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Rivera-Agosto MM, Cantres-Fonseca O, Irizarry-Nieves LE, Rodríguez-Cintrón W. Patient With Leukocytosis and Persistent Dry Cough. Fed Pract 2023; 40:321-323. [PMID: 38562160 PMCID: PMC10984688 DOI: 10.12788/fp.0407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
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Morales-Colón S, Rivera-Agosto MM, Mercader-Pérez M, Cantres-Contreras O, Rodríguez-Cintrón W. Intrapleural Thrombolytics as First Line Therapy for Complicated Parapneumonic Effusions and Empyema in Patients with Prohibitive Surgical Risk: A Cases Series. P R Health Sci J 2023; 42:241-245. [PMID: 37709682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVE In complicated parapneumonic effusion or Empyema, approximately 25% of patients require surgical intervention which can be associated with a mortality risk of almost 20%. However, the use combination of rt-tPA and DNase in elderly patients with prohibitive surgical risk has improved outcomes. The main goal of our study is to highlight the utility of intrapleural thrombolysis in patients with prohibitive risk for surgery. METHODS A retrospective record review study of patients (n=23) with complicated parapneumonic pleural effusion or empyema treated with tPA and DNase from January 1st of 2015 to March 18th, 2019 at VACHCS. Data collected to describe the outcome of intrapleural thrombolytics included demographic, pleural fluid analysis, surgical risk assessment, diagnosis and initiation treatment day, doses, chest imaging, drainage rate, chest tube size and average days in place, inflammatory markers, microbiology, antibiotics, and complications. RESULTS Only 21.7% of patients were considered surgical candidates. Seventy-four percent had a 30-day post-surgical mortality risk of > 2.5% using the National Surgery Office (NSO) risk calculator. Post-operative inpatient stay was 99.7% and estimated post operative ICU stay average was >80%. Primary outcome (pleural drainage improvement) obtained in 73.9%. Most common serious complications included sepsis (52.2%) and nonserious was residual hydropneumothorax (47.8%). CONCLUSION This study demonstrates that administration of intrapleural thrombolytics through a percutaneous pleural catheter achieved successful drainage safely and without the need for surgical interventions in a selected group of advanced age, elderly patients with pleural infections who were deemed to be high surgical risk.
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Affiliation(s)
- Sulimar Morales-Colón
- Division of Pulmonary and Critical Care Medicine, Department of Medicine VA Caribbean Health Care System, San Juan, Puerto Rico
| | - Mariela M Rivera-Agosto
- Division of Pulmonary and Critical Care Medicine, Department of Medicine VA Caribbean Health Care System, San Juan, Puerto Rico
| | - Mariana Mercader-Pérez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine VA Caribbean Health Care System, San Juan, Puerto Rico
| | - Onix Cantres-Contreras
- Division of Pulmonary and Critical Care Medicine, Department of Medicine VA Caribbean Health Care System, San Juan, Puerto Rico
| | - William Rodríguez-Cintrón
- Division of Pulmonary and Critical Care Medicine, Department of Medicine VA Caribbean Health Care System, San Juan, Puerto Rico
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Rodríguez-Cintrón W, Morales-Colón S, Martínez-González J, Albors-Sanchez J. Lung Cancer Screening in Community-Based Practice in Puerto Rico: A Survey of Puerto Rico Pulmonologists. P R Health Sci J 2022; 41:161-164. [PMID: 36018746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Lung Cancer (LC) in Puerto Rico (PR) is the fifth most common malignancy (5.2%), the third most common among men (5.9%) and the fifth among women (4.6%), with a mortality of 11.3%. Despite current data demonstrating the importance and clinical value for lung cancer screening LDCT Screening among high risk patients remains low regardless of the potential to prevent thousands of lung cancer deaths per year. Due to significant disparities in health care in PR it is believed that LDCT use for lung cancer screening in PR is not been enforced in the private sector. METHODS A self-administered anonymous survey was provided to a group of pulmonologists at the annual meeting of the PR Pneumology Society. The survey contained questions regarding characteristics of their practice and implementation of lung cancer screening. Provided information was tabulated in percentages. RESULTS A total of 31 pulmonologists participated in the administration of the survey. Most participants had their medical practice in the metropolitan area (52%), which is the most populated area with best access to physicians and health care services. The sample from the north area comprised 19% of the subjects. All respondents were affiliated to health care institutions. As most of them served 1-3 health care centers (96%) with access to specialized equipment such as Chest CT. Most of the physicians (99%) had availability of chest CT scan within 1 hour from their practices and 97% were aware of the U.S. Preventive Services Task Force lung cancer screening recommendations. Their age range was 41 and over (55%). Despite the above there were discrepancies when asked about lung cancer screening implementation. Sixteen (16) percent did not perform lung cancer screening at all, and 77% that performed screening, reported limitations to it. CONCLUSION This data suggests that although lung cancer screening has shown to reduce mortality and is recommended by the USPTF, it is not been conducted appropriately in PR. The main limitation identified was what the health insurance had to offer rather than lack of health insurance. Other factor to take in consideration is the lack of a comprehensive screening program for Lung Cancer anywhere in the island. In addition, costs associated with staff and implementation were noted as a significant barrier among the surveyed pulmonologists.
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Affiliation(s)
- William Rodríguez-Cintrón
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, VA Caribbean Healthcare System, San Juan, Puerto Rico
| | - Sulimar Morales-Colón
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, VA Caribbean Healthcare System, San Juan, Puerto Rico
| | - Juancarlo Martínez-González
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, VA Caribbean Healthcare System, San Juan, Puerto Rico
| | - Joan Albors-Sanchez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, VA Caribbean Healthcare System, San Juan, Puerto Rico
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Vázquez-Ramos D, Cordero-Gomez A, Rodríguez-Cintrón W. Recurrent Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema Refractory to Fresh Frozen Plasma. Fed Pract 2019; 36:584-586. [PMID: 31892783 PMCID: PMC6913613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The case of a patient with refractory angioedema who was treated with fresh frozen plasma without success raises concern for its effectiveness.
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Affiliation(s)
- Danessa Vázquez-Ramos
- and are Fellows, and is the Program Director of the Pulmonary and Critical Care Fellowship, all in the Department of Pulmonary and Critical Care Medicine at Veterans Affairs Caribbean Healthcare System in San Juan, Puerto Rico
| | - Arelis Cordero-Gomez
- and are Fellows, and is the Program Director of the Pulmonary and Critical Care Fellowship, all in the Department of Pulmonary and Critical Care Medicine at Veterans Affairs Caribbean Healthcare System in San Juan, Puerto Rico
| | - William Rodríguez-Cintrón
- and are Fellows, and is the Program Director of the Pulmonary and Critical Care Fellowship, all in the Department of Pulmonary and Critical Care Medicine at Veterans Affairs Caribbean Healthcare System in San Juan, Puerto Rico
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Torres-Luna J, Mercader-Pérez M, Magno P, Rodríguez-Cintrón W. Anterior and Posterior Mediastinum Leiomyomas Arising From the Parietal Pleura. Ann Thorac Surg 2019; 111:e263-e265. [PMID: 31521591 DOI: 10.1016/j.athoracsur.2019.07.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 07/19/2019] [Accepted: 07/25/2019] [Indexed: 10/26/2022]
Abstract
A 72-year-old male patient was found with enlarged nodes in the anterior and posterior mediastinum on screening imaging studies of the chest. The anterior node appeared as a single cystic lesion without significant metabolic activity on scintigraphy images. The posterior node was a single solid lesion in the lower left periesophageal space above the diaphragmatic crura with moderate metabolic uptake. Endoscopic ultrasound allowed a transesophageal endosonography-guided fine needle aspiration of the posterior node. The anterior lesion was sampled via percutaneous transthoracic approach. Biopsy revealed aggregates of mesenchymal cells with spindle nuclei; immunohistochemistry confirmed two primary leiomyomas of the mediastinum.
