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Vol. 1 No. 1 (2025): Ponce Health Sciences University Scientific Journal - First Issue
Articles
Abstract
Amid the 2019 coronavirus (COVID-19) pandemic, regional disparities in outcomes were identified as crucial for an effective public health response. Regional variations in COVID-19 outcomes in the United States of America (USA) were studied in this retrospective cross-sectional analysis, with a focus on in-hospital mortality rates among COVID-19 patients with pneumonia or respiratory failure, using the 2021 National Inpatient Sample dataset. Patients aged ≥18 years with confirmed diagnoses of COVID-19 associated pneumonia or respiratory failure were included in the study. The association between hospital census regions and in-hospital mortality rates was examined using multivariate logistic regression, adjusting for demographic, clinical, and hospital characteristics. Significant disparities in regional COVID-19 outcomes in the USA were revealed by the results. Mortality rates in the COVID-19 study cohort ranged from 14% in the Midwest to 18% in the West. Adjusted significant differences were shown by regression analysis, with the West exhibiting up to 28% higher odds of death (odds ratio: 1.28, 95% confidence interval: 1.218–1.354, p<0.001) than the Midwest, the region with the lowest mortality. The importance of accounting for demographic, clinical, and contextual factors in understanding these disparities and addressing regional disparities to promote health equity during the ongoing pandemic was underscored by these substantial regional variations in COVID-19 mortality rates in the USA.
Author: José A. Acosta, MD, MBA, MPH
DOI: https://doi.org/10.71332/5rnhnz41
Keywords: COVID-19 pneumonia mortality rates, National Inpatient Sample, Regional disparities, Respiratory failure
References
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Bollyky, T.J.; Castro, E.; Aravkin, A.Y.; Bhangdia, K.; Dalos, J.; Hulland, E.N.; Kiernan, S.; Lastuka, A.; McHugh, T.A.; Ostroff, S.M. Assessing COVID-19 pandemic policies and behaviours and their economic and educational trade-offs across US states from Jan 1, 2020, to July 31, 2022: an observational analysis. The Lancet 2023, 401, 1341-1360, DOI:http://dx.doi.org/10.1016/S0140-6736(23)00461-0.
Eiermann, M.; Wrigley-Field, E.; Feigenbaum, J.J.; Helgertz, J.; Hernandez, E.; Boen, C.E. Racial Disparities in Mortality During the 1918 Influenza Pandemic in United States Cities. Demography 2022, 59, 1953-1979, DOI:http://dx.doi.org/10.1215/00703370-10235825.
Andrulis, D.P.; Siddiqui, N.J.; Purtle, J.; Cooper, M.R. H1N1 influenza pandemic and racially and ethnically diverse communities in the United States. 2012.
Masiano, S.P.; Martin, E.G.; Bono, R.S.; Dahman, B.; Sabik, L.M.; Belgrave, F.Z.; Adimora, A.A.; Kimmel, A.D. Suboptimal geographic accessibility to comprehensive HIV care in the US: regional and urban-rural differences. J Int AIDS Soc 2019, 22, e25286, DOI:http://dx.doi.org/10.1002/jia2.25286.
Isath, A.; Malik, A.H.; Goel, A.; Gupta, R.; Shrivastav, R.; Bandyopadhyay, D. Nationwide Analysis of the Outcomes and Mortality of Hospitalized COVID-19 Patients. Curr Probl Cardiol 2023, 48, 101440, DOI:http://dx.doi.org/10.1016/j.cpcardiol.2022.101440.
FDA Approves First COVID-19 Vaccine Approval Signifies Key Achievement for Public Health. Available online: https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine (accessed on 2 April 2024).
Bast, E.; Tang, F.; Dahn, J.; Palacio, A. Increased risk of hospitalisation and death with the delta variant in the USA. The Lancet Infectious Diseases 2021, 21, 1629-1630, DOI:http://dx.doi.org/10.1016/S1473-3099(21)00685-X.
Khera, R.; Angraal, S.; Couch, T.; Welsh, J.W.; Nallamothu, B.K.; Girotra, S.; Chan, P.S.; Krumholz, H.M. Adherence to methodological standards in research using the national inpatient sample. JAMA 2017, 318, 2011-2018, DOI:http://dx.doi.org/10.1001/jama.2017.17653.
MapChart. Available online: https://www.mapchart.net/usa.html (accessed on 4 April 2024).
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McCormick, P.J.; Lin, H.M.; Deiner, S.G.; Levin, M.A. Validation of the All Patient Refined Diagnosis Related Group (APR-DRG) Risk of Mortality and Severity of Illness Modifiers as a Measure of Perioperative Risk. J Med Syst 2018, 42, 81, DOI:http://dx.doi.org/10.1007/s10916-018-0936-3.
HCUP. NIS Description of Data Elements - FEMALE Available online: https://hcup-us.ahrq.gov/db/vars/female/nisnote.jsp#general (accessed on 6 April 2024).
HCUP. ZIPINC_QRTL - Median household income for patient's ZIP Code (based on current year) Available online: https://hcup-us.ahrq.gov/db/vars/zipinc_qrtl/nisnote.jsp (accessed on 27 March 2024).
3M™ All Patient Refined Diagnosis Related Groups (APR DRGs). . Available online: https://www.3m.com/3M/en_US/health-information-systems-us/drive-value-based-care/patient-classification-methodologies/apr-drgs/ (accessed on April 6, 2024).
NIS Overview. Available online: https://hcup-us.ahrq.gov/nisoverview.jsp (accessed on April 6, 2024).
Wordtune AI21 Labs, 2024. Available online: https://www.wordtune.com/ (accessed on April 6, 2024).
OpenAI (2020). Chatbot GPT-4. OpenAI. . Available online: https://chat.openai.com/ (accessed on 6 June 2024).
Vandenbroucke, J.P.; von Elm, E.; Altman, D.G.; Gotzsche, P.C.; Mulrow, C.D.; Pocock, S.J.; Poole, C.; Schlesselman, J.J.; Egger, M.; Initiative, S. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg 2014, 12, 1500-1524, DOI:http://dx.doi.org/10.1016/j.ijsu.2014.07.014.
Vardar, U.; Ilelaboye, A.; Murthi, M.; Atluri, R.; Park, D.Y.; Khamooshi, P.; Ojemolon, P.E.; Shaka, H.; Khamooshi, P. Racial Disparities in Patients With COVID-19 Infection: A National Inpatient Sample Analysis. Cureus 2023, 15, e35039, DOI:http://dx.doi.org/10.7759/cureus.35039.
Vallabhajosyula, S.; Patlolla, S.H.; Dunlay, S.M.; Prasad, A.; Bell, M.R.; Jaffe, A.S.; Gersh, B.J.; Rihal, C.S.; Holmes Jr, D.R.; Barsness, G.W. Regional variation in the management and outcomes of acute myocardial infarction with cardiogenic shock in the United States. Circulation: Heart Failure 2020, 13, e006661, DOI:http://dx.doi.org/10.1161/CIRCHEARTFAILURE.119.006661.
Mullins, R.J.; Diggs, B.S.; Hedges, J.R.; Newgard, C.D.; Arthur, M.; Adams, A.L.; Veum-Stone, J.; Lenfesty, B.; Trunkey, D.D. Regional Differences in Outcomes for Hospitalized Injured Patients. Journal of Trauma and Acute Care Surgery 2006, 60, 691-700, DOI:http://dx.doi.org/10.1097/01.ta.0000210454.92078.89.
Kolte, D.; Khera, S.; Aronow, W.S.; Palaniswamy, C.; Mujib, M.; Ahn, C.; Iwai, S.; Jain, D.; Sule, S.; Ahmed, A. Regional variation in the incidence and outcomes of in-hospital cardiac arrest in the United States. Circulation 2015, 131, 1415-1425, DOI:http://dx.doi.org/10.1161/CIRCULATIONAHA.114.014542.
