in a SUD
group and non-SUD group. 97 patients (29.6%) met criteria for
at least one SUD, 230 patients (70.3%) did not. Conduct disorder
and oppositional defiant disorder (ODD) were found to be co-morbid
with SUD. Depressive, psychotic and anxiety disorders were found
to be statistically more prevalent in the group without SUD. Regarding
gender differences, males predominated in the substance use group
and presented conduct disorder as co-morbid with SUD. In female
sample, conduct disorder as well as impulse control disorders
were found to be co-morbid with SUD. The study found a lower rate
of SUD in inpatient Puerto Rican adolescents than studies in inpatient
samples in the US. The study replicates previous research findings
in the US that show statistically significant comorbidity in adolescents
with SUD with conduct disorder and ODD. Regarding gender differences,
males had higher prevalence of SUD when compared to females. Conduct
disorder comorbidity was found to be statistically significant
in both male and female adolescents with SUD. Universal Hearing Screening in a High Risk Population, G.Reyes,
H. Velez, M. Torregrosa. Department of Pediatrics, Neonatology
Section, Medical Science Campus, San Juan, P.R. 00901 Tensile Strength of Different Metal Copings on Minimally Retentive
Standardized Crown Preparations: Pilot Study. Tooth preparation with reduced height or high occlusal convergence
of abutment walls could compromise retention of ceramometal restorations.
PURPOSE: To evaluate the effect of alloy type on coping retention
using minimally retentive preparations with different surface
treatments. METHODS AND MATERIALS: Eight recently extracted human
third molars were prepared for standardized crown preparations
with minimal retention using a custom-made pantograph. One control
and three experimental copings were fabricated in each alloy type
(i.e. noble metal and base metal). Copings received different
surface treatments: noble metal castings were sandblasted, metal
primed and tin-plated; base metal copings were sandblasted, metal
primed and etched. Castings were cemented with a self-adhesive
resin cement. Control specimens were cemented using zinc phosphate.
Crowns were removed using an Instron testing machine after tensile
loading. The failure mode after debonding was recorded. RESULTS:
Mean dislodgement forces were 220.53 N, 168.98 N and 90.15 N for
noble metal copings treated with sandblasting, metal primer and
tin-plating. Base metal castings debonded at 105.85 N, 175.85
N and 104.21 N for sandblasted, metal primed and etched specimens
respectively. Noble and base specimens cemented with zinc phosphate
failed at 69.88 N and 77.9 N. CONCLUSIONS: Within the limitations
of this study, sandblasting and metal primer treatments were superior
for noble metal copings, while metal primer permitted higher retention
for base metal castings. For base alloy, there was no significant
difference between sandblasting and etching. Zinc phosphate cement
showed the lowest retentive strength for both alloys. Partially
supported by RCMI. Signs and Symptoms Experienced by Puerto Rican Men and Women Living with HIV/AIDS This study describes the sign and symptom experience of 44 men
and women with HIV/AIDS living in Puerto Rico in a community housing
project. Findings indicate that this sample of people were experiencing
depression,(52.2%), muscle aches(50%), insomnia (45.4%), difficulty
concentrating (43%) and painful joints (43.3%). The gynecological
symptoms experiencing were pelvic pain (11.4%), vaginal itching
(11.3%), and vaginal odor (6.8%). These findings support the need
for symptom assessment and management interventions to prevent
or reducing prevalent symptoms in person with HIV infection.Symptom
management for persons living with HIV/AIDS is recognized as an
extremely important component of self-care. Factores Asociados al Uso de Medidas de Prevención para Evitar la Infección/reinfección del VIH en un Grupo de Deambulantes en un Area de San Juan en el Año 2002. El objetivo general de la investigación fue identificar
los factores asociados al uso de medidas de prevención
para evitar la infección/reinfección del VIH en
un grupo de deambulantes masculinos y femeninos adultos/as de
un área de San Juan en el año 2002. Las variables
del estudio fueron: características sociodemográficas;
susceptibilidad, severidad, beneficios y barreras percibidas;
factores modificantes; claves para la acción; autoeficacia
y acción de salud. La muestra fue de 50 deambulantes [19
mujeres (38.0%) y 31 hombres (62.0%)]. El estudio fue exploratorio.