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Affiliation(s)
- Jonathan Torres-Luna
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Veterans Administration Hospital, VA Caribbean Health Care System, San Juan, Puerto Rico
| | - Mariana Mercader-Pérez
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Veterans Administration Hospital, VA Caribbean Health Care System, San Juan, Puerto Rico
| | - Priscilla Magno
- Division of Gastroenterology, Department of Medicine, Veterans Administration Hospital, VA Caribbean Health Care System, San Juan, Puerto Rico
| | - William Rodríguez-Cintrón
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Veterans Administration Hospital, VA Caribbean Health Care System, San Juan, Puerto Rico.
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Ramos-Rossy J, Otero-Domínguez Y, Axtmayer J, Torres-Palacios J, Cantres O, Rodríguez-Cintrón W. An Unexpected Cause of Sepsis: Keep Pursuing the Source of Infection. P R Health Sci J 2019; 38:118-119. [PMID: 31260557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
An 86-year-old man was found with altered mental status, fever and aphasia. His physical exam revealed nuchal rigidity but no other meningeal signs. Because the patient's mental status was declining, he was intubated and placed in mechanical ventilation. His head CT scan was unremarkable, without evidence of mass effect. A lumbar puncture yielded cerebrospinal fluid that was remarkable for the presence of gram-positive cocci in pairs. His blood cultures showed gram-negative bacilli. Given the presence of these organisms, a polymicrobial infection was suspected. An abdomino pelvic CT scan showed a multi-septated abscess within the right hepatic lobe. CT-guided percutaneous drainage was performed and a specimen for culture obtained, which grew Klebsiella pneumoniae. After receiving intravenous antibiotics and supportive care, the patient showed clinical improvement. In this patient, there was a central nervous system infection secondary to bacteremia in the setting of an intrabdominal infection. The inquiring clinician should take note that whenever a polymicrobial infection is evidenced, more than one site of infection should be considered in the differential diagnosis.
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Affiliation(s)
| | | | | | | | - Onix Cantres
- VA Caribbean Healthcare System, San Juan, Puerto Rico
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Flores J, Del Olmo F, Aleman J, Otero Y, Rodríguez-Cintrón W. Resuscitation Strategies in Early Septic Shock: A Survey of Puerto Rico Intensive Care Physicians. P R Health Sci J 2019; 38:8-14. [PMID: 30924909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Severe sepsis and Septic Shock may progress in the first hours after presentation and has been associated with an increased mortality. Prompt recognition and treatment of early septic shock (ESS) may improve survival. The purpose of our study was to describe the monitoring and management strategies of ESS, within Intensive Care Units (ICU) in Puerto Rico (PR). METHODS In order to achieve our objective, a self-administered survey, previously validated by the Canadian Critical Care Trials Group, was administered to 25 physicians during a Critical Care Medicine (CCM) Meeting. Questions about usual monitoring and resuscitation end-points were administered. RESULTS Most of the participants were affiliated to community hospitals (84%) and 92% were pulmonary or CCM specialists, with more than 15 years of working experience (80%). Monitoring devices and parameters mostly used by at least 85% of the respondents were: Oxygen Saturation, Foley catheters, Telemetry, Heart Rate, Blood Pressure, and Urinary Output. Intra-arterial lines and Central Venous Pressure were less used. Most use normal saline (96%), as the initial fluid of resuscitation. Only 24% would use inotropes to improve perfusion. CONCLUSION Significant variability exists in the management of ESS among physicians in the ICU in PR. Compared to other studies, fewer physicians in PR use invasive monitoring techniques. These results highlight the need for quality education and training in CCM as well as continuing education in the field.
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Affiliation(s)
- Juan Flores
- VA Caribbean Healthcare System, San Juan, Puerto Rico
| | | | - Jesse Aleman
- VA Caribbean Healthcare System, San Juan, Puerto Rico
| | - Yomayra Otero
- VA Caribbean Healthcare System, San Juan, Puerto Rico
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Del Olmo F, Otero Y, Flores J, Aleman J, Rodríguez-Cintrón W. Dying in the Intensive Care Unit. P R Health Sci J 2019; 38:3-7. [PMID: 30924908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To document (using available data) the profile of the patients seen by the hospital's palliative service (PS) and who died in the medicine intensive care unit (ICU) of the Veterans Affairs Caribbean Healthcare System. METHODS A record review of subjects who died in the ICU from January 1, 2012, to December 31, 2014. Demographic data, underlying comorbidities, the cause of death, the length of stay, evaluation made by the PS, and the withdrawal of life support (when such occurred) were recorded for each patient. RESULTS A total of 200 patients met the criteria, mostly males. All the women and 50% of the men were over 79 years old. Seventy three percent of the patients were on mechanical ventilation when admitted, most having come from the emergency department. Fewer than 15% had advance directives. Forty-nine percent had been admitted to a hospital facility at least once during the year prior to their current admission. Most of the patients (60.5%) died within the first week, while 13% died within the first 24 hours. PS was requested for 56% of those who survived more than 24 hours, of which only 10% underwent the withdrawal-of-care protocol. CONCLUSION A small percentage of the patients who died in the ICU had advance directives at the time of admission, this though all were of advanced age, had recently been discharged after a prior hospital stay, suffered from 1 or more chronic illnesses, or had a history of mental or physical disease. Our findings underscore the need for the early referral of patients of the type previously mentioned to a PS.
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Affiliation(s)
| | - Yomayra Otero
- VA Caribbean Healthcare System, San Juan, Puerto Rico
| | - Juan Flores
- VA Caribbean Healthcare System, San Juan, Puerto Rico
| | - Jesse Aleman
- VA Caribbean Healthcare System, San Juan, Puerto Rico
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Ramos-Rossy J, Flores J, Otero-Domínguez Y, Torres-Palacios J, Rodríguez-Cintrón W. Hypoxemic Respiratory Failure Secondary to Zika Virus Infection. P R Health Sci J 2018; 37:S99-S101. [PMID: 30576587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
An 80-year-old man experienced general weakness, myalgias, arthralgias, fever, chills, and diarrhea for one week. He had hypotension and tachycardia. He also had leukocytosis, thrombocytopenia, increased creatinine levels, elevated liver enzymes, elevated creatine phosphokinase (CPK) levels, and metabolic acidosis with hypoxemia, for which he was admitted to the Intensive Care Unit (ICU). His chest x-ray showed decreased lung volumes. Ceftriaxone and levofloxacin were empirically started to cover leptospirosis and community acquired pneumonia, respectively. The patient continued with clinical deterioration and the antibiotic therapy was changed to linezolid, cefepime, and doxycycline. He required endotracheal intubation and mechanical ventilation support due to progressive hypoxemic respiratory failure. A bronchoscopy showed no evidence of bacterial infectious process. The patient developed clinical improvement with successful extubation afterwards (4 days after initial intubation). He was later discharged home with physical therapies. A serum specimen was tested with real-time polymerase chain reaction (RT-PCR) technique, producing a positive result only for Zika virus. Confirmatory molecular diagnostic testing was performed at the Center for Disease Control (CDC).