Kim, S.J.; Medina, M.; Zhong, L.; Chang, J. Factors associated with in-hospital death among pneumonia patients in US hospitals from 2016~ 2019. International Journal of Health Policy and Management 2023, 12, DOI:http://dx.doi.org/10.34172/ijhpm.2023.7390.
Roth, G.A.; Emmons-Bell, S.; Alger, H.M.; Bradley, S.M.; Das, S.R.; de Lemos, J.A.; Gakidou, E.; Elkind, M.S.V.; Hay, S.; Hall, J.L.; et al. Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic. JAMA Network Open 2021, 4, e218828-e218828, DOI:http://dx.doi.org/10.1001/jamanetworkopen.2021.8828.
Rosenthal, N.; Cao, Z.; Gundrum, J.; Sianis, J.; Safo, S. Risk factors associated with in-hospital mortality in a US national sample of patients with COVID-19. JAMA network open 2020, 3, e2029058-e2029058, DOI:http://dx.doi.org/10.1001/jamanetworkopen.2020.29058.
Lurie, N.; Sharfstein, J.M. State-to-state differences in US COVID-19 outcomes: searching for explanations. The Lancet 2023, 401, 1314-1315, DOI:http://dx.doi.org/10.1016/S0140-6736(23)00726-2.
Bechman, K.; Yates, M.; Mann, K.; Nagra, D.; Smith, L.-J.; Rutherford, A.I.; Patel, A.; Periselneris, J.; Walder, D.; Dobson, R.J. Inpatient COVID-19 mortality has reduced over time: results from an observational cohort. PloS one 2022, 17, e0261142, DOI:http://dx.doi.org/10.1371/journal.pone.0261142.
Ibuka, Y.; Matsuda, Y.; Shoji, K.; Ishigaki, T. Evaluation of regional variations in healthcare utilization. Japanese Journal of Statistics and Data Science 2020, 3, 349-365.
Couillard, B.K.; Foote, C.L.; Gandhi, K.; Meara, E.; Skinner, J. Rising geographic disparities in US mortality. Journal of Economic Perspectives 2021, 35, 123-146.
Duong, W.Q.; Grigorian, A.; Farzaneh, C.; Nahmias, J.; Chin, T.; Schubl, S.; Dolich, M.; Lekawa, M. Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region. The American Surgeonâ„¢ 2021, 87, 988-993, DOI:http://dx.doi.org/10.1177/0003134820960063.
Hanna, D.B.; Selik, R.M.; Tang, T.; Gange, S.J. Disparities among US states in HIV-related mortality in persons with HIV infection, 2001–2007. Aids 2012, 26, 95-103.
Singh, G.K.; Azuine, R.E.; Siahpush, M.; Williams, S.D. Widening geographical disparities in cardiovascular disease mortality in the United States, 1969-2011. International Journal of MCH and AIDS 2015, 3, 134.
O’Keefe, E.B.; Meltzer, J.P.; Bethea, T.N. Health disparities and cancer: racial disparities in cancer mortality in the United States, 2000–2010. Frontiers in public health 2015, 3, 51.
Dugani, S.B.; Wood-Wentz, C.M.; Mielke, M.M.; Bailey, K.R.; Vella, A. Assessment of disparities in diabetes mortality in adults in US rural vs nonrural counties, 1999-2018. JAMA network open 2022, 5, e2232318-e2232318.
Kirby, J.B.; Taliaferro, G.; Zuvekas, S.H. Explaining racial and ethnic disparities in health care. Medical care 2006, 44, I-64-I-72.
Fiscella, K.; Sanders, M.R. Racial and ethnic disparities in the quality of health care. Annual review of public health 2016, 37, 375-394.
Lazar, H.L. Administrative databases for outcomes research-quick, easy, but dirty. J Card Surg 2017, 32, 757, DOI:http://dx.doi.org/10.1111/jocs.13380.
Introduction to the HCUP National Inpatient Sample (NIS) 2021. Available online: https://hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2021.jsp (accessed on 29 March 2024).
Abstract
Minimally invasive techniques for lumbar spinal fusions have evolved significantly to treat lumbar spinal stenosis, degenerative spondylolisthesis, and many other complex conditions. This study evaluates the clinical outcomes of patients aged 65 and older who underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with robotic assistance. In this single-surgeon single-institution retrospective cohort study, 72 patients aged 65 and older who underwent MIS-TLIF from 2018 to 2021 were analyzed. Patients had diagnoses of lumbar spinal stenosis, with or without degenerative spondylolisthesis. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and lower extremities at baseline, and 6, 9, or 12 months postoperatively. The data was analyzed, and outcomes were compared using paired t-tests. Significant improvements in disability were observed postoperatively, with mean ODI scores decreasing from 46.4% to 9.3% (95% CI: -41.2, -33.1). In terms of pain intensity, mean VAS scores for back pain decreased from 8.0 to 3.5 (95% CI: -5.1, -3.9) and leg pain scores also decreased from 8.2 to 2.9 (95% CI: -5.9, -4.6). These changes indicate substantial clinical improvements (p < 0.001). This study substantiates the efficacy of MIS-TLIF in significantly improving pain relief and functional mobility among seniors with lumbar conditions. The substantial reductions in ODI and VAS scores highlight its clinical benefits potential to set a new standard of care. By offering a robotically assisted, minimally invasive alternative, this approach aligns with contemporary healthcare objectives of enhancing patient recovery while minimizing procedural risks and costs.
Authors:
- Emil Varas-Rodríguez
- Gabriel González-Díaz
- Alexander Matos
- Miguel Cartagena
- Oscar Duyos
DOI: https://doi.org/10.71332/qwffpj20
Keywords: MIS-TLIF, Robotic Spine Surgery, Lumbar Stenosis, Degenerative Spondylolisthesis, Elderly Patient Care, Spinal Fusion, Postoperative Outcomes, Quality of Life, Orthopedics
References
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Wang, Michael Y et al. “An analysis of the differences in the acute hospitalization charges following minimally invasive versus open posterior lumbar interbody fusion.” Journal of neurosurgery. Spine vol. 12,6 (2010): 694-9. doi:10.3171/2009.12.SPINE09621.
Dhall, Sanjay S et al. “Clinical and radiographic comparison of mini-open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up.” Journal of neurosurgery. Spine vol. 9,6 (2008): 560-5. doi:10.3171/SPI.2008.9.08142.
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Fu, Kai-Ming G et al. “Correlation of higher preoperative American Society of Anesthesiology grade and increased morbidity and mortality rates in patients undergoing spine surgery.” Journal of neurosurgery. Spine vol. 14,4 (2011): 470-4. doi:10.3171/2010.12.SPINE10486.
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Jang, Jee-Soo, and Sang-Ho Lee. “Minimally invasive transforaminal lumbar interbody fusion with ipsilateral pedicle screw and contralateral facet screw fixation.” Journal of neurosurgery. Spine vol. 3,3 (2005): 218-23. doi:10.3171/spi.2005.3.3.0218.
Deutsch, Harel, and Michael J Musacchio Jr. “Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation.” Neurosurgical focus vol. 20,3 E10. 15 Mar. 2006, doi:10.3171/foc.2006.20.3.11.
Masiano, S.P.; Martin, E.G.; Bono, R.S.; Dahman, B.; Sabik, L.M.; Belgrave, F.Z.; Adimora, A.A.; Kimmel, A.D. Suboptimal geographic accessibility to comprehensive HIV care in the US: regional and urban-rural differences. J Int AIDS Soc 2019, 22, e25286, DOI:http://dx.doi.org/10.1002/jia2.25286.