Los objetivos fueron describir el perfil sociodemográfico
de los/as participantes; identificar su susceptibilidad, severidad,
beneficios y barreras percibidas, sus factores modificantes y
claves para la acción; identificar cuán seguros/as
se sientían para evitar la infección/reinfección
con el VIH e identificar las acciones de salud realizaron. Se
utilizó una encuesta de 131 preguntas y se empleó
el Modelo de Creencias de la Salud. Las edades fluctuaron entre
22 y 50 años. Se encontró una baja percepción
de susceptibilidad y una alta percepción de severidad de
infectarse/reinfectarse con el VIH. La mayoría se habían
realizado la prueba del VIH. Las mujeres informaron más
resultados positivos que los hombres. Los/as participantes percibieron
la masturbación como beneficiosa para protegerse del VIH.La
mayoría se sentían seguros/as de intercambiar jeringuillas
usadas por nuevas. El 25.0% de los hombres y el 60.0% de las mujeres
usaban el condón. Se recomendó realizar un estudio
con deambulantes VIH positivos/as y VIH negativos/as, correlacionando
las variables del Modelo de Creencias de la Salud y hacer comparaciones. Análisis de sobrevivencia de mujeres con cáncer
de cuerpo uterino en comparación con cáncer de cuello
uterino diagnosticadas en Puerto Rico durante 1987 a 1992. Se realizó un estudio de cohorte retrospectivo poblacional
cuyo objetivo principal consistía en evaluar la experiencia
de sobrevivencia observada entre las mujeres con cáncer
de cuello uterino y las mujeres con cáncer de cuerpo uterino.
Se obtuvo del Registro Central de Cáncer de Puerto Rico
información sobre mujeres (995 casos) entre las edades
de 40 a 70 años diagnosticadas con los tipos de cáncer
de interés. La hipótesis principal del estudio proponía
que la probabilidad de sobrevivencia observada en un tiempo específico
era diferente para pacientes con cáncer de cuello uterino
que las que tenían cáncer de cuerpo uterino. El
periodo de seguimiento promediaba en unos 9 años. Se describió
la cohorte principalmente mediante un perfil epidemiológico
y curvas de sobrevivencia Kaplan-Meir (K-M) por tipo de cáncer
y etapa del tumor. Un 77% de los casos de cuerpo uterino se diagnosticaron
en etapa localizada comparada con un 52% de los casos de cuello
uterino. Encontramos que la sobrevivencia fue significativamente
mayor: para las mujeres con cáncer de cuerpo uterino (p
< 0.0001); para mujeres menores de 65 años (p = 0.0005);
y para tumores diagnosticados en etapa temprana. El efecto de
la edad en la sobrevivencia solo fue importante en la etapa localizada.
Las modalidades de tratamiento difieren por tipo de cáncer
y etapa del tumor. Las mujeres con cáncer de cuello uterino
tienen 69% (HR = 1.69, IC 95%: 1.37, 2.09) mayor riesgo de morir
que las mujeres con cáncer de cuerpo uterino, aún
ajustando por la etapa del tumor al momento del diagnóstico.
Los resultados de este estudio concuerdan en que el efecto mayor
sobre la sobrevivencia es la etapa del tumor al momento del diagnostico.
También sugiere que debemos enfocar mayores esfuerzos preventivos
en el grupo de mujeres con cáncer de cuello uterino ya
que la enfermedad aparenta ser más letal y todavía
la mitad de las mujeres son diagnosticadas en etapas avanzadas.
La limitación principal del estudio es que la información
sobre la causa de muerte Growth and Dietary Habits Assessment of a Rural Pediatric Population
in the Dominican Republic. A Morales-Mena, N. Celestin MD, F.
Aledo MD, M. Aponte MD, C. Perez MD, G Reyes MD. Department of
Pediatrics, UPR School of Medicine TRANSLATIONAL CONTROL OF INTERLEUKIN-3 MRNA: INVOLVEMENT OF THE
ADENOSINE/URIDINE-RICH ELEMENT mRNA stability plays an important role in controlling gene expression. Many mRNAs implicated in cardiovascular and pulmonary diseases are regulated at the post-transcriptional level. Most of these transcripts harbor sequences rich in adenosine and uridine (AREs), which play a role in the regulation of their stability. The main objective of this study is to understand how the AREs in the 3' untranslated region (3'UTR) of the Interleukin-3 (IL-3) mRNA regulate its translation. To achieve this goal we have developed an efficient HeLa cell-free translational extract. In addition, we have made several luciferase reporter constructs harboring specific regions of the IL-3 3’-UTR. The effect of the IL-3 ARE on translation has been monitored in both rabbit reticulocyte lysates (RRLs) and HeLa cell extracts. The results from these experiments demonstrated that the presence of the cap structure and the poly A tail has a synergistic effect in the translation of the luciferase mRNA. In addition, the IL-3 ARE dramatically reduces the luciferase activity of the reporter chimera in both RRLs and HeLa cell-free translational extracts. The reduction observed in luciferase levels is not due to an altered stability of the reporter mRNA. Consistent with this result, the functional half-lives of the reporter constructs used in the extracts were identical. These results suggest that the IL-3 ARE can reduce the translation efficiency in our in vitro systems. All together, these studies will allow us to better understand the mechanism of how AREs control the process of translation in mammalian cells and will also contribute in the molecular understanding of several human diseases. Supported by a grant from NHLBI (KO1 HL-04355) Trace Elements in Water and Sediments of the Jobos Bay Area,