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Affiliation(s)
| | - Juan Flores
- VA Caribbean Healthcare System, San Juan, PR
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10
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Neophytou AM, Oh SS, White M, Mak A, Hu D, Huntsman S, Eng C, Serebrisky D, Borrell LN, Farber HJ, Meade K, Davis A, Avila PC, Thyne SM, Rodríguez-Cintrón W, Rodríguez-Santana JR, Kumar R, Brigino-Buenaventura E, Sen S, Lenoir MA, Williams LK, Benowitz NL, Balmes JR, Eisen EA, Burchard EG. Secondhand smoke exposure and asthma outcomes among African-American and Latino children with asthma. Thorax 2018; 73:1041-1048. [PMID: 29899038 PMCID: PMC6225993 DOI: 10.1136/thoraxjnl-2017-211383] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/29/2018] [Accepted: 05/08/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Secondhand smoke (SHS) exposures have been linked to asthma-related outcomes but quantitative dose-responses using biomarkers of exposure have not been widely reported. OBJECTIVES Assess dose-response relationships between plasma cotinine-determined SHS exposure and asthma outcomes in minority children, a vulnerable population exposed to higher levels of SHS and under-represented in the literature. METHODS We performed analyses in 1172 Latino and African-American children with asthma from the mainland USA and Puerto Rico. We used logistic regression to assess relationships of cotinine levels ≥0.05 ng/mL with asthma exacerbations (defined as asthma-related hospitalisations, emergency room visits or oral steroid prescription) in the previous year and asthma control. The shape of dose-response relationships was assessed using a continuous exposure variable in generalised additive logistic models with penalised splines. RESULTS The OR for experiencing asthma exacerbations in the previous year for cotinine levels ≥0.05 ng/mL, compared with <0.05 ng/mL, was 1.40 (95% CI 1.03 to 1.89), while the OR for poor asthma control was 1.53 (95% CI 1.12 to 2.13). Analyses for dose-response relationships indicated increasing odds of asthma outcomes related with increasing exposure, even at cotinine levels associated with light SHS exposures. CONCLUSIONS Exposure to SHS was associated with higher odds of asthma exacerbations and having poorly controlled asthma with an increasing dose-response even at low levels of exposure. Our results support the conclusion that there are no safe levels of SHS exposures.
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Affiliation(s)
- Andreas M. Neophytou
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley CA, USA
| | - Sam S. Oh
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Marquitta White
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Angel Mak
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Donglei Hu
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Scott Huntsman
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Luisa N. Borrell
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Harold J. Farber
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Kelley Meade
- Children’s Hospital and Research Center, Oakland, CA, USA
| | - Adam Davis
- Children’s Hospital and Research Center, Oakland, CA, USA
| | - Pedro C. Avila
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shannon M. Thyne
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | - Rajesh Kumar
- Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | | | - Saunak Sen
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | - L. Keoki Williams
- Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA
| | - Neal L. Benowitz
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - John R. Balmes
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley CA, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ellen A. Eisen
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley CA, USA
| | - Esteban G. Burchard
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Ramos-Rossy J, Cantres O, Torres A, Casal J, Otero Y, Arzon-Nieves G, Rodríguez-Cintrón W. Flexible Bronchoscopic Removal of 3 Foreign Objects. Fed Pract 2018; 35:24-26. [PMID: 30766383 PMCID: PMC6366794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Consider flexible bronchoscopy as an option to retrieve aspirated foreign bodies in the airway.
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Affiliation(s)
- Javier Ramos-Rossy
- and are Fellows; and are Attending Physicians; is a Research Coordinator; and is Attending Physician, Section Chief, and Program Director, all in the Pulmonary and Critical Care Medicine Program at the VA Caribbean Healthcare System in San Juan, Puerto Rico
| | - Onix Cantres
- and are Fellows; and are Attending Physicians; is a Research Coordinator; and is Attending Physician, Section Chief, and Program Director, all in the Pulmonary and Critical Care Medicine Program at the VA Caribbean Healthcare System in San Juan, Puerto Rico
| | - Alfonso Torres
- and are Fellows; and are Attending Physicians; is a Research Coordinator; and is Attending Physician, Section Chief, and Program Director, all in the Pulmonary and Critical Care Medicine Program at the VA Caribbean Healthcare System in San Juan, Puerto Rico
| | - Jesús Casal
- and are Fellows; and are Attending Physicians; is a Research Coordinator; and is Attending Physician, Section Chief, and Program Director, all in the Pulmonary and Critical Care Medicine Program at the VA Caribbean Healthcare System in San Juan, Puerto Rico
| | - Yomayra Otero
- and are Fellows; and are Attending Physicians; is a Research Coordinator; and is Attending Physician, Section Chief, and Program Director, all in the Pulmonary and Critical Care Medicine Program at the VA Caribbean Healthcare System in San Juan, Puerto Rico
| | - Ginger Arzon-Nieves
- and are Fellows; and are Attending Physicians; is a Research Coordinator; and is Attending Physician, Section Chief, and Program Director, all in the Pulmonary and Critical Care Medicine Program at the VA Caribbean Healthcare System in San Juan, Puerto Rico
| | - William Rodríguez-Cintrón
- and are Fellows; and are Attending Physicians; is a Research Coordinator; and is Attending Physician, Section Chief, and Program Director, all in the Pulmonary and Critical Care Medicine Program at the VA Caribbean Healthcare System in San Juan, Puerto Rico
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Albors-Sánchez J, Rodríguez-Cintrón W, Otero-Domínguez Y. A Forgotten Cause of Cardiac Tamponade. Fed Pract 2018; 35:49-52. [PMID: 30766358 PMCID: PMC6367996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although purulent pericarditis is rare, it is essential to recognize its clinical features due to the high mortality rate in patients with a missed diagnosis.
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Affiliation(s)
- Joan Albors-Sánchez
- and are Fellow Physicians, and is an Attending Physician, all in the Pulmonary and Critical Care Medicine Department at the Veterans Affairs Caribbean Health Care System in San Juan, Puerto Rico
| | - William Rodríguez-Cintrón
- and are Fellow Physicians, and is an Attending Physician, all in the Pulmonary and Critical Care Medicine Department at the Veterans Affairs Caribbean Health Care System in San Juan, Puerto Rico
| | - Yomayra Otero-Domínguez
- and are Fellow Physicians, and is an Attending Physician, all in the Pulmonary and Critical Care Medicine Department at the Veterans Affairs Caribbean Health Care System in San Juan, Puerto Rico
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13
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Ramos-Rossy J, Cantres-Fonseca O, Arzon-Nieves G, Otero-Dominguez Y, Baez-Corujo S, Rodríguez-Cintrón W. Misleading Diagnosis of Idiopathic Pulmonary Fibrosis: A Clinical Concern. Fed Pract 2018; 35:40-42. [PMID: 30766342 PMCID: PMC6248220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Diagnosis of Sjogren syndrome should be based on consideration of the clinical presentation, a pulmonary function test, blood and rheumatology laboratory findings, radiographic imaging patterns, and biopsy results.