Isath, A.; Malik, A.H.; Goel, A.; Gupta, R.; Shrivastav, R.; Bandyopadhyay, D. Nationwide Analysis of the Outcomes and Mortality of Hospitalized COVID-19 Patients. Curr Probl Cardiol 2023, 48, 101440, DOI:http://dx.doi.org/10.1016/j.cpcardiol.2022.101440.
FDA Approves First COVID-19 Vaccine Approval Signifies Key Achievement for Public Health. Available online: https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine (accessed on 2 April 2024).
Bast, E.; Tang, F.; Dahn, J.; Palacio, A. Increased risk of hospitalisation and death with the delta variant in the USA. The Lancet Infectious Diseases 2021, 21, 1629-1630, DOI:http://dx.doi.org/10.1016/S1473-3099(21)00685-X.
Khera, R.; Angraal, S.; Couch, T.; Welsh, J.W.; Nallamothu, B.K.; Girotra, S.; Chan, P.S.; Krumholz, H.M. Adherence to methodological standards in research using the national inpatient sample. JAMA 2017, 318, 2011-2018, DOI:http://dx.doi.org/10.1001/jama.2017.17653.
MapChart. Available online: https://www.mapchart.net/usa.html (accessed on 4 April 2024).
Quan, H.; Sundararajan, V.; Halfon, P.; Fong, A.; Burnand, B.; Luthi, J.-C.; Saunders, L.D.; Beck, C.A.; Feasby, T.E.; Ghali, W.A. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical care 2005, 43, 1130-1139, DOI:http://dx.doi.org/10.1097/01.mlr.0000182534.19832.83.
McCormick, P.J.; Lin, H.M.; Deiner, S.G.; Levin, M.A. Validation of the All Patient Refined Diagnosis Related Group (APR-DRG) Risk of Mortality and Severity of Illness Modifiers as a Measure of Perioperative Risk. J Med Syst 2018, 42, 81, DOI:http://dx.doi.org/10.1007/s10916-018-0936-3.
HCUP. NIS Description of Data Elements - FEMALE Available online: https://hcup-us.ahrq.gov/db/vars/female/nisnote.jsp#general (accessed on 6 April 2024).
HCUP. ZIPINC_QRTL - Median household income for patient's ZIP Code (based on current year) Available online: https://hcup-us.ahrq.gov/db/vars/zipinc_qrtl/nisnote.jsp (accessed on 27 March 2024).
3M™ All Patient Refined Diagnosis Related Groups (APR DRGs). . Available online: https://www.3m.com/3M/en_US/health-information-systems-us/drive-value-based-care/patient-classification-methodologies/apr-drgs/ (accessed on April 6, 2024).
NIS Overview. Available online: https://hcup-us.ahrq.gov/nisoverview.jsp (accessed on April 6, 2024).
Wordtune AI21 Labs, 2024. Available online: https://www.wordtune.com/ (accessed on April 6, 2024).
OpenAI (2020). Chatbot GPT-4. OpenAI. . Available online: https://chat.openai.com/ (accessed on 6 June 2024).
Vandenbroucke, J.P.; von Elm, E.; Altman, D.G.; Gotzsche, P.C.; Mulrow, C.D.; Pocock, S.J.; Poole, C.; Schlesselman, J.J.; Egger, M.; Initiative, S. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg 2014, 12, 1500-1524, DOI:http://dx.doi.org/10.1016/j.ijsu.2014.07.014.
Vardar, U.; Ilelaboye, A.; Murthi, M.; Atluri, R.; Park, D.Y.; Khamooshi, P.; Ojemolon, P.E.; Shaka, H.; Khamooshi, P. Racial Disparities in Patients With COVID-19 Infection: A National Inpatient Sample Analysis. Cureus 2023, 15, e35039, DOI:http://dx.doi.org/10.7759/cureus.35039.
Vallabhajosyula, S.; Patlolla, S.H.; Dunlay, S.M.; Prasad, A.; Bell, M.R.; Jaffe, A.S.; Gersh, B.J.; Rihal, C.S.; Holmes Jr, D.R.; Barsness, G.W. Regional variation in the management and outcomes of acute myocardial infarction with cardiogenic shock in the United States. Circulation: Heart Failure 2020, 13, e006661, DOI:http://dx.doi.org/10.1161/CIRCHEARTFAILURE.119.006661.
Mullins, R.J.; Diggs, B.S.; Hedges, J.R.; Newgard, C.D.; Arthur, M.; Adams, A.L.; Veum-Stone, J.; Lenfesty, B.; Trunkey, D.D. Regional Differences in Outcomes for Hospitalized Injured Patients. Journal of Trauma and Acute Care Surgery 2006, 60, 691-700, DOI:http://dx.doi.org/10.1097/01.ta.0000210454.92078.89.
Kolte, D.; Khera, S.; Aronow, W.S.; Palaniswamy, C.; Mujib, M.; Ahn, C.; Iwai, S.; Jain, D.; Sule, S.; Ahmed, A. Regional variation in the incidence and outcomes of in-hospital cardiac arrest in the United States. Circulation 2015, 131, 1415-1425, DOI:http://dx.doi.org/10.1161/CIRCULATIONAHA.114.014542.
Kim, S.J.; Medina, M.; Zhong, L.; Chang, J. Factors associated with in-hospital death among pneumonia patients in US hospitals from 2016~ 2019. International Journal of Health Policy and Management 2023, 12, DOI:http://dx.doi.org/10.34172/ijhpm.2023.7390.
Roth, G.A.; Emmons-Bell, S.; Alger, H.M.; Bradley, S.M.; Das, S.R.; de Lemos, J.A.; Gakidou, E.; Elkind, M.S.V.; Hay, S.; Hall, J.L.; et al. Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic. JAMA Network Open 2021, 4, e218828-e218828, DOI:http://dx.doi.org/10.1001/jamanetworkopen.2021.8828.
Rosenthal, N.; Cao, Z.; Gundrum, J.; Sianis, J.; Safo, S. Risk factors associated with in-hospital mortality in a US national sample of patients with COVID-19. JAMA network open 2020, 3, e2029058-e2029058, DOI:http://dx.doi.org/10.1001/jamanetworkopen.2020.29058.
Lurie, N.; Sharfstein, J.M. State-to-state differences in US COVID-19 outcomes: searching for explanations. The Lancet 2023, 401, 1314-1315, DOI:http://dx.doi.org/10.1016/S0140-6736(23)00726-2.
Bechman, K.; Yates, M.; Mann, K.; Nagra, D.; Smith, L.-J.; Rutherford, A.I.; Patel, A.; Periselneris, J.; Walder, D.; Dobson, R.J. Inpatient COVID-19 mortality has reduced over time: results from an observational cohort. PloS one 2022, 17, e0261142, DOI:http://dx.doi.org/10.1371/journal.pone.0261142.
Ibuka, Y.; Matsuda, Y.; Shoji, K.; Ishigaki, T. Evaluation of regional variations in healthcare utilization. Japanese Journal of Statistics and Data Science 2020, 3, 349-365.
Couillard, B.K.; Foote, C.L.; Gandhi, K.; Meara, E.; Skinner, J. Rising geographic disparities in US mortality. Journal of Economic Perspectives 2021, 35, 123-146.
Duong, W.Q.; Grigorian, A.; Farzaneh, C.; Nahmias, J.; Chin, T.; Schubl, S.; Dolich, M.; Lekawa, M. Racial and Sex Disparities in Trauma Outcomes Based on Geographical Region. The American Surgeonâ„¢ 2021, 87, 988-993, DOI:http://dx.doi.org/10.1177/0003134820960063.
Hanna, D.B.; Selik, R.M.; Tang, T.; Gange, S.J. Disparities among US states in HIV-related mortality in persons with HIV infection, 2001–2007. Aids 2012, 26, 95-103.
Singh, G.K.; Azuine, R.E.; Siahpush, M.; Williams, S.D. Widening geographical disparities in cardiovascular disease mortality in the United States, 1969-2011. International Journal of MCH and AIDS 2015, 3, 134.