Puerto Rico. Jobos Bay National Estuarine Research Reserve (JBNERR), located
in the south coast of Puerto Rico, provides important habitats
to endangered species. Pollutants such as trace elements originating
from human activities could reach JBNERR resulting in adverse
ecological effects. Trace element levels in water and sediment
of JBNERR were determined and compared to a reference site (La
Parguera). Levels of arsenic (As), cadmium (Cd), copper (Cu),
mercury (Hg), lead (Pb), selenium (Se)-only for water, iron (Fe)-only
for sediments and zinc (Zn) were determined by atomic absorption
spectrometry. Average values for metals in water samples from
JBNERR and La Parguera were similar and considered low. Sediment
average values for Zn in JBNERR and La Parguera were 63 and 26
µg/g dw, respectively. Concentrations of Cu in JBNERR and
La Parguera were 29 and 13 µg/g dw, repectively. Average
concentrations of sediment samples in Jobos Bay and La Parguera
compared similarly to Joyuda, (a pristine lagoon) and not to a
polluted estuarine system like San José Lagoon. In order
to distinguish between natural and anthropogenic sources, correlation
matrix and enrichment factor analyses for each metal will be calculated.
Metal distribution in Scomberomorus spp. and Lutjanus spp. from Jobos Bay National Estuarine Research Reserve, Puerto Rico C.A. Salgado-Ramírez; I. Mansilla-Rivera; C.J. Rodríguez-Sierra.
Department of Environmental Jobos Bay National Estuarine Research Reserve (JBNERR) is a natural
reserve located in southern Puerto Rico that is susceptible to
development of the area. Trace metals are among aquatic pollutants
most frequently detected in estuarine systems. Metals attaining
high concentrations in fish tissues could result in detrimental
effects on reproduction, behavior, growth, and survival. The objective
of this study is to determine the distribution of arsenic (As),
cadmium (Cd), copper (Cu), lead (Pb), selenium (Se), and zinc
(Zn) in muscles, livers, gonads and gills of two sport fish species
(Scomberomorus spp. and Lutjanus spp.) commonly captured and consumed
by recreational fishermen of the area. A total of 32 fish were
collected from six different stations at JBNEER, whereas 18 fish
specimens were collected from a reference site (La Parguera).
Fish tissues are being acid digested in a microwave oven and metals
analyzed by atomic absorption spectrometry. Pb and Cd levels of
Scomberomorus spp. were below the minimum reporting limit in all
tissues. Average As levels (µg/g dw) in liver (6.2), gonads
(4.7) and muscle (4.4) of Scomberomorus spp. from Jobos Bay were
significantly higher than those from La Parguera (4.6, 2.6 and
2.7, respectively). Gill filaments from Jobos Bay obtained significant
higher Se levels (8.0 µg/g dw) than La Parguera (5.5 µg/g
dw). Only Cu levels (µg/g dw) in fish liver from La Parguera
(28.2) were higher from those from Jobos Bay (17.3). No statistical
significant differences between sites were found for Zn in any
of the tissues. In Vitro Antifungal Susceptibility Testing of Recent Clinical Isolates of Candida Species from Various Hospitals of Puerto Rico by Broth Microdilution, Etest and Disk Diffusion Methods: A Comparison Study. Management of candidiasis, specially the invasive type, has become
increasingly more difficult due to the emergence of azole-resistant
isolates and non-albicans Candida species. Antifungal susceptibility
testing for detection of resistant isolates may become a standard
of care if a simple, rapid and cost-effective method is available
in clinical laboratories. In Puerto Rico, neither identification
to species level nor susceptibility testing is routinely done
for Candida. In vitro activities of fluconazole (FL), itraconazole
(IT), amphotericin B (AP), voriconazole (VO) and caspofungin (CA)
against clinical isolates of Candida spp. from various medical
centers of Puerto Rico are being assessed by comparing the National
Committee for Clinical Laboratory Standards (NCCLS) broth microdilution
reference method (BMD) with the Etest and the NCCLS disk diffusion
(DD) method. Preliminary results for 74 isolates showed percentages
of agreement ranging between 60-100% for the BMD-Etest comparison
when testing AP, FL, IT and VO against both C. albicans and non-albicans
species. Comparison of the BMD with the DD protocol showed a weak
negative correlation between diameter of zone of inhibition and
minimum inhibitory concentration for FL and CA (r = 28 and r =
0.09, respectively). These results were consistent with those
reported by Barry (1996) Kirkpatrick (1998) and Pfaller (2003).