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Affiliation(s)
- Javier Ramos-Rossy
- and are Pulmonary and Critical Care Medicine Fellow Physicians; and are Pulmonary and Critical Care Medicine Attending Physicians; and is a Research Study Coordinator, all at the VA Caribbean Healthcare System in San Juan, Puerto Rico
| | - Onix Cantres-Fonseca
- and are Pulmonary and Critical Care Medicine Fellow Physicians; and are Pulmonary and Critical Care Medicine Attending Physicians; and is a Research Study Coordinator, all at the VA Caribbean Healthcare System in San Juan, Puerto Rico
| | - Ginger Arzon-Nieves
- and are Pulmonary and Critical Care Medicine Fellow Physicians; and are Pulmonary and Critical Care Medicine Attending Physicians; and is a Research Study Coordinator, all at the VA Caribbean Healthcare System in San Juan, Puerto Rico
| | - Yomayra Otero-Dominguez
- and are Pulmonary and Critical Care Medicine Fellow Physicians; and are Pulmonary and Critical Care Medicine Attending Physicians; and is a Research Study Coordinator, all at the VA Caribbean Healthcare System in San Juan, Puerto Rico
| | - Stella Baez-Corujo
- and are Pulmonary and Critical Care Medicine Fellow Physicians; and are Pulmonary and Critical Care Medicine Attending Physicians; and is a Research Study Coordinator, all at the VA Caribbean Healthcare System in San Juan, Puerto Rico
| | - William Rodríguez-Cintrón
- and are Pulmonary and Critical Care Medicine Fellow Physicians; and are Pulmonary and Critical Care Medicine Attending Physicians; and is a Research Study Coordinator, all at the VA Caribbean Healthcare System in San Juan, Puerto Rico
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Martínez-González J, Robles-Arias C, Rodríguez-Cintrón W. Rapidly Progressive and Almost Lethal Pneumonia. P R Health Sci J 2017; 36:41-43. [PMID: 28266699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We herein describe the case of a 65-year-old male patient who presented with Osler's triad, which is the combination of endocarditis, pneumonia, and meningitis. This report is even more unusual since the pathogen isolated was the invasive and virulent strain of Streptococcus pneumoniae serotype 3. The clinical entity described is also called Austrian syndrome. Even though rare in this antibiotic era, the syndrome remains one of high morbidity and mortality. This particular case is of paramount importance for the clinician reader. First, it documents the clinical features associated with invasive pneumococcal disease and the Austrian syndrome. Second, and equally important, it highlights why following the Surviving Sepsis Campaign guidelines saves lives. For this case, the following steps were taken: 1. As a surrogate for perfusion, early and aggressive fluid resuscitation therapy (guided by lactic acid levels) was instituted; 2. also early in the treatment, broad spectrum antibiotics were administered; 3. to guide antibiotic therapy, microbiological cultures were obtained. The patient subsequently improved and was transferred to the internal medicine ward to complete 4 weeks of antibiotic therapy.
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Affiliation(s)
| | - Carlos Robles-Arias
- Pulmonary/Critical Care Medicine, VA Caribbean Healthcare System, San Juan, PR
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Galanter JM, Gignoux CR, Oh SS, Torgerson D, Pino-Yanes M, Thakur N, Eng C, Hu D, Huntsman S, Farber HJ, Avila PC, Brigino-Buenaventura E, LeNoir MA, Meade K, Serebrisky D, Rodríguez-Cintrón W, Kumar R, Rodríguez-Santana JR, Seibold MA, Borrell LN, Burchard EG, Zaitlen N. Differential methylation between ethnic sub-groups reflects the effect of genetic ancestry and environmental exposures. eLife 2017; 6:e20532. [PMID: 28044981 PMCID: PMC5207770 DOI: 10.7554/elife.20532] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/23/2016] [Indexed: 12/19/2022] Open
Abstract
Populations are often divided categorically into distinct racial/ethnic groups based on social rather than biological constructs. Genetic ancestry has been suggested as an alternative to this categorization. Herein, we typed over 450,000 CpG sites in whole blood of 573 individuals of diverse Hispanic origin who also had high-density genotype data. We found that both self-identified ethnicity and genetically determined ancestry were each significantly associated with methylation levels at 916 and 194 CpGs, respectively, and that shared genomic ancestry accounted for a median of 75.7% (IQR 45.8% to 92%) of the variance in methylation associated with ethnicity. There was a significant enrichment (p=4.2×10-64) of ethnicity-associated sites amongst loci previously associated environmental exposures, particularly maternal smoking during pregnancy. We conclude that differential methylation between ethnic groups is partially explained by the shared genetic ancestry but that environmental factors not captured by ancestry significantly contribute to variation in methylation.
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Affiliation(s)
- Joshua M Galanter
- Department of Medicine, University of California, San Francisco, United States
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, United States
| | | | - Sam S Oh
- Department of Medicine, University of California, San Francisco, United States
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, United States
| | - Dara Torgerson
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, United States
| | - Maria Pino-Yanes
- Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Neeta Thakur
- Department of Medicine, University of California, San Francisco, United States
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, United States
| | - Donglei Hu
- Department of Medicine, University of California, San Francisco, United States
| | - Scott Huntsman
- Department of Medicine, University of California, San Francisco, United States
| | - Harold J Farber
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, Texas
| | - Pedro C Avila
- Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Kelly Meade
- Department of Pediatrics, Children’s Hospital and Research Center, Oakland, United States
| | | | | | - Rajesh Kumar
- Division of Allergy and Immunology, The Ann and Robert H Lurie Children’s Hospital of Chicago, Chicago, United States
| | | | - Max A Seibold
- Center for Genes, Environment, and Health, Department of Pediatrics, National Jewish Health, Denver, United States
| | - Luisa N Borrell
- Graduate School of Public Health and Health Policy, City University of New York, New York, United States
| | - Esteban G Burchard
- Department of Medicine, University of California, San Francisco, United States
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, United States
| | - Noah Zaitlen
- Department of Medicine, University of California, San Francisco, United States
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Rivera-Guzmán N, Del Olmo-Arroyo F, Robles-Arías CM, Rodríguez-Cintrón W. Transient AV Block as a Hemodynamic Complication of the Influenza A Virus: A Case Report. P R Health Sci J 2016; 35:173-175. [PMID: 27623145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Influenza virus causes annual epidemics of respiratory illness characterized by sudden onset of fever, malaise, myalgias, headache, cough, and other respiratory complains. Each year in the United States, it is estimated that this debilitating respiratory illness accounts for 294,000 excess hospitalizations and 36,000 attributable deaths. Epidemiological studies describe increased cardiovascular mortality during influenza seasons. Cardiovascular involvement in acute influenza infection can occur through direct effects of the virus on the myocardium or through exacerbation of existing cardiovascular disease. The purpose of this report is to document a transient atrioventricular (AV) block with hemodynamic compromise after infection with the influenza virus in a patient with underlying cardiac disease without myocarditis.