O’Keefe, E.B.; Meltzer, J.P.; Bethea, T.N. Health disparities and cancer: racial disparities in cancer mortality in the United States, 2000–2010. Frontiers in public health 2015, 3, 51.
Dugani, S.B.; Wood-Wentz, C.M.; Mielke, M.M.; Bailey, K.R.; Vella, A. Assessment of disparities in diabetes mortality in adults in US rural vs nonrural counties, 1999-2018. JAMA network open 2022, 5, e2232318-e2232318.
Kirby, J.B.; Taliaferro, G.; Zuvekas, S.H. Explaining racial and ethnic disparities in health care. Medical care 2006, 44, I-64-I-72.
Fiscella, K.; Sanders, M.R. Racial and ethnic disparities in the quality of health care. Annual review of public health 2016, 37, 375-394.
Lazar, H.L. Administrative databases for outcomes research-quick, easy, but dirty. J Card Surg 2017, 32, 757, DOI:http://dx.doi.org/10.1111/jocs.13380.
Introduction to the HCUP National Inpatient Sample (NIS) 2021. Available online: https://hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2021.jsp (accessed on 29 March 2024).
Abstract
Prostate cancer (PCa) is the leading cause of cancer in Puerto Rican men and exhibits significant racial disparities globally. Although only 8% of cases invade beyond the prostate, predicting PCa aggressiveness is challenging. This study investigated the potential of the retinoblastoma tumor suppressor protein phosphorylated in Serine 249 (Phospho-Rb S249), N-cadherin, β-catenin, and E-cadherin as biomarkers for identifying aggressive PCa in Puerto Rican men. We hypothesized that the expression of these proteins could serve as biomarkers for identifying PCa tumors with potential to becoming aggressive in Puerto Rican men. Immunohistochemistry was performed on 23 biopsies from Puerto Rican men to evaluate the biomarkers’ expression, and correlation analyses examined associations with clinicopathological parameters. Results showed that Phospho-Rb S249 expression correlated positively with tumor size and positive cores in patients with Gleason scores ≥4+3. β-catenin was positively associated with tumor size and carcinoma percentage in Gleason scores >4+3. E-cadherin expression negatively correlated with grade group, indicating a protective role. In contrast, N-cadherin and β-catenin were more prominent in Gleason scores <3+4, hinting at their involvement in early epithelial-to-mesenchymal transition (EMT). A decision tree analysis identified N-cadherin expression as a key determinant for classifying PCa aggressiveness, with an 82% likelihood. These findings suggest N-cadherin as a biomarker for identifying PCa with the potential to become aggressive. While our study provides promising results, further validation in a larger patient cohort is needed to increase the robustness and reliability of our findings. Also, combining multiple biomarkers could further enhance the specificity of aggressive PCa detection.
Authors:
- Sheila M. Valle Cortés
- Jaileene Pérez Morales
- Mariely Nieves Plaza
- Raymond Quiñones Alvarado
- Gilberto Ruiz Deyá
- Juan C. Santa Rosario
- Pedro Santiago Cardona
DOI: https://doi.org/10.71332/wdwgem70
Keywords: Prostate cancer, B-catenin, Puerto Rico, Epitheliat-toMesenchymal Transition (EMT)
References
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Abstract
Physician burnout is a global concern, yet its prevalence among Puerto Rico’s surgeons remains underexplored. This study assesses burnout among orthopaedic surgeons working within the island’s strained healthcare system, marked by economic disparities, privatization, and physician exodus. A cross-sectional survey was conducted among 67 orthopaedic surgeons (over 60% of the island's workforce) and 27 romantic partners. The survey included the Maslach Burnout Inventory-Human Services Survey, General Health Questionnaire 12, and the Revised Dyadic Adjustment Scale. Burnout was identified in 28.4% of surgeons, with 58.2% reporting high emotional exhaustion and 37.3% high depersonalization. No respondents exhibited low personal accomplishment. The most frequently cited stressor was Puerto Rico's healthcare system, particularly health insurance restrictions (66.7%). Additionally, 25.4% of surgeons showed signs of mental health concerns, and 22.0% experienced relationship distress. While emotional exhaustion and depersonalization present as alarmingly high, resilience in personal accomplishment was notable. Interventions are needed to address systemic stressors while leveraging cultural factors that protect against burnout.
Author:
- Gabriel González-Díaz
- Emil Varas-Rodríguez
- Joshua Vivas
- Francis Cedeño
- Gerardo E. Rodríguez-Matias
- Jerry Cruz
- Hans Hess
- Oscar Duyos
DOI: https://doi.org/10.71332/79h63q52
Keywords: burnout, emotional exhaustion, puerto rico, healthcare system, resilience, orthopaedic surgeons
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Abstract
Hermansky-Pudlak Syndrome (HPS), characterized by oculocutaneous albinism and a bleeding diathesis, is an autosomal recessive disorder particularly found in Puerto Ricans. The highest prevalence is noted in the northwest of Puerto Rico, where one in 1,800 individuals are affected. Due to its complex presentation and treatment regimen, health information must ideally be accessible, understandable, and of high quality. We selected three keyword phrases in English and three in Spanish that describe the disease in layman’s terms and entered them as prompts in a Google search to simulate patient-initiated searches. The first 20 websites for each of the six terms were analyzed for quality and readability utilizing a DISCERN instrument questionnaire and an online readability test tool, respectively. The results for the English terms yielded a mean general reliability of 72.8%, with the quality and reliability of treatment information at a mean of 37.4%. The average grade level (AGL) recommended for the English sites was 14, with academic and private/commercial sites scoring 15 and 13, respectively. For the Spanish keywords, the general mean reliability was 65.8%, and the treatment information mean score was 27.4%. The recommended AGL for Spanish websites was 16. Although information on HPS is readily available, our analysis suggests that the complexity of the content may be high, with extreme variations in quality. This phenomenon was observed in both languages. Our results highlight the need to provide understandable, simple, and reliable quality information in both languages for educational purposes.
Author:
- Laura I. Ortiz-López, MD
- Karla M. Santiago-Soltero, MD
- Sofia Milosavljevic, BA
- Krithika Nayudu, BA
- Mihir K. Patil, BA
- Goranit Sakunchotpanit, BS
- Rhea Malik
- TJ Hazen, BA
- Stephanie Sánchez-Meléndez, MD
- Vinod E. Nambudiri, MD, MBA
DOI: https://doi.org/10.71332/vp3egj48
Keywords: Hermansky-Pudlak Syndrome, Online Health Information, Albinism, Quality and Readability, Hispanic, Genodermatosis, Bilingual
References
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Abstract
Obesity and Type 2 Diabetes Mellitus (T2DM) represent significant global health challenges, contributing to high morbidity and mortality due to a combination of lifestyle, dietary, and genetic factors. Traditional management strategies, including lifestyle modifications, pharmacotherapy, and bariatric surgery, often fail to achieve sustained weight loss and glycemic control or are overly invasive. This review explores the potential of semaglutide (a glucagon-like peptide-1 [GLP-1] receptor agonist) and tirzepatide (a dual GLP-1/glucose-dependent insulinotropic polypeptide [GIP] receptor agonist) as transformative therapies for obesity and T2DM management. These agents act by stimulating glucose-dependent insulin secretion, suppressing glucagon release, delaying gastric emptying, and reducing appetite, resulting in significant weight reduction and improved glycemic control. Tirzepatide further enhances these benefits through dual receptor activation, promoting fat oxidation and additional metabolic benefits. Clinical trials, such as the STEP and SURPASS programs, demonstrate that semaglutide and tirzepatide achieve weight loss of up to 20.9% of initial body weight, comparable to bariatric surgery, and HbA1c reductions exceeding 2%, surpassing the 0.5% to 2% reductions typically observed with other T2DM therapies. These agents also improve cardiometabolic health and quality of life. Both drugs are generally well-tolerated, with gastrointestinal issues being the most common side effects. These therapies redefine obesity and diabetes as treatable chronic conditions, transforming metabolic health management. This review examines their mechanisms of action, efficacy, and safety, underscoring their potential to revolutionize the approach to these conditions.