This retrospective study will provide information on the antifungal
susceptibility patterns of Candida spp. and will be useful in
the treatment of patients with systemic candidiasis. Supported
by a grant from Merck-Sharp & Dohme awarded to Dr. Benjamin
Bolaños. Teaching Professionalism: A New Curriculum The purpose of this project is to introduce a curriculum in professionalism at the UPR School of Medicine. A group of students and faculty of the UPR School of Medicine are collaborating in a pilot project to develop this educational activity. We started with first year students in the Introduction to Clinical Skills Course. An anonymous survey in which the students answered questions on professionalism based on short vignettes of difficult situations was given. They then received the “Charter on Medical Professionalism” and watched the film “The Choice is Yours” followed by a reflection and discussion period. In the third activity the students met with preceptors in small groups to discuss vignettes of situations in which different principles of professionalism were exemplified. Finally, students were given the same survey they received in the first activity. No significant differences were present between the surveys. Student and faculty feedback about the activities was very positive and reinforced the need for formal teaching on this subject. This resulted in inclusion of the curriculum in the first year of Medicine. A pilot curriculum for the second year has been started. We expect students to develop a heightened awareness of what professional behavior is; these attitudes should be maintained and reinforced during the rest of their training. For this, the curriculum will be expanded to include formative activities during the other three years. An evaluation instrument to measure student performance on professionalism through medical school will be developed
EXPERIENCIA EN LA COMUNIDAD PARA LA PROMOCIÓN DE LA SALUD ORAL: UN CURSO VIVENCIAL El Centro Hispano de Excelencia de la Escuela de Odontología,
tiene como uno de sus objetivos el desarrollar en el estudiantado
y facultad la competencia cultural y el sentido de servicio a
través de experiencias vivenciales comunitarias. Para cumplir
con este objetivo, se desarrolló un curso titulado Promoción
de la Salud Oral en una Comunidad Especial. Este curso se ofreció
por primera vez en el periodo de mayo-agosto del 2004. Participaron
17 estudiantes de cuarto año de Odontología y se
trabajó en la Comunidad Especial San Isidro en Canóvanas,
PR. El curso fue diseñado desde una perspectiva multidisciplinaria
en la cual se tuvo la participación de líderes comunitarios
de San Isidro, Psicólogos/as, Educadores/as en Salud, Educadores
y Odontólogos/as. En el curso se discutieron temas relacionados
a la competencia cultural, trabajo efectivo en la comunidad, desarrollo
de planes de intervención, preparación de materiales
educativos apropiados, implantación de la reforma de salud
y servicios relacionados a la salud oral, y la función
del odontólogo/a en la promoción de la salud oral
en comunidades especiales. Se realizaron dos visitas a la comunidad
y se diseñaron las intervenciones a partir de los resultados
de un estudio de necesidades sobre la salud oral realizado en
la Comunidad San Isidro. De los resultados obtenidos en el estudio
de necesidades se identificó que la población a
atenderse en esta ocasión lo eran los/as estudiantes de
la escuela intermedia de la Comunidad. Se identificó la
necesidad de prevención de caries y problemas de ortodoncia.
El 100% de los/as estudiantes participantes indicó estar
muy satisfecho/a con la experiencia. Además, indicaron
que se deben desarrollar otros cursos y/o experiencias clínicas
en comunidades para exponer al estudiantado directamente al servicio
comunitario. El Rol Cambiante de la Comadrona en Puerto Rico desde el Siglo
XIII hasta el Presente El propósito del estudio fue investigar y analizar el
rol de la comadrona en la salud reproductiva de las mujeres puertorriqueñas
a través de la historia. Al momento no existe en Puerto
Rico ningún escrito que relate cómo surgieron y
evolucionaron las comadronas, ya que la información disponible
se encuentra fragmentada en diferentes archivos históricos.