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Boodosingh DR, Robles-Arias C, Alemán-Ortiz JR, Rodríguez-Cintrón W. A rare cause of altered mental status and fever in a young military recruit in Puerto Rico. P R Health Sci J 2014; 33:200-202. [PMID: 25563039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Heat stroke (HS) is a medical emergency characterized by increased core body temperature with associated systemic inflammatory response leading to a syndrome of multi-organ damage in which encephalopathy predominates. We describe a case of a 29 year old male recruit presenting with altered mental status during military training in Puerto Rico. Associated symptoms included high grade fever, dizziness, nausea, vomiting, blurred vision and profuse sweating followed by loss of consciousness. Upon arrival to medical evaluation the patient was found with dry skin and depressed Glasgow Coma Score. Initial laboratories, clinical evolution of symptoms and imaging studies were consistent with the diagnosis of HS. Patient was managed with mechanical ventilatory support, intravenous fluids and external cooling measures. He was later discharged home without any neurological sequelae. To our knowledge this is the first documented case of HS in Puerto Rico.
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Galanter JM, Gignoux CR, Torgerson DG, Roth LA, Eng C, Oh SS, Nguyen EA, Drake KA, Huntsman S, Hu D, Sen S, Davis A, Farber HJ, Avila PC, Brigino-Buenaventura E, LeNoir MA, Meade K, Serebrisky D, Borrell LN, Rodríguez-Cintrón W, Estrada AM, Mendoza KS, Winkler CA, Klitz W, Romieu I, London SJ, Gilliland F, Martinez F, Bustamante C, Williams LK, Kumar R, Rodríguez-Santana JR, Burchard EG. Genome-wide association study and admixture mapping identify different asthma-associated loci in Latinos: the Genes-environments & Admixture in Latino Americans study. J Allergy Clin Immunol 2014; 134:295-305. [PMID: 24406073 PMCID: PMC4085159 DOI: 10.1016/j.jaci.2013.08.055] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 08/27/2013] [Accepted: 08/27/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Asthma is a complex disease with both genetic and environmental causes. Genome-wide association studies of asthma have mostly involved European populations, and replication of positive associations has been inconsistent. OBJECTIVE We sought to identify asthma-associated genes in a large Latino population with genome-wide association analysis and admixture mapping. METHODS Latino children with asthma (n = 1893) and healthy control subjects (n = 1881) were recruited from 5 sites in the United States: Puerto Rico, New York, Chicago, Houston, and the San Francisco Bay Area. Subjects were genotyped on an Affymetrix World Array IV chip. We performed genome-wide association and admixture mapping to identify asthma-associated loci. RESULTS We identified a significant association between ancestry and asthma at 6p21 (lowest P value: rs2523924, P < 5 × 10(-6)). This association replicates in a meta-analysis of the EVE Asthma Consortium (P = .01). Fine mapping of the region in this study and the EVE Asthma Consortium suggests an association between PSORS1C1 and asthma. We confirmed the strong allelic association between SNPs in the 17q21 region and asthma in Latinos (IKZF3, lowest P value: rs90792, odds ratio, 0.67; 95% CI, 0.61-0.75; P = 6 × 10(-13)) and replicated associations in several genes that had previously been associated with asthma in genome-wide association studies. CONCLUSIONS Admixture mapping and genome-wide association are complementary techniques that provide evidence for multiple asthma-associated loci in Latinos. Admixture mapping identifies a novel locus on 6p21 that replicates in a meta-analysis of several Latino populations, whereas genome-wide association confirms the previously identified locus on 17q21.
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Affiliation(s)
- Joshua M Galanter
- Department of Medicine, University of California, San Francisco, Calif; Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, Calif.
| | - Christopher R Gignoux
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, Calif
| | - Dara G Torgerson
- Department of Medicine, University of California, San Francisco, Calif
| | - Lindsey A Roth
- Department of Medicine, University of California, San Francisco, Calif
| | - Celeste Eng
- Department of Medicine, University of California, San Francisco, Calif
| | - Sam S Oh
- Department of Medicine, University of California, San Francisco, Calif
| | | | - Katherine A Drake
- Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, Calif
| | - Scott Huntsman
- Department of Medicine, University of California, San Francisco, Calif
| | - Donglei Hu
- Department of Medicine, University of California, San Francisco, Calif
| | - Saunak Sen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, Calif
| | - Adam Davis
- Children's Hospital and Research Center Oakland, Oakland, Calif
| | - Harold J Farber
- Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Pedro C Avila
- Division of Allergy-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | | | | | - Kelley Meade
- Children's Hospital and Research Center Oakland, Oakland, Calif
| | | | - Luisa N Borrell
- Department of Health Sciences, Graduate Program in Public Health, Lehman College, City University of New York, Bronx, NY
| | | | | | | | - Cheryl A Winkler
- Frederick National Laboratory for Cancer Research, National Institutes of Health, Frederick, Md
| | - William Klitz
- School of Public Health, University of California, Berkeley, Calif
| | | | - Stephanie J London
- National Institute of Environmental Health Sciences, National Institutes of Health, Dept of Health and Human Services, Research Triangle Park, NC
| | - Frank Gilliland
- Department of Preventive Medicine, University of Southern California, Los Angeles, Calif
| | | | | | - L Keoki Williams
- Department of Internal Medicine, Henry Ford Health System, Detroit, Mich
| | - Rajesh Kumar
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | | | - Esteban G Burchard
- Department of Medicine, University of California, San Francisco, Calif; Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, Calif
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Torgerson DG, Capurso D, Ampleford EJ, Li X, Moore WC, Gignoux CR, Hu D, Eng C, Mathias RA, Busse WW, Castro M, Erzurum SC, Fitzpatrick AM, Gaston B, Israel E, Jarjour NN, Teague WG, Wenzel SE, Rodríguez-Santana JR, Rodríguez-Cintrón W, Avila PC, Ford JG, Barnes KC, Burchard EG, Howard TD, Bleecker ER, Meyers DA, Cox NJ, Ober C, Nicolae DL. Genome-wide ancestry association testing identifies a common European variant on 6q14.1 as a risk factor for asthma in African American subjects. J Allergy Clin Immunol 2012; 130:622-629.e9. [PMID: 22607992 DOI: 10.1016/j.jaci.2012.03.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 02/22/2012] [Accepted: 03/06/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Genetic variants that contribute to asthma susceptibility might be present at varying frequencies in different populations, which is an important consideration and advantage for performing genetic association studies in admixed populations. OBJECTIVE We sought to identify asthma-associated loci in African American subjects. METHODS We compared local African and European ancestry estimated from dense single nucleotide polymorphism genotype data in African American adults with asthma and nonasthmatic control subjects. Allelic tests of association were performed within the candidate regions identified, correcting for local European admixture. RESULTS We identified a significant ancestry association peak on chromosome 6q. Allelic tests for association within this region identified a single nucleotide polymorphism (rs1361549) on 6q14.1 that was associated with asthma exclusively in African American subjects with local European admixture (odds ratio, 2.2). The risk allele is common in Europe (42% in the HapMap population of Utah residents with Northern and Western European ancestry from the Centre d'Etude du Polymorphisme Humain collection) but absent in West Africa (0% in the HapMap population of Yorubans in Ibadan, Nigeria), suggesting the allele is present in African American subjects because of recent European admixture. We replicated our findings in Puerto Rican subjects and similarly found that the signal of association is largely specific to subjects who are heterozygous for African and non-African ancestry at 6q14.1. However, we found no evidence for association in European American or Puerto Rican subjects in the absence of local African ancestry, suggesting that the association with asthma at rs1361549 is due to an environmental or genetic interaction. CONCLUSION We identified a novel asthma-associated locus that is relevant to admixed populations with African ancestry and highlight the importance of considering local ancestry in genetic association studies of admixed populations.