Author: James P. Torres-Pirela
DOI: https://doi.org/10.71332/ekx6t266
Keywords: Semaglutide, Tirzepatide, GLP-1 receptor agonist, GIP receptor agonist, Obesity, Type 2 Diabetes Mellitus
References
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Abstract
The role of early-onset obesity-related genetic predisposition and leptin receptor variants have been previously studied. However, studies involving sleep-related disorders linked to a genetic predisposition, leading to obesity, and how leptin could play a role in sleep-related disorders have been limited. In this study, we explore a case of how leptin receptor variants could play a role in the relationship between obesity and sleep-related disorders. We present a case of a morbidly obese (BMI of 62.87 kg/m2) Puerto Rican teenage female with a past medical history of type 2 diabetes mellitus, hypothyroidism, essential primary hypertension, and obstructive sleep apnea (OSA), who was evaluated due to complications regarding sleeping difficulties, despite being on Continuous Positive Airway Pressure (CPAP) treatment. Genetic studies performed to assess the causes of obesity revealed BBS9 heterozygous gene for a sequence variant defined as c.396GC and heterozygous LEPR gene for a sequence variant defined as c.658GA, which has been associated with an increased predisposition to obesity. This case report emphasizes the value of genetic research in figuring out the root causes of obesity and its comorbidities, especially in cases of early-onset obesity and co-occurring disorders such as OSA. The discovery of genetic variations in LEPR and BBS9 genes offers crucial information on potential mechanisms underlying the clinical phenotype of the patient.
Author:
- José Colón-Soto
- Bryan Vega-Sanabria
- Roberto A. Cardona-Quiñones
- Alexandra Balsalobre Vélez
- Simón Carlo-Torres, MD
- Jesús Meléndez-Montañez, MD
- Wilfredo De Jesús-Rojas, MD, FAAP, MSc, ATSF
DOI: https://doi.org/10.71332/cv0z6q31
Keywords: leptin receptor variants, early-onset diabetes, obstructive sleep apnea
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Melendez-Montañez, J. M., & De Jesus-Rojas, W. (2024). The Tip of the Iceberg: Genotype of Puerto Rican Pediatric Obesity. Genes, 15(4), 394. https://doi.org/10.3390/genes15040394
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Forsythe, E., & Beales, P. L. (2013). Bardet-Biedl syndrome. European Journal of Human Genetics : EJHG, 21(1), 8–13. https://doi.org/10.1038/ejhg.2012.115
Chen, J., Smaoui, N., Hammer, M. B. H., Jiao, X., Riazuddin, S. A., Harper, S., Katsanis, N., Riazuddin, S., Chaabouni, H., Berson, E. L., & Hejtmancik, J. F. (2011). Molecular analysis of Bardet-Biedl syndrome families: report of 21 novel mutations in 10 genes. Investigative Ophthalmology & Visual Science, 52(8), 5317–5324. https://doi.org/10.1167/iovs.11-7554
Barton, A. R., Hujoel, M. L. A., Mukamel, R. E., Sherman, M. A., & Loh, P.-R. (2022). A spectrum of recessiveness among Mendelian disease variants in UK Biobank. American Journal of Human Genetics, 109(7), 1298–1307. https://doi.org/10.1016/j.ajhg.2022.05.008
Katsanis, N. (2004). The oligogenic properties of Bardet-Biedl syndrome. Human Molecular Genetics, 13 Spec No 1, R65-71. https://doi.org/10.1093/hmg/ddh092
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Myers, M. G., Heymsfield, S. B., Haft, C., Kahn, B. B., Laughlin, M., Leibel, R. L., Tschöp, M. H., & Yanovski, J. A. (2012). Challenges and opportunities of defining clinical leptin resistance. Cell Metabolism, 15(2), 150–156. https://doi.org/10.1016/j.cmet.2012.01.002
Liu, J., Lai, F., Hou, Y., & Zheng, R. (2022). Leptin signaling and leptin resistance. Medical Review (Berlin, Germany), 2(4), 363–384. https://doi.org/10.1515/mr-2022-0017
Berger, S., & Polotsky, V. Y. (2018). Leptin and Leptin Resistance in the Pathogenesis of Obstructive Sleep Apnea: A Possible Link to Oxidative Stress and Cardiovascular Complications. Oxidative Medicine and Cellular Longevity, 2018, 5137947. https://doi.org/10.1155/2018/5137947
Abstract
This is a case describing the sequence of stercoral ulceration leading to fecal impaction and subsequent feculent peritonitis in a patient with end-stage renal disease (ESRD). Analyzing the patient’s operative course and hospitalization illustrates the complex nature of ESRD and the associated circumstances leading to this patient’s death. Utilizing the patient’s imaging and pathology results concludes that medication resins such as sevelamer caused mucosal ulceration in her colon. These results emphasize current literature which describes the potential for gastrointestinal complications with use of sevelamer.
Author:
- Shruti Rai
- Loren Bach
DOI: https://doi.org/10.71332/7z4qvf31
Keywords: sevelamer, colonic ulceration, feculent peritonitis, end-stage renal disease, hyperphosphatemia
References
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Abstract
Founding of Clínica del Sur: Disparities in healthcare access and affordability exacerbate the constraints presented by a complex socioeconomic landscape in Puerto Rico (PR). According to the U.S. Census Bureau, the median household income in PR is $24,112, and 41.7% of people live in poverty on the island [1]. While the U.S. Census Bureau states that just 5.1% of people in PR do not have healthcare coverage, the healthcare system in PR struggles with employee shortages and lack of federal funding [2]. This makes healthcare less accessible despite Puerto Ricans having health insurance. As the elderly population continues to grow to the point that the percentage of elderly people in PR is among the top ten globally, challenges arise in accessing healthcare with family members migrating to the U.S. [1].
In 2019, medical students at Ponce Health Sciences University (PHSU) sought out to address these healthcare disparities. Despite significant earthquakes and the COVID-19 pandemic, the Student-Run Free Clinic (SRFC) Clínica del Sur was born in 2022. The clinic serves as a reliable resource for underserved populations and an opportunity for preclinical health sciences students to gain clinical experience and conduct research. Since its founding, Clínica del Sur has been run by students in medicine, psychology, nursing, and public health. Since then, the clinic has expanded to offer dermatology, dental, and neurology services. Clínica del Sur strives to provide comprehensive care in these areas to best serve the needs of its community similar to the Student-Run Clinic of University of Texas Río Grande Valley School of Medicine, which treats patients who do not have access to primary care [3]. Other clinics such as Qlinic, an LGBTQIA+ clinic at Cornell University, focus on one area of healthcare such as behavioral therapy in mental healthcare [4].
As a member of the National Association of Free and Charitable Clinics (NAFC), Clínica del Sur has been funded by the following organizations: Americares, Direct Relief, Brother’s Brother Foundation, Fundación Intellectus, and Heart to Heart Foundation. Through this membership, the clinic has also received a grant from CeraVe, from which the Sun Protection Campaign was launched to raise awareness and provide education on sun protection. Equipment has been acquired through the grant to improve the clinic’s dermatology services. For example, many patients are lost to follow-up due to the complicated structure of the island's healthcare system. To relieve patients of this burden, the clinic acquired a camera to capture photos of areas of concern on the skin so that patients have the necessary information in their file for their referral for continued cost-free care. The clinic is also a member of the Society of Student-Run Free Clinics (SSRFC), through which it hopes to gain funding and networking opportunities.