Los objetivos principales son documentar la evolución de
las comadronas en Puerto Rico recopilando diversas fuentes, y
validar esos hallazgos mediante el uso de la historia oral con
entrevistas a comadronas. El beneficio primordial del estudio
es que, una vez la información esté compilada, ofrece
la oportunidad a otros profesionales de analizar los problemas
de salud desde diferentes perspectivas salubristas, mientras se
revela la presencia continua de la partería a través
de la historia. La información sobre las comadronas fue
recopilada de archivos históricos dispersos, y fue agrupada
en cuatro categorías: características de la práctica,
leyes/reglamentos, licenciatura/permisos, y adiestramientos. Luego
se preparó una guía de preguntas cubriendo las mismas
categorías, y fue suministrada a cuatro comadronas que
practicaron durante las décadas de los 40’s y 50’s
en diferentes áreas de Puerto Rico. La mayor parte de sus
respuestas coincidieron entre sí, y a la misma vez, validaron
los hallazgos históricos para la misma época. Al
finalizar el estudio, se obtuvo un documento que relata la historia
de las comadronas en Puerto Rico utilizando tanto archivos históricos,
como la propia voz de quienes fueron sus protagonistas, y cuyos
principios básicos se mantienen hasta el presente. Collaborative Mini Residence Programs for Faculty Development in Bioterrorism and Emergency Preparedness. Capriles, JA, Rabionet, S, and Estremera, L. University of Puerto Rico (UPR), Graduate School of Public Health. Health threats to the public are constantly emerging. During
a Bioterrorism event public health professional must assume a
leadership role. In collaboration with Emory Center for Public
Health Preparedness, the UPR Center will provide a mini residence
based at Rollins School of Public Health (RSPH), Emory, Atlanta;
for 4 University of Puerto Rico (UPR) faculty members. Objective:
The objectives were derived from the Bioterrorism and Emergency
Readiness Competencies for Public Health workers. Because the
needs of the participants will vary based upon their background
and future roles, each participant will work in collaboration
with an appropriate RSPH faculty mentor to determine his or her
specific objectives. Activities: Participants will attend seminars
in bioterrorism, interviews with educational and multimedia experts,
explore relationships of science, politics and policy, and discuss
local public health and emergency preparedness contemporary issues
with officials of the Georgia Division of Public Health. Results:
Mini residence is an excellent means to develop knowledge, skills
and attitudes toward Public Health Preparedness issues. This program
strengthens the relationship between both academic centers, and
the Puerto Rico Department of Health. Conclusion: The UPR will
develop new curricula for first responders, develop and adapt
training materials, and collaborate efficiently with the local
health department in public health preparedness and workforce
development. The identification of training needs and priorities
will be a continuous endeavor involving faculty and students from
the UPR Center. Case supporting our teaching that the etiology of Preeclampsia
is no longer unknown. It is difficult to explain why a disorder that complicates up
to 20% of first pregnancies has been allowed to remain unknown
regarding etiology. It might be because it is "cured"
by delivery, and because of the high survival rates of the prematurely
delivered newborns. We have proposed that Preeclampsia is caused
by polypeptides released by the trophoblast when PO2 declines
below 30 torr, and have suggested a cause related title for this
disorder, namely Hypoxic trophoblast produced capillary hypertension
(HTPCH). We have supported our hypothesis by demonstrating low
PO2 in the blood of umbilical vein of patients with HTPCH, and
observing marked improvement of the mother, when correction of
her hypovolemia and hemoconcentration, restored fetal PO2 (by
cordocentesis) toward norm. Our maximal prolongation of gestation
has been 5 wks (from 26 to 31). The following case demonstrates
the role of the trophoblast in HTPCH. Patient was young primigravida
at midgestation who was transferred directly to our Medical ICU
because of severe HTPCH, leading to marked pulmonary congestion.
In spite of the treatment given, her condition deteriorated. She
became hypotensive end hypoxic, with arterial PO2 of 40 torr in
spite of ventilation with 100% O2. She was declared moribund.
