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San Juan, Puerto Rico

Martinez J.H.,San Juan City Hospital
Boletín de la Asociación Médica de Puerto Rico | Year: 2013

Nontoxic goiter is a diffuse or nodular enlargement of the thyroid gland that does not result from an inflammatory or neoplastic process and is not associated with abnormal thyroid function. Familial forms of goiter in areas not known to feature iodine deficiency are much less common. However, not all individuals in the same iodine deficiency region develop goiter and iodine supplementation does not prevent goiter development in all treated individuals. The etiology of euthyroid goiter is still incompletely understood. It is assumed that the development of goiter depends on various interactions between genetic and environmental factors. We present an overview on the thyroid physiology, which is important for a better understanding of Familial Euthyroid Multinodular Goiter. Source

Guzman L.,San Juan City Hospital
Boletín de la Asociación Médica de Puerto Rico | Year: 2013

Chylous jejunal cysts are extremely rare entities and if not diagnosed promptly may lead to severe complications like bowel obstruction, loss of small bowel and even death. We present the case of a 4 year-old-male referred to our institution with severe abdominal pain, constipation, abdominal distention and radiological findings of large amount of fluid in the lower abdomen with associated bowel obstruction. Operative findings were that of large chylous jejunal cyst causing segmental volvulus. Resection of the involved jejunal segment and cyst along with bowel detorsion was undertaken. Literature review on the subject follows. Source

Fernandez Gonzalez F.,San Juan City Hospital
Boletín de la Asociación Médica de Puerto Rico | Year: 2013

The inappropriate antibiotic can lead to serious negative effects on health. This has been the cause of emergence of multidrug resistant bacteria and the need of surveillance of antibiotics in the inpatient setting. An adequate knowledge on which and when prescribing antibiotics is essential to avoid these issues. Because of this problems, guidelines have been developed to educate and control the misuse and abuse of antibiotics and improve clinical outcomes. We evaluated the medical knowledge, medical trends, and the effectiveness of professional interventions among Puerto Rico physicians in promoting prudent antibiotic prescribing. A comparative study was performed using a questionnaire about prudent antibiotic use in common infections seen in Puerto Rico. It was distributed among the major three internal medicine training programs at San Juan, internal medicine physicians and general physicians. General physicians failed to treat adequately asymptomatic bacteriuria, and overall failed in treating other common conditions when compared with residents and internal medicine physicians. One of our questions was related to the treatment of Extended Spectrum Beta Lactamase (ESBL) positive Escherichia coli (E. coli) and more than 50% of the surveyed failed to answer the question correctly. Conditions as viral respiratory tract infections and community acquired pneumonia had the higher correctly answered questions among the groups. Our questionnaire demonstrates that guidelines have to reach the education among the general physician population to decrease the overuse of inadequate antibiotics, and education should be strengthen on those internal medicine physicians that have already completed formal training. Source

Palermo-Garofalo C.,San Juan City Hospital
Boletín de la Asociación Médica de Puerto Rico | Year: 2013

Amiodarone is used in a large number of cardiac conditions. Amiodarone-induced thyroid dysfunction has been reported to affect up to 20% of users. Amiodarone can lead to both amiodarone-induced hypothyroidism (AIH) and less commonly amiodarone-induced thyrotoxicosis (AIT). There are two main forms of AIT. Type 1 AIT, a form of io-dine-induced hyperthyroidism, and type 2, a drug-induced destructive thyroiditis. Type 1 AIT develops on individuals with underlying thyroid disease. Treatment of Type 1 AIT includes the use of antithyroid drugs and discontinuation of amiodarone. Type 2 AIT is commonly self-limiting in nature. In this article wedescribe a patient with Amiodarone-induced thyrotoxicosis discussing its clinical features and medical therapeutic approach. Source

Pereira O.M.,San Juan City Hospital
Boletín de la Asociación Médica de Puerto Rico | Year: 2013

To describe the pregnancy and neonatal outcomes of women receiving 17alpha-hydroxyprogesterone to prevent subsequent preterm birth in our institution. Forty-two patient received treatment by VITA healthcare and their charts were reviewed for results and outcomes. An increase in average gestational age at the time of delivery was noticed as well as an increase in weeks gained compared to previous preterm birth. More than 75% of the patients prolonged their pregnancy with the use of 17alpha-hydroxyprogesterone. Continuation of the study and stratifying patients will help in identifying other risk factors and establishing criteria for improved prevention of preterm birth and prognosis. Source

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