Author:
- Brittany Hahney, MPH
- Laura Domenech, MD
DOI: https://doi.org/10.71332/sv2b0m65
Keywords: student-run free clinic, preclinical, medical education, volunteers, health disparities, clinical skills, interprofessional
References
Auman-Gooding, K. Demographers identify the causes, challenges of a rapidly aging Puerto Rico. Penn State Social Science Research Institute 2023.
Roman, J. The Puerto Rico healthcare crisis. Ann Am Thorac Soc 2015, 12, 1760-1763. https://doi.org/10.1513/AnnalsATS.201508-531PS
Cauba, J. N., Callan, A., Alvarado, J., & Tapia, B. Establishing the first student-run clinic to provide free health care to a South Texas Colonia. J Stud Run Clin 2024, 10. https://doi.org/10.59586/jsrc.v10i1.415
Nghiem, J., Liu, M., Fruitman, K., Zhou, C., Zonana, J., Outram, T., Ceccolini, C. J., Spellun, J., & Hankins, D. Exploring preclinical medical students’ experience facilitating group dialectical behavioral therapy (DBT) for a student-run mental health clinic: A qualitative study. Acad Psychiatry 2024, 48, 334-338. https://doi.org/10.1007/s40596-024-01975-x
Abstract
Wilfredo De Jesus-Rojas, MD
Ponce Health Sciences University Scientific Journal
August 14, 2024
Dear Editor-in-Chief,
As former ESL (English as a Second Language) students who have pursued science, technology, engineering and mathematics (STEM) fields and current researchers and instructors, we intimately understand the challenges faced by students adapting not just to a new language, but to the complex context in which that language is used in academic settings. Our experiences have given us unique insights into the difficulties ESL students encounter in higher education, particularly in STEM disciplines.
Research aligns with our personal observations. ESL students often struggle with academic language proficiency, which can severely impact their ability to understand complex materials and engage in academic discourse [1]. These students are also more likely to face higher attrition rates [2], with studies indicating that they are more likely to experience academic probation or drop out compared to their native English-speaking peers [3]. ESL students often encounter significant obstacles in accessing and understanding academic resources that are primarily available in English, which can impede their ability to fully engage with the material.
To illustrate the challenges and potential solutions, we would like to share an experience from Nelson's academic journey that led us to appreciate the potential of generative AI in ESL students' education. During his graduate studies, Nelson was enrolled in a rigorous Real Analysis course. Despite his best efforts, he found himself struggling to grasp the material. In a meeting with his then mentor, Prof. Doug Moupasiri, Nelson confessed his difficulties. Prof. Moupasiri asked a simple yet profound question: “What other books on the subject have you read?'' When Nelson admitted that he had only been using the assigned textbook, Prof. Moupasiri encouraged him to explore other authors' works. This advice—to seek out different perspectives—was a turning point in Nelson's academic career. By finding an author whose style resonated with him, he was able to understand concepts that had previously eluded him. This experience made us realize that sometimes, the issue is not with the subject itself but with how it is presented.
This is where we see a tremendous opportunity for generative Al tools to support students, particularly ESL students, in their learning journey. ESL students often benefit from different learning approaches, and findings show that they have positive perceptions of AI-based learning tools, appreciating their personalized learning paths and time-saving advantages [4]. As evidenced in recent studies [5], AI technologies are already being successfully used in medical education to provide real-time feedback on quizzes, assist in anatomy learning, and support the recognition and diagnosis of medical images. Additionally, a study performed in a medical school in Puerto Rico showed that integrating a course aimed to bridge the gaps in AI knowledge among participants resulted in more positive perceptions of AI. However, it also revealed a lack of practical experience with AI applications, emphasizing the need for better integration of AI into educational programs [6].
Initiatives aimed specifically at Hispanic students are demonstrating the value of incorporating AI literacy into their education, helping them critically evaluate and effectively use AI technologies across different contexts [7]. By equipping students with essential AI competencies, these programs foster not only academic success but also readiness for AI-rich environments at home and in the workplace. We believe extending such support to ESL students can enhance equitable access to education by providing adaptive and personalized learning paths that cater to specific language needs. Just as different authors can present the same subject in varying ways, generative AI can offer students alternative explanations, analogies, and examples that align more closely with their individual learning styles. This ability to reshape content makes generative AI particularly powerful for students at institutions in Puerto Rico and elsewhere, allowing them to bridge gaps in understanding through tailored explanations in their native language or more accessible rephrasing, ultimately making challenging subjects more comprehensible.
Generative AI is not just a tool for information retrieval but a companion in the learning process, helping students navigate complex subjects with a personalized approach that traditional methods may not always provide. The greatest value of generative AI as a tutor lies in its ability to customize learning experiences, tailoring them to fit the context and background of each student. As we continue to integrate AI into the educational landscape, it is our hope that we can leverage these tools to not only enhance learning but also to empower students to overcome the challenges that come with language barriers and different learning styles. Just as Nelson's mentor's advice reshaped his educational path, we believe encouraging the correct use of generative AI can play a similar role for many students, directly impacting academic outcomes.
We urge educators and administrators to consider the potential of generative AI as a powerful tool for addressing the unique challenges faced by ESL students and those from diverse backgrounds. By embracing this technology, we can create a more inclusive and effective learning environment that supports all students in reaching their full potential.
Sincerely,
Nelson Colón Vargas, PhD and Marcos J. Ramos-Benitez, PhD
Author:
- Nelson Colón-Vargas, PhD
- Marcos J. Ramos Benítez, PhD
DOI: https://doi.org/10.71332/vta3fq83
Keywords: artificial intelligence, English as a Second Language, AI-learning
References
Andrade, M.S., International students in English-speaking universities: Adjustment factors. Journal of Research in International Education, 2006. 5(2): p. 131-154.
Zheng, R.X., et al., Unravelling the differences in attrition and academic performance of international and domestic nursing students with English as an additional language. Nurse Educ Today, 2014. 34(12): p. 1455-9.
Rodriguez, D., et al., Factors that challenge English learners and increase their dropout rates: recommendations from the field. International Journal of Bilingual Education and Bilingualism, 2022. 25(3): p. 878-894.
Amante-Nochefranca, G., et al. AI-Assisted English Language Learning and Teaching in a Developing Country: An Investigation of ESl Student’s Beliefs and Challenges. in Artificial Intelligence, Data Science and Applications. 2024. Cham: Springer Nature Switzerland.
Zhang, W., et al., AI in Medical Education: Global situation, effects and challenges. Education and Information Technologies, 2024. 29(4): p. 4611-4633.
Heredia-Negrón, F., et al., Assessing the Impact of AI Education on Hispanic Healthcare Professionals' Perceptions and Knowledge. Educ Sci (Basel), 2024. 14(4).
Sinha, N., Madhavarao, R., Freeman, R., Oujo, I., & Boyd, J. (2024). AI Literacy for Hispanic-Serving Institution (HSI) Students. In AAAI Spring Symposium Series (SSS-24). Palo Alto, CA: Association for the Advancement of Artificial Intelligence
Vol. 2 No. 1 (2026): Second Edition PHSU-SJ
Articles
Abstract
Specific antibody deficiency (SAD) is a primary immunodeficiency disease (PID) in which patients present with recurrent sinopulmonary bacterial infections and decreased antibody responses to polysaccharide antigens following vaccination. SAD memory phenotype refers to an initial serologic and clinical response to the 23-valent polysaccharide vaccine followed by the loss of protective antibodies within six months. Various PID can present with diminished specific antibody responses, and it is known that patients with SAD can develop Common Variable Immunodeficiency (CVID) later in life. We present the case of a 7-year-old male with significant history of recurrent sinopulmonary infections since the age of two, who was diagnosed with SAD memory phenotype. A PID genetic panel revealed a TNFRSF13C genetic variant of unknown significance in Exon 3: c.534_543delinsAATAGCAGG (p.Ala179Ilefs*46). This variant results in a frameshift in the B cell-activating factor receptor (BAFFR) encoding gene. BAFFR is essential for the survival and maturation of transitional B cells into mature follicular and marginal zone B cells and has an important role in the development of T-independent antibody responses. BAFFR deficiency is known to be a genetic etiology for CVID and heterozygous missense polymorphisms have been implicated as risk factors for the development of CVID. The patient’s phenotype, which demonstrates inadequate T-independent antibody responses, correlates with the previously described phenotype of patients with TNFRSF13C variants. Here, we present a patient with SAD memory phenotype harboring a frameshift heterozygous variant in BAFFR. This case highlights the need to consider rare genetic causes in patients with PID.