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Affiliation(s)
- Dara G Torgerson
- Department of Human Genetics, University of Chicago, Chicago, Il 60637, USA
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20
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Torgerson DG, Gignoux CR, Galanter JM, Drake KA, Roth LA, Eng C, Huntsman S, Torres R, Avila PC, Chapela R, Ford JG, Rodríguez-Santana JR, Rodríguez-Cintrón W, Hernandez RD, Burchard EG. Case-control admixture mapping in Latino populations enriches for known asthma-associated genes. J Allergy Clin Immunol 2012; 130:76-82.e12. [PMID: 22502797 DOI: 10.1016/j.jaci.2012.02.040] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 12/20/2011] [Accepted: 02/02/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Polymorphisms in more than 100 genes have been associated with asthma susceptibility, yet much of the heritability remains to be explained. Asthma disproportionately affects different racial and ethnic groups in the United States, suggesting that admixture mapping is a useful strategy to identify novel asthma-associated loci. OBJECTIVE We sought to identify novel asthma-associated loci in Latino populations using case-control admixture mapping. METHODS We performed genome-wide admixture mapping by comparing levels of local Native American, European, and African ancestry between children with asthma and nonasthmatic control subjects in Puerto Rican and Mexican populations. Within candidate peaks, we performed allelic tests of association, controlling for differences in local ancestry. RESULTS Between the 2 populations, we identified a total of 62 admixture mapping peaks at a P value of less than 10(-3) that were significantly enriched for previously identified asthma-associated genes (P= .0051). One of the peaks was statistically significant based on 100 permutations in the Mexican sample (6q15); however, it was not significant in Puerto Rican subjects. Another peak was identified at nominal significance in both populations (8q12); however, the association was observed with different ancestries. CONCLUSION Case-control admixture mapping is a promising strategy for identifying novel asthma-associated loci in Latino populations and implicates genetic variation at 6q15 and 8q12 regions with asthma susceptibility. This approach might be useful for identifying regions that contribute to both shared and population-specific differences in asthma susceptibility.
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Affiliation(s)
- Dara G Torgerson
- Department of Medicine, University of California San Francisco, San Francisco, CA 94158, USA.
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21
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Arjomandi M, Galanter JM, Choudhry S, Eng C, Hu D, Beckman K, Chapela R, Rodríguez-Santana JR, Rodríguez-Cintrón W, Ford J, Avila PC, Burchard EG. Polymorphism in Osteopontin Gene (SPP1) Is Associated with Asthma and Related Phenotypes in a Puerto Rican Population. Pediatr Allergy Immunol Pulmonol 2011; 24:207-214. [PMID: 22276228 DOI: 10.1089/ped.2011.0095] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 08/21/2011] [Indexed: 11/12/2022]
Abstract
Recent studies have shown that osteopontin, a cytokine with suggested immunoregulatory functions, may contribute to pathogenesis of asthma. To determine whether single-nucleotide polymorphisms (SNPs) in SPP1, the gene encoding osteopontin, are associated with risk of asthma, we genotyped 6 known SNPs in SPP1 in the well-characterized Genetics of Asthma in Latino Americans population of 294 Mexican and 365 Puerto Rican parent-child asthma trios. The associations between SNPs and asthma or asthma-related phenotypes were examined by transmission disequilibrium tests as implemented in the family-based association test program. Three polymorphisms, 1 in exon 7 (rs1126616C) and 2 in the 3'-untranslated region (rs1126772A and rs9138A) of SPP1, were associated with diagnosis of asthma, severity of asthma, asthma in subjects with elevated immunoglobulin E (IgE) (IgE >100 IU/mL), and postbronchodilator FEV(1) in Puerto Ricans (P values=0.00007-0.04). The CC genotype of rs1126616 conferred an odds ratio of 1.7 (95% CI=[1.3, 2.3], P value adjusted for multiple comparisons=0.001) for asthma compared with the CT and TT genotypes. Furthermore, haplotype analysis identified rs1126616C-rs1126772A-rs9138A to be associated with an increased risk for asthma, severity of asthma, and asthma in subjects with elevated IgE (P=0.03). There was no association between the SPP1 SNPs and asthma outcomes in Mexicans. Our findings suggest that the SPP1 gene is a risk factor for asthma and asthma-related phenotypes in Puerto Ricans, and are consistent with previous animal and human studies on the role of osteopontin in pathogenesis of asthma.
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Kovacic MB, Myers JMB, Wang N, Martin LJ, Lindsey M, Ericksen MB, He H, Patterson TL, Baye TM, Torgerson D, Roth LA, Gupta J, Sivaprasad U, Gibson AM, Tsoras AM, Hu D, Eng C, Chapela R, Rodríguez-Santana JR, Rodríguez-Cintrón W, Avila PC, Beckman K, Seibold MA, Gignoux C, Musaad SM, Chen W, Burchard EG, Hershey GKK. Identification of KIF3A as a novel candidate gene for childhood asthma using RNA expression and population allelic frequencies differences. PLoS One 2011; 6:e23714. [PMID: 21912604 PMCID: PMC3166061 DOI: 10.1371/journal.pone.0023714] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 07/23/2011] [Indexed: 11/18/2022] Open
Abstract
Background Asthma is a chronic inflammatory disease with a strong genetic predisposition. A major challenge for candidate gene association studies in asthma is the selection of biologically relevant genes. Methodology/Principal Findings Using epithelial RNA expression arrays, HapMap allele frequency variation, and the literature, we identified six possible candidate susceptibility genes for childhood asthma including ADCY2, DNAH5, KIF3A, PDE4B, PLAU, SPRR2B. To evaluate these genes, we compared the genotypes of 194 predominantly tagging SNPs in 790 asthmatic, allergic and non-allergic children. We found that SNPs in all six genes were nominally associated with asthma (p<0.05) in our discovery cohort and in three independent cohorts at either the SNP or gene level (p<0.05). Further, we determined that our selection approach was superior to random selection of genes either differentially expressed in asthmatics compared to controls (p = 0.0049) or selected based on the literature alone (p = 0.0049), substantiating the validity of our gene selection approach. Importantly, we observed that 7 of 9 SNPs in the KIF3A gene more than doubled the odds of asthma (OR = 2.3, p<0.0001) and increased the odds of allergic disease (OR = 1.8, p<0.008). Our data indicate that KIF3A rs7737031 (T-allele) has an asthma population attributable risk of 18.5%. The association between KIF3A rs7737031 and asthma was validated in 3 independent populations, further substantiating the validity of our gene selection approach. Conclusions/Significance Our study demonstrates that KIF3A, a member of the kinesin superfamily of microtubule associated motors that are important in the transport of protein complexes within cilia, is a novel candidate gene for childhood asthma. Polymorphisms in KIF3A may in part be responsible for poor mucus and/or allergen clearance from the airways. Furthermore, our study provides a promising framework for the identification and evaluation of novel candidate susceptibility genes.