Our Department then decided to take her to the OR to remove the
population of the hypoxic trophoblast. One hour after supra-cervical
hysterectomy her PO2 had risen to 180 torr, and she had an uneventful
recovery. Hazards to use alpha adrenergic receptor blocking agents to treat
acute hypertension. There is no information why sudden rise in BP to above 300 torr
in normotensive individuals, as it occurs during strenuous exercise
e.g. weight lifting, never causes a "stroke". We have
proposed that it is due to alpha receptor mediated compensatory
vasoconstriction in cerebral arteries, since Force=Pressure X
Area. Because we never treat individuals with normal arterial
musculature with antihypertensive agents, except pregnant patients
with the so called Preeclampsia, the process of mandatory vasoconstriction
has escaped the attention of cardiologists. We are presenting
two cases to support our hypothesis that intact alpha adrenergic
receptors are essential to protect cerebral circulation during
acute hypertension. Isoformas del Gene de Fusión PML-RARa Parecen Modular
la Respuesta del Paciente de Leucemia Promielocítica Aguda
al Tratamiento con Acido Retinoico Los pacientes de leucemia promielocítica aguda (APL) presentan
varias isoformas del gene de fusión PML-RARa, y esta variación
genética parece modular la respuesta al tratamiento establecido
con ácido retinoico (ATRA). En el laboratorio estamos identificando
las isoformas de los pacientes de la Unidad de Hematología
del Hospital Universitario. Nuestro propósito es establecer
un perfil del paciente que incluya la isoforma del gen y relacionar
dicho perfil con su respuesta a tratamiento y la progresión
de la condición una vez terminado el tratamiento. Muestras
de sangre de los pacientes fueron sometidas a una extracción
de RNA, para establecer la expresión del gene de fusión
mediante RT-PCR. El 37.5 % de los pacientes tienen forma larga
(L),12% forma corta (S) y 37.5 % forma variable (V). El 100% de
los pacientes con forma corta (S), recayeron al menos una vez
en un periodo de dos años. Los pacientes con las otras
dos formas hasta el momento no han recaido. Estudiamos el caso
de un paciente que fue refractario dos veces a la terapia con
ATRA. En cada recaída se demostró la expresión
de la forma corta. Esto es cónsono con investigaciones
hechas en otros paises que parecen señalar que pacientes
con dicha isoforma demuestran remisiones cortas. Nuestros resultados
sugieren que la caracterización molecular puede ser un
arma adicional para poder identificar los subgrupos de APL que
sean mas propensos a las recaídas y cuyo seguimiento debe
ser mas controlado. Efficacy of hydroxyurea in treatment of Puerto Rican children
with sickle cell anemia Hydroxyurea (HU) is very useful in treatment of adult patients
with sickle cell disease (Charache, 1995). Its use in children
has been limited due to concerns with long-term complications
regarding potential neoplastic effects (Zimmerman, 2004). A retrospective
study of pediatric sickle cell disease (SCD) patients treated
with HU was conducted to determine its efficacy in the management
of severe clinical manifestations. We analyzed 38 patients treated.
Their ages ranged from 14 months to 17 years, mean (M) 5.76 yrs;
duration of therapy from 6 to 96 months (M= 36.2 months). 23 (74.2%)
patients with >1 year therapy showed significant improvement
in clinical course (p<0.05); mean optimal HU dose 23.7 mg/kg/day.
23 (74.2%) showed a reduction in WBC and increase in MCV respectively.
Nineteen (79.2%) of twenty-four had increase in fetal hemoglobin
levels after 6 months of therapy (mean increase: 2.52 times baseline
levels), 9 (47.4%) with levels above 16%. Only 3 (8%) patients
developed significant neutropenia (ANC <1,500/mm³) that
resolved after decreasing or discontinuing medication. No dermatologic,
hepatic or renal side effects were noticed, except for mild ALT
increase in 2 (5.3%) patients. Our study showed the efficacy of
hydroxyurea diminishing the severity of clinical course in children
with SCD, without evidence of serious side effects, even in patients
who started treatment at an early age. Bleeding and Closure Times as Measures of Bleeding Diathesis
in Hermansky-Pudlak Syndrome and VonWillebrand disease Diltiazem as an effective therapy in preparation for pheochromocytoma
surgery Hypertensive crisis can be a devastating event during surgery
for a pheochromocytoma (PHEO). Alpha blockade with phenoxybenzamine
has been established as the standard preparation before surgery.
The safety use of alternate means of therapy such as calcium channel
blockers has been attempted with variable results. An 11 year
old boy presented with episodes of dizziness, paleness and excruciating
headaches on voiding since 1½ years before evaluation.
Symptoms became worse as time went by. A 24 hour urine collection
revealed increased norepinephrine levels at 3,566 pg/ml (nl 0-399)
and normetanephrine 4.18 nmol/l (nl<0.9) with normal epinephrine
(23 pg/ml, nl 0-99) and metanephrine levels (<0.20 nmol/l,
nl <0.50). Further studies included normal calcitonin serum
levels (8.5 pg/ml, nl <11.5) and intact PTH molecule (37 pg/ml).
An abdominopelvic MRI revealed the presence of a mass anterior
to the bladder. An Octreoscan --positive for Somatostatin receptors--
imaging study confirmed the solely presence of a mass at the described
location. He was admitted to the pediatric ward where calcium
channel blockade with diltiazem was pursued along with intravenous
aggressive hydration. He underwent surgical excision of the bladder
PHEO under general anesthesia with peak blood pressures registered
at no higher than 140/75 mmHg. Post surgical course was uneventful
without requiring further antihypertensive therapy. In summary,
a boy with bouts of headaches secondary to the release of cathecolamines
from a bladder (extra adrenal) phechromocytoma is presented. We
conclude that calcium channel blockers may be safely employed
in preparation for pheochromocytoma surgery. Comunidad de Cantera: Oportunidades y retos para el aprendizaje de Enfermería La practica de la enfermería en la comunidad, como experiencia
de aprendizaje permite a los estudiantes de enfermería
aumentar sus conocimientos mediante la aplicación de destrezas.