Authors:
- Mariana Acuña
- Dr. De Jesús Rojas
- Dr. Fernández Dávila
DOI: https://doi.org/10.71332/5y3gtw10
Keywords: Specific Antibody Deficiency, BAFFR, TNFRSF13C
References
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5. Tangye, S. G., Al-Herz, W., Bousfiha, A., Cunningham-Rundles, C., Franco, J. L., Holland, S. M., Klein, C., Morio, T., Oksenhendler, E., Picard, C., Puel, A., Puck, J., Seppänen, M. R. J., Somech, R., Su, H. C., Sullivan, K. E., Torgerson, T. R., & Meyts, I. Human Inborn Errors of Immunity: 2022 Update on the Classification from the International Union of Immunological Societies Expert Committee. Journal of clinical immunology 2022, 42(7), 1473–1507. https://doi.org/10.1007/s10875-022-01289-3
6. Warnatz, K., Salzer, U., Rizzi, M., Fischer, B., Gutenberger, S., Böhm, J., Kienzler, A. K., Pan-Hammarström, Q., Hammarström, L., Rakhmanov, M., Schlesier, M., Grimbacher, B., Peter, H. H., & Eibel, H. B-cell activating factor receptor deficiency is associated with an adult-onset antibody deficiency syndrome in humans. Proceedings of the National Academy of Sciences of the United States of America 2009, 106(33), 13945–13950. https://doi.org/10.1073/pnas.0903543106
7. Sevdali, E., Block Saldana, V., Speletas, M., & Eibel, H. BAFF receptor polymorphisms and deficiency in humans. Current opinion in immunology 2021, 71, 103–110. https://doi.org/10.1016/j.coi.2021.06.008
8. Kakkas, I., Tsinti, G., Kalala, F., Farmaki, E., Kourakli, A., Kapousouzi, A., Dimou, M., Kalaitzidou, V., Sevdali, E., Peristeri, A. M., Tsiouma, G., Patiou, P., Papadimitriou, E., Vassilakopoulos, T. P., Panayiotidis, P., Kioumi, A., Symeonidis, A., & Speletas, M. TACI Mutations in Primary Antibody Deficiencies: A Nationwide Study in Greece. Medicina 2021, 57(8), 827. https://doi.org/10.3390/medicina57080827
9. Salzer, U., Chapel, H. M., Webster, A. D., Pan-Hammarström, Q., Schmitt-Graeff, A., Schlesier, M., Peter, H. H., Rockstroh, J. K., Schneider, P., Schäffer, A. A., Hammarström, L., & Grimbacher, B. Mutations in TNFRSF13B encoding TACI are associated with common variable immunodeficiency in humans. Nature genetics 2005, 37(8), 820–828. https://doi.org/10.1038/ng1600
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14. Pieper, K., Rizzi, M., Speletas, M., Smulski, C. R., Sic, H., Kraus, H., Salzer, U., Fiala, G. J., Schamel, W. W., Lougaris, V., Plebani, A., Hammarstrom, L., Recher, M., Germenis, A. E., Grimbacher, B., Warnatz, K., Rolink, A. G., Schneider, P., Notarangelo, L. D., & Eibel, H. A common single nucleotide polymorphism impairs B-cell activating factor receptor's multimerization, contributing to common variable immunodeficiency. The Journal of allergy and clinical immunology 2014, 133(4), 1222–1225. https://doi.org/10.1016/j.jaci.2013.11.021
15. Ng, L. G., Sutherland, A. P., Newton, R., Qian, F., Cachero, T. G., Scott, M. L., Thompson, J. S., Wheway, J., Chtanova, T., Groom, J., Sutton, I. J., Xin, C., Tangye, S. G., Kalled, S. L., Mackay, F., & Mackay, C. R. B cell-activating factor belonging to the TNF family (BAFF)-R is the principal BAFF receptor facilitating BAFF costimulation of circulating T and B cells. Journal of immunology 2004, 173(2), 807–817. https://doi.org/10.4049/jimmunol.173.2.807
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17. Sasaki, Y., Casola, S., Kutok, J. L., Rajewsky, K., & Schmidt-Supprian, M. TNF family member B cell-activating factor (BAFF) receptor-dependent and -independent roles for BAFF in B cell physiology. Journal of immunology 2004, 173(4), 2245–2252. https://doi.org/10.4049/jimmunol.173.4.2245
Abstract Background: Although skin conditions are frequent in people living with HIV (PLWH), no prior studies have described them in Puerto Rico. This study assesses non-neoplastic cutaneous conditions in PLWH at a community clinic. Methods: We performed a cross-sectional analysis of 1,000 PLWH treated from January 2019 to December 2024. Sociodemographic, clinical, and dermatologic data were extracted from electronic records. Descriptive and bivariate analyses (Chi-square or Fisher’s exact) were conducted with p<0.05 considered significant. Results: Non-neoplastic skin conditions were identified in 19.1% of participants (241 diagnoses). The most common were herpes simplex virus (5.3%), dermatitis (2.8%), and warts (2.5%). Longer duration of HIV infection was significantly associated with skin conditions (p=0.004). No associations were found with sex, age, CD4 count, or viral load. Conclusion: Non-neoplastic dermatologic conditions remain prevalent among PLWH in Puerto Rico. These findings support incorporating routine dermatologic assessment into HIV care.
Authors:
- Itzamar Pastrana-Echevarría
- Alicia Báez-Cruz
- Mileidy Hernández-Nieves
- Alejandro Pinilla-Baquero
- Oscar Lugo-Capera
- Diana Fernández-Santos
- Angel Mayor-Becerra
- Alexandra Conde-Toro
DOI: https://doi.org/10.71332/kytmn476
Keywords: HIV, Skin conditions, Puerto Rico
References
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24- Sendrasoa F, Falimiarintsoa V, Ramarozatovo L, Rapelanoro Rabenja F. Mucocutaneous manifestations among HIV-infected patients in Madagascar: cross-sectional study. JMIR Dermatol. 2023;6:e47199. doi:10.2196/47199. Available from: https://derma.jmir.org/2023/1/e47199
25- Anshory M, Effendi RMRA, Rosandy MG, Kalim H, Nijsten TEC, Schappin R, Nouwen JL, Thio HB. Dermatological manifestation of HIV infection: systematic review and meta-analysis. BMC Infect Dis. 2025 Oct 29;25(1):1446. doi: 10.1186/s12879-025-11827-0. PMID: 41162862; PMCID: PMC12573998.
Abstract
Scoliosis is a deformity of the spine in all three planes. The most common types emerge in otherwise healthy children during adolescent growth. Spine imaging is required for diagnosis and surveillance to determine whether the deformity is progressing. Epidemiologic studies that looked at the long-term effects of receiving multiple spine x-rays in childhood showed a concerning increase in adult malignancy. However, many of those studies were based on exposure from x-ray equipment 50 or more years ago. This paper examines the current risk of receiving necessary spinal x-rays using modern equipment and up to date exposure recommendations from the leading medical organizations. Using example treatment scenarios, children are receiving x-ray exposure that is well below the safe limits. Results show that cumulative radiation doses in adolescents with typical AIS range from 2.04 – 12.21 mSv, a safe cumulative dosage, while the most extreme cases would reach up to 28.45 mSv, a slight increase in risk.