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Affiliation(s)
- Melinda Butsch Kovacic
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
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23
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Jin Y, Hu D, Peterson EL, Eng C, Levin AM, Wells K, Beckman K, Kumar R, Seibold MA, Karungi G, Zoratti A, Gaggin J, Campbell J, Galanter J, Chapela R, Rodríguez-Santana JR, Watson HG, Meade K, Lenoir M, Rodríguez-Cintrón W, Avila PC, Lanfear DE, Burchard EG, Williams LK. Dual-specificity phosphatase 1 as a pharmacogenetic modifier of inhaled steroid response among asthmatic patients. J Allergy Clin Immunol 2010; 126:618-25.e1-2. [PMID: 20673984 DOI: 10.1016/j.jaci.2010.06.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 06/03/2010] [Accepted: 06/08/2010] [Indexed: 11/15/2022]
Abstract
BACKGROUND Inhaled corticosteroids (ICSs) are considered first-line treatment for persistent asthma, yet there is significant variability in treatment response. Dual-specificity phosphatase 1 (DUSP1) appears to mediate the anti-inflammatory action of corticosteroids. OBJECTIVE We sought to determine whether variants in the DUSP1 gene are associated with clinical response to ICS treatment. METHODS Study participants with asthma were drawn from the following multiethnic cohorts: the Genetics of Asthma in Latino Americans (GALA) study; the Study of African Americans, Asthma, Genes & Environments (SAGE); and the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-ethnicity (SAPPHIRE). We screened GALA study participants for genetic variants that modified the relationship between ICS use and bronchodilator response. We then replicated our findings in SAGE and SAPPHIRE participants. In a group of SAPPHIRE participants treated with ICSs for 6 weeks, we examined whether a DUSP1 polymorphism was associated with changes in FEV(1) and self-reported asthma control. RESULTS The DUSP1 polymorphisms rs881152 and rs34507926 localized to different haplotype blocks and appeared to significantly modify the relationship between ICS use and bronchodilator response among GALA study participants. This interaction was also seen for rs881152 among SAPPHIRE but not SAGE participants. Among the group of SAPPHIRE participants prospectively treated with ICSs for 6 weeks, rs881152 genotype was significantly associated with changes in self-reported asthma control but not FEV(1). CONCLUSION DUSP1 polymorphisms were associated with clinical response to ICS therapy and therefore might be useful in the future to identify asthmatic patients more likely to respond to this controller treatment.
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Affiliation(s)
- Ying Jin
- Center for Health Services Research, Henry Ford Health System, Detroit, Mich; Wayne State University School of Medicine, Detroit, Mich 48202, USA
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Fernández R, Galera A, Casal J, Rodríguez-Cintrón W. An uncommon cause of uncontrolled asthma: case report. J Asthma 2008; 45:766-9. [PMID: 18972292 DOI: 10.1080/02770900802252101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Bronchial asthma is one of the most common chronic conditions seen by any health care professional. Multiple stimuli may lead to acute airway hyperresponsiveness and an exacerbation of the disease, gastroesophageal reflux disease being one of them. We report the case of an elderly patient with chronic gastroesophageal reflux disease who secondarily developed a tracheoesophageal fistula, resulting in recurrent exacerbations of previously well-controlled asthma. After endoscopic correction of the fistula, the patient's respiratory disease improved dramatically, with essentially no exacerbations requiring urgent care or hospitalization.
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Affiliation(s)
- Ricardo Fernández
- Fellowship Training Program, San Juan City Hospital, San Juan, Puerto Rico
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Blondet M, Yapor P, Latalladi-Ortega G, Alicea E, Torres-Palacios A, Rodríguez-Cintrón W. Prevalence and risk factors for sleep disordered breathing in a Puerto Rican middle-aged population. Sleep Breath 2008; 13:175-80. [DOI: 10.1007/s11325-008-0216-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 08/02/2008] [Accepted: 08/04/2008] [Indexed: 11/24/2022]
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Díaz JL, Casal J, Rodríguez-Cintrón W. Flow-volume loops: clinical correlation. P R Health Sci J 2008; 27:181-182. [PMID: 18616048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Flow volume loops are an essential part of spirometry testing. Their appearance can give information that can be helpful in the differential diagnosis of a patient's clinical condition. We present two clinical scenarios in which careful evaluation of the flow-volume loop gives an insight into the cause of the disease process.
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Affiliation(s)
- José Luís Díaz
- Pulmonary/Critical Care, VA Caribbean Healthcare System, San Juan Puerto Rico
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27
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Galanter J, Choudhry S, Eng C, Nazario S, Rodríguez-Santana JR, Casal J, Torres-Palacios A, Salas J, Chapela R, Watson HG, Meade K, LeNoir M, Rodríguez-Cintrón W, Avila PC, Burchard EG. ORMDL3 gene is associated with asthma in three ethnically diverse populations. Am J Respir Crit Care Med 2008; 177:1194-200. [PMID: 18310477 DOI: 10.1164/rccm.200711-1644oc] [Citation(s) in RCA: 203] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Independent replication of genetic associations in complex diseases, particularly in whole-genome association studies, is critical to confirm the association. OBJECTIVES A whole-genome association study identified ORMDL3 as a promising candidate gene for asthma in white populations. Here, we attempted to confirm the role of ORMDL3 genetic variants in asthma in three ethnically diverse populations: Mexican, Puerto Rican, and African American. METHODS We used family-based analyses to test for association between seven candidate single-nucleotide polymorphisms (SNPs) in and around the ORMDL3 gene and asthma and related phenotypes in 701 Puerto Rican and Mexican parent-child trios. We also evaluated these seven SNPs and an additional ORMDL3 SNP in 264 African American subjects with asthma and 176 healthy control subjects. MEASUREMENTS AND MAIN RESULTS We found significant associations between two SNPs within ORMDL3 (rs4378650 and rs12603332) and asthma in Mexicans and African Americans (P = 0.028 and 0.001 for rs4378650 and P = 0.021 and 0.001 for rs12603332, respectively), and a trend toward association in Puerto Ricans (P = 0.076 and 0.080 for SNPs rs4378650 and rs12603332, respectively). These associations became stronger among Mexican and Puerto Rican subjects with asthma with IgE levels greater than 100 IU/ml. We did not find any association between ORMDL3 SNPs and baseline lung function or response to the bronchodilator albuterol. CONCLUSIONS Our results confirm that the ORMDL3 locus is a risk factor for asthma in ethnically diverse populations. However, inconsistent SNP-level results suggest that further studies will be needed to determine the mechanism by which ORMDL3 predisposes to asthma.
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Affiliation(s)
- Joshua Galanter
- Lung Biology Center, Department of Medicine, Institute for Human Genetics, University of California, San Francisco, California 94143-2911, USA.
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Fahed-Inigo GP, Torres-Palacios A, Rodríguez-Cintrón W. Hepatopulmonary syndrome. P R Health Sci J 2007; 26:159-62. [PMID: 17722431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
This is a report of a 56-year-old male who was admitted to the Intensive Care Unit of the San Juan V.A. Medical Center with altered mental status and severe hypoxemia. He was diagnosed with severe hyponatremia and hepatopulmonary syndrome.