Los objetivos de intervención: Realizar estimado de necesidades
de salud de la comunidad, desarrollar intervenciones de enfermería
basadas en necesidades identificadas, evaluar el impacto de las
intervenciones. La metodología utilizada en la fase inicial
consistió de revisión de literatura, recopilación
de datos de la comunidad mediante proceso de entrevistas y aplicación
de instrumentos para determinar necesidades. En la segunda fase
se elaboró un perfil de los participantes y se desarrolló
un plan de intervención de enfermería en colaboración
con miembros de la comunidad. En la fase final se implemento el
plan desarrollado, se realizo la evaluación y se diseminaron
los resultados. La muestra estuvo constituída por participantes
del Centro Cultural y de Servicios de Cantera: preescolares, envejecientes
y diez familias de Cantera. Los hallazgos relevantes en el grupo
de preescolares: déficit de conocimientos relacionados
a higiene del ambiente y personal, manejo de emociones inadecuada
y problemas de autoestima. Se manifestó la necesidad de
conocimiento sobre manejo y control de la diabetes, problemas
de estima propia y de soledad entre los participantes del grupo
de envejecientes. En las familias se detectó pobre conocimiento
de estilos de vida saludables, condiciones de salud y auto cuidado.
Algunas intervenciones realizadas: referidos, educaciones estructuradas
sobre estilos de vida saludable, autoestima, autocuidado, estrategias
de adherencia, clínicas de detección temprana. INTERNATIONAL COLLABORATION FOR THE DEVELOPMENT OF A WEB-BASED CLINICAL CASE SIMULATION The purpose of this session is to illustrate the World Wide Health
Information System Simulation Linkage (WHISSL) project, which
is an international experiment in the development and dissemination
of web-based educational software managed by The University of
Texas Medical Branch. The Bureau of Health Professions (HRSA)
funds this project. It is based on a problem solving educational
strategy; its main goal is to encourage the student to search
for optimal treatments taking into consideration the patients
community, income and cultural expectations. The program is a
source of simulated patients with whom health science students
can interact through a variety of assignments. In this session
the presenters will describe how the case was developed and how
it can be incorporated into discipline-specific courses dealing
with rehabilitation and primary care patient management. PARTICIPACIÓN SOCIAL EN SALUD. HERRAMIENTA DE GESTIÓN EN CENTROS ASISTENCIALES DE UNA RED DE SALUD Estudio de intervención, descriptivo, correlacional y de corte transversal, cuyo propósito fue la implementación de una propuesta de participación social en salud, a fin de ver y analizar como la comunidad aprovecha los espacios de la participación social bajo la gestión pública de los Servicios de Salud que se prestan, con un enfoque participativo. El universo estuvo constituido por la población de la provincia de Arauco en la Octava Región, Chile N=175.000 habitantes, se trabajo con una muestra aleatoria simple, N=825 personas. Para el análisis de datos de utilizó la modelización de variables por la regresión logística múltiple, permitiendo obtener: varianza y variabilidades de cada una de las variables, además la prueba de significación estadística; Chi Cuadrado. Como instrumento recolector de datos se utilizó un cuestionario, el cual previo a su aplicación fue validado por: (criterios de jueces, grupo focal y prueba piloto). Los resultados indicaron que el 73.4% de la población estudiada tiene alta aceptación por las actividades diseñadas en la propuesta de participación social, y alto empoderamiento y sostenibilidad de las actividades que se desarrollan en el interior de la provincia. Un 58.9% de la población en estudio reconoció que existen los espacios de participación social en salud y un 72% opina que se toman en cuenta sus opiniones en los consejos de desarrollo como órgano asesor del directivo del establecimiento de salud. El estudio de esta temática, experiencias prácticas y de impacto, en Latinoamérica y en particular en Chile, son prácticamente inexistentes, por ello la importancia de poder dar a conocer los resultados de una experiencia de trabajo validada científicamente, donde se dieron respuesta a las interrogantes siguientes: ¿Están creados los espacios de Participación Social en Salud y son estos aprovechados por la comunidad? ¿Son realmente las actividades diseñadas por la Unidad de Promocion de la Salud y Participación Social, las optimas para empoderar a la comunidad en los temas de participación social?. Palabras claves: Participación Social en Salud. A CAREER IN CLINICAL RESEARCH: UNIQUE OPPORTUNITY TO MAKE A DIFFERENCE Estela S Estapé, MT, PhD, José Rodríguez Orengo, PhD, Maria T. San Martin, MT, MS and Barbara Segarra, MT, MS., College of Health Related Professions and School of Medicine, Medical Sciences Campus, University of Puerto Rico The Medical Sciences Campus is offering a Post-doctoral Master of Science and Graduate Certificate program in clinical research. These programs are offered as joint degrees by the School of Medicine and College of Health Related Professions. Other partners in the development and implementation of these programs are the academic units of the Medical Sciences Campus, Mayo Clinic