Authors:
- Kevin Orellana
- Patrick Knott
DOI: https://doi.org/10.71332/yvk3pq91
Keywords: Scoliosis, Diagnostic Imaging, Risk Reduction
References
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Abstract
Struma ovarii is a rare ovarian teratoma composed predominantly of thyroid tissue, representing less than 1% of all ovarian tumors. The clinical presentation of struma ovarii can vary widely, from an asymptomatic palpable abdominal mass, hyperthyroidism (elevated free T4 and/or T3; low TSH), and, in rare cases, pseudo-Meigs syndrome. Diagnosis is often based on postoperative histopathological confirmation of thyroid tissue. We present a case of a 44-year-old Hispanic female with an incidental finding of an adnexal mass, pleural effusion, and ascitic fluid, but with normal tumor markers, cancer antigen 125 (CA-125), and carcinoembryonic antigen (CEA). Postoperative pathological examination confirmed struma ovarii, with pseudo-Meigs syndrome. Unexpectedly, the patient developed ovarian remnant syndrome (ORS). This case contributes to the limited literature describing struma ovarii associated with pseudo-Meigs syndrome and normal tumor markers, highlighting the diverse clinical spectrum of this tumor. It also underscores the need for a high index of suspicion for struma ovarii in atypical cases, regardless of tumor marker levels. The development of ORS further emphasizes the importance of long-term follow-up after definitive surgical management.
Authors:
- Lennis Colón-Rivera
- Angelymar Vélez-Santana
- Samatha M. De Filipps
- Hostos Fernández-Caamaño
DOI: https://doi.org/10.71332/73pzsd21
Keywords: struma ovarii, ovarian tumor, pseudo-Meigs syndrome, ovarian remnant syndrome
Abstract
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Authors:
- Gabriel Román-Ríos
- Arnaldo Santos-López
- Dr. De Jesús Rojas
DOI: https://doi.org/10.71332/kg6svc69
Keywords: pediatric pneumonia, pleural effusion, artificial intelligence, 3D lung reconstruction, computed tomography, lung segmentation, parapneumonic effusion, innovative imaging
References
1. Fedorov, A.; Beichel, R.; Kalpathy-Cramer, J.; Finet, J.; Fillion-Robin, J.-C.; Pujol, S.; Bauer, C.; Jennings, D.; Fennessy, F.; Sonka, M.; et al. 3D Slicer as an Image Computing Platform for the Quantitative Imaging Network. Magn Reson Imaging 2012, 30, 1323–1341, doi:10.1016/j.mri.2012.05.001.
2. Bumm, R.; Lasso, A.; Kawel-Böhm, N.; Wäckerlin, A.; Ludwig, P.; Furrer, M. First Results of Spatial Reconstruction and Quantification of COVID-19 Chest CT Infiltrates Using Lung CT Analyzer and 3D Slicer. British Journal of Surgery 2021, 108, znab202.077, doi:10.1093/bjs/znab202.077.
3. Marchi, G.; Mercier, M.; Cefalo, J.; Salerni, C.; Ferioli, M.; Candoli, P.; Gori, L.; Cucchiara, F.; Cenerini, G.; Guglielmi, G.; et al. Advanced Imaging Techniques and Artificial Intelligence in Pleural Diseases: A Narrative Review. Eur Respir Rev 2025, 34, 240263, doi:10.1183/16000617.0263-2024.
4. Hu, K.; Chopra, A.; Kurman, J.; Huggins, J.T. Management of Complex Pleural Disease in the Critically Ill Patient. J Thorac Dis 2021, 13, 5205–5222, doi:10.21037/jtd-2021-31.
5. Khalifa, M.; Albadawy, M. AI in Diagnostic Imaging: Revolutionising Accuracy and Efficiency. Computer Methods and Programs in Biomedicine Update 2024, 5, 100146, doi:10.1016/j.cmpbup.2024.100146.
Abstract
Underserved communities face persistent barriers to dermatologic care, yet little is known about their perceptions of barriers to access, knowledge gaps, and motivations to seek care. We conducted a two-day student-run free clinic (SRFC) in Puerto Rico, providing free dermatologic services and administering a Spanish-language questionnaire to assess patient demographics, sun protection behaviors, barriers to care, and perceived impact of the clinic. Of 350 patients, 267 (76.3%) completed the survey. The cohort was predominantly female (91.4%) and Hispanic (97.8%), with 72.7% reporting a dermatologic condition, but over half (51.3%) having never seen a dermatologist. Common barriers included difficulty obtaining appointments (42.5%) and lack of self-perceived need (38.8%). Only 6.4% felt very informed about skin cancer, and 26.6% reported never practicing sun protection. Twelve biopsies revealed both benign and malignant diagnoses, including mammary Paget’s and melanoma in situ. Patients who self-identified as informed about skin cancer reported more frequent use of sun protection and greater engagement in sun-avoidant behaviors. Most participants cited the clinic’s no-cost services as a major factor improving healthcare access. Our findings highlight the dual burden of high dermatologic disease prevalence and limited access to specialty care in Puerto Rico, exacerbated by a physician shortage and socioeconomic barriers. SRFCs can help reduce dermatologic workforce burnout by supplementing clinical capacity, allowing dermatologists to focus on complex cases while medical students assist with triage, education, and basic care delivery. Incorporating medical students in dermatologic outreach may amplify impact by expanding services capacity and promoting awareness and education in underserved populations.
Authors:
- María Vázquez-Machado
- Lara Diez-Asad
- Chavely Calderón Casellas
- Eric Graulau
- Dr. Santiago-Soltero
- Andrés Ortiz-Franco
- Sofía Díaz
- Deborah Colón-Lara
- Dr. Blanco
DOI: https://doi.org/10.71332/rxamt829
Keywords: Dermatology, Student Run Free Clinic, Health Disparities, Community Outreach
References
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Abstract
Ureteral injuries, often iatrogenic during gynecological or endo-urological procedures, can severely impact quality of life and renal function, potentially causing sepsis or renal failure. The distal ureter is most vulnerable, and resulting strictures require management based on their cause, location, and length. Short distal strictures are treated with ureteroureterostomy or ureteroneocystostomy, while longer ones may require a Boari flap with psoas hitch or ileal ureter replacement. This study evaluates postoperative renal function and symptoms recurrence in patients treated with these techniques for complex ureteral injuries. A retrospective review of 14 patients treated between 2007 and 2017 was conducted. Nine underwent laparoscopic Boari flap and five ileal loop interposition, with at least five years of follow-up. Intraoperative and postoperative outcomes were analyzed. Indications included endoscopic surgery strictures (3), radiation-induced strictures (2), and non-urological iatrogenic injuries (7). Two patients had primary ureteral cancer. Mean operative time was 158 minutes, and hospital stay averaged 2.1 days. Preoperative creatinine was 1.3 mg/dL, increasing to 1.4 mg/dL and 1.5 mg/dL at one and three months postoperatively. CT cystogram showed vesicoureteral reflux in all Boari flap patients. At five years, all patients were symptom-free with unobstructed ureters. Complications included one ileus and one anastomotic stricture. Boari flap and ileal ureter replacement are effective alternatives for complex ureteral strictures, preserving renal function. Larger studies are needed to validate these findings against standard open techniques.
Author:
- Dr. Cintrón-Cartagena
- Amanda Torres-Arroyo
- Emil Varas-Rodríguez
- Gustavo Colón
- Rodrigo Ortiz
- Dr. Ruiz-Deyá
DOI: https://doi.org/10.71332/283bzy33
Keywords: Ureteral injuries, Ureteral strictures, Boari flap, Ileal ureter replacement
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