at Rochester, San Juan Veteran’s Administration Medical Center and the Puerto Rico Department of Health. Priority for admission is given to faculty from MSC or SJVAMC. The program prepares investigators who will be able to lead and expand clinical research at the UPR-MSC and other partner institutions by a well designed curriculum, selected group of faculty in order to develop competitive research applications for funding as well as an effective presentation and communication of scientific knowledge and findings. As part of the admission process for the post-doctoral master, applicants are required to select their research focus in one of the following health conditions: cancer, diabetes, HIV, oral health, cardiovascular and respiratory diseases; all of which are considered as health disparities for the Hispanic population. The post-doctoral master and graduate certificate in clinical research are unique multidisciplinary academic offerings that will facilitate research interaction among disciplines and enhance the team approach to problem solving. A brief background of the implementation process as well as the description of the first two years experience in relation to admissions, program components, research projects, and future initiatives, will be presented and discussed. The program is mainly supported by a career development grant
(CRECD) from the National Center for Research Resources, National
Institutes of Health (1R25RR17589). Judging Clinical Competencies in Pediatrics in Third Year Medical Studients Purpose: An OSCE is a useful method for measuring the student’s ability to identify clinical problems, analyze and apply clinical knowledge in practice. The evaluation of applied knowledge is a formidable task during the clinical years at any medical school. Pediatric patients present a challenge to medical students. During the third year pediatric clerkship there is a need to evaluate students clinical thinking and management skills using clinical cases. A variety of clinical cases were created to perform summative evaluation at an OSCE at the end of our 9 week Pediatric Clerkship. Methods: The OSCE was designed to contain 3 different stations. Each station evaluates different objectives using standaridized patients (SP’s) and baby manikins. During the last 2.5 years a total of 19 cases have been created. Each exam has a new set of clinical vignettes. The first station evaluates the health maintenance topic, patient education and management; the second station evaluates applied clinical knowledge in common pediatric illnesses, management and patient education; the third station evaluates adolescent topics, physical exam skills, patient education, management and how to write a prescription. All cases evaluate communication skills. Other topics integrated and evaluated within the cases are: nutrition, child abuse, managed care and radiology. 17 minutes were used for each station. The components of competence were assessed in a planed or structured way. Results: During the last 2.5 years 272 students were evaluated. 96.69%
approved the exam on the first take. The mean score is 92.5%. Conclusion: The OSCE is a useful method for evaluation of medical students.
A pediatric OSCE is a challenging experience for them. This evaluation
method can also detect the weakness points of students. It also
helps in guiding and developing student’s performance by
using a structured and planned summative examination. Third year
OSCE’s also help students prepare for their 4th year CPX
and for the USMLE step 2 CS exam. Creación de Cursos en Línea en Profesiones de la Salud: Modelo Educativo que Incorpora la Tecnología. C. Ortiz, MBA; R. García, Ph.D, A. Castro, M.S. Proyecto Título V, Oficina del Rector, Recinto de Ciencias Médicas, Universidad de Puerto Rico, Puerto Rico. La falta de destrezas en computadoras de estudiantes y facultad; y la dificultad de incorporar las tecnologías de información en los programas de la salud fundamentan el Componente de Tecnologías de Información del Proyecto Título V. Entre los objetivos del mismo está el que un grupo de 50 profesores de las escuelas a las que este sirve desarrollen las destrezas necesarias para diseñar y crear cursos en línea. Como estrategia a los profesores se les: invita a someter propuestas competitivas; selecciona según las propuestas; ofrece una serie de diez talleres en teoría de educación a distancia, diseño instruccional y la plataforma Blackboard; asesora durante seis meses de manera individualizada en el diseño y la creación de los cursos propuestos. Los resultados son: tres grupos de profesores capacitados y un cuarto grupo en el proceso de capacitación para un total de 25; diseño y creación de 25 cursos en línea en una variedad de profesiones de la salud; desarrollo de un grupo interdisciplinario de profesores que conocen y utilizan esta modalidad. En conclusión la creación de cursos en línea en las profesiones de la salud es un modelo educativo que incorpora la tecnología y coloca al profesor como uno que facilita el proceso de aprendizaje, modelo esencial para ampliar los ofrecimientos dentro de escenarios no tradicionales permanentes o temporeros, Subvencionado por el Programa Título V del Departamento de Educación Federal a través del “Grant” PO31S010027
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