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Abstract
Sleep complaints are very common among the general population and are usually accompanied by significant medical, psychological and social disturbances (Redline S, Strohl K, Otolaryngol Clin North Am, 132:303, 1999). A higher prevalence of sleep complaints has been described in the elderly (Vgontzas AN, Kales A, Annu Rev Med, 50:387-400, 1999). It is manifested by breathing disturbances during sleep, loud snoring, difficulties maintaining sleep, fatigue, daytime sleepiness, mood effects and impairment of daily activities (Lugaresi E, Cirignotta F, Zucconi M et al., Good and poor sleepers: an epidemiological survey of the San Marino population, Raven, New York, pp 1-12, 1983; Kales A, Soldatos CR, Kales JD, Am Fam Physician, 22:101-108, 1980). It has been associated with cardiovascular, endocrine and neurocognitive manifestations. Growing interest in early diagnosis and treatment has been noted in recent years based on emerging knowledge about the potential health consequences when the disease goes untreated (Nanen AM, Dunagan DP, Fleisher A et al., Chest, 121:1741, 2002). The veteran population in the mainland has a higher tendency for obesity, high blood pressure (HBP), sleep disorders and chronic alcohol consumption (Mustafa M, Erokwu N, Ebose I, Strohl K, Sleep Breath, 9:57-63, 2005). The Hispanic veteran population has never been studied in detail for sleep disorders and related conditions. We used previously validated screening tools for sleep disturbance breathing. Two hundred and forty-five questionnaires were administered. We found a higher prevalence of Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) in our population compared with data from the mainland (USA). The mean age was 64 years (+/-11). Ninety seven per cent were males. The mean body mass index was 25 kg/cm(2); mean Epworth Sleepiness Scale score was 8. Thirty-four per cent met high-risk criteria for sleep apnea, 53% for insomnia, 13% for symptoms suggestive of narcolepsy and 13% for those suggestive of restless leg syndrome. There were high incidences of alcohol consumption (37.6%), diabetes (32.7%), hypercholesterolemia (31.8%), depression (31.8%), hypertension (39.6%) and post-traumatic stress disorder (PTSD) (9.8%).
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Affiliation(s)
- María Elena Ocasio-Tascón
- San Juan VA Medical Center, 10 Casia Street, Pulmonary and Critical Care Section (111E), San Juan, 00927-5800, Puerto Rico.
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Loubriel BL, Díaz JL, Casal J, Rodríguez-Cintrón W. STICKING TO LIFE: CLOSURE OF A BRONCHOPLEURAL FISTULA WITH FIBRIN GLUE IN A PATIENT WITH SEVERE BULLOUS EMPHYSEMA. Chest 2006. [DOI: 10.1378/chest.130.4_meetingabstracts.289s-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
A 71-year-old male with coronary artery disease, hypertension, diabetes mellitus, tobacco and opioid dependence came to the emergency room complaining of one episode of retrosternal chest pain oppressive in nature of one day of evolution. He had acute respiratory distress and required mechanical ventilation. The initial impression was myocardial ischemia, but electrocardiography and cardiac enzymes ruled it out. During the following hours, neck and tongue edema developed. He was started on broad-spectrum antibiotics empirically. Neck computed tomography scan revealed a left parapharyngeal and submandibular abscess. The abscess was drained. The source of infection was found on the second molar of the left lower jaw. The patient improved and was successfully weaned from mechanical ventilation. Despite advances in therapy, Ludwig's angina remains a potentially lethal infection in which early recognition plays a crucial role.
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Affiliation(s)
- María Elena Ocasio-Tascón
- Pulmonary and Critical Care Section, San Juan Veterans Affairs Medical Center, San Juan, Puerto Rico.
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Cedeño A, Galera A, Torres A, Rodríguez-Cintrón W. Acute lung injury/acute respiratory distress syndrome: a need for education. P R Health Sci J 2002; 21:305-8. [PMID: 12572237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To examine the timeliness of the diagnosis of patients with ALI/ARDS at the San Juan VA Medical Intensive Care Unit. We were also interested in determining the incidence and the overall 28-day mortality for ARDS during the study period. METHODS Retrospective record review of all admissions to the San Juan Veterans Affairs Medical ICU during a two-year period (1997-1998). RESULTS During the study period, 587 patients were admitted to the medical ICU. All had APACHE II scoring performed during their first 24 hours of admission. Twenty-three patients were found to have an A-a gradient of 350 or less. However, two patients were later identified as having radiographic changes compatible with Congestive Heart Failure and were excluded from the study. The incidence of ALI/ARDS was found to be 3.6% at our institution. Of the 21 patients with ARDS, in only 4 the diagnosis of ARDS was documented on their charts. CONCLUSION Our findings suggest that education in the recognition of ARDS should be aggressively done. In order to implement the recently published successful strategies in the mechanical ventilation of patients with ARDS, it should be first recognized. Our patients need it.
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Affiliation(s)
- Arturo Cedeño
- Pulmonary and Critical Care Medicine Section, San Juan Veterans Affairs Medical Center, 10 Casia St., San Juan, Puerto Rico 00921-3201
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Cedeño A, Rodríguez P, Rodríguez-Cintrón W. Acute respiratory distress syndrome in the trauma intensive care unit: the other view. P R Health Sci J 2002; 21:309-12. [PMID: 12572238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To study the timeliness of the diagnosis of patients with acute respiratory distress syndrome (ARDS)/acute lung injury (ALI) at the Puerto Rico Trauma Center (PRTC) and to determine the overall 28 day mortality for ARDS during the study period. METHOD A retrospective review of all admissions to the Trauma Intensive Care Unit (TICU) from August 2000 to August 2001 was done. Patients with the diagnosis of ARDS/ALI were selected, records examined, and clinical data obtained for analysis. FINDINGS Of the 537 patient admitted to the PRTC, 236 patient were admitted to TICU. Of these, 17 patients were identified as having hypoxemic ratios below 200 and 13 patients were identified as having ARDS as established by the American-European Consensus Conference of 1994. Their mean age was 41 years, the main cause of ARDS was due to pulmonary contusion due to blunt chest trauma. The 28-day survival for this group was 43%. Subgroup analysis showed that there was 86% mortality when the polytraumatized patient developed sepsis. CONCLUSION The majority of the cases of ARDS were correctly identified as such by caregivers at the time of diagnosis. Mortality as predicted by Injury Severity Score in our ARDS patients' correlates with overall mortality in our TICU. Mortality in this group is lower than that of reported literature, in sharp contrast to our medical ICU counterparts.
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Affiliation(s)
- Arturo Cedeño
- Pulmonary and Critical Care Medicine Section, University of Puerto Rico School of Medicine, San Juan Veterans Affairs Medical Center, 10 Casia St, San Juan, Puerto Rico 00921-3201
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Príncipe-Rodríguez K, Rodríguez-Cintrón W, Torres-Palacios A, Casal-Hidalgo J. Substituted judgement: should life-support decisions be made by a surrogate? P R Health Sci J 1999; 18:405-9. [PMID: 10730310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To evaluate the utility of the substituted judgement standard in terminally ill patients by determining agreement between patients, family proxies and physicians. BACKGROUND Several studies have addressed the utility of substituted judgement, showing conflicting data whether surrogates are accurate predicting patient's wishes. METHODS Patients with acquired immunodeficiency syndrome, congestive heart failure, chronic liver disease admitted to the San Juan Veterans Affairs Medical Center in Puerto Rico from November 1997 to February 1998 were evaluated. A questionnaire presented three hypothetical situations on withholding and withdrawal of life-support and CPR. The percent agreement was used as a measure of concordance between choices made by physician, surrogate and patients. RESULTS Twenty patients met inclusion criteria (5 chronic liver disease, 9 heart failure, 6 AIDS). Relatives had a higher percent of agreement as compared to physicians in all vignettes. Even though, none did better than chance in predicting patient's wishes (k < 0.4). There was a tendency for relatives not to provide a wanted life-support measure, and for physicians to provide an unwanted life-support measure. CONCLUSION The poor agreement between patients and surrogates suggests that substituted judgement is not an accurate tool to make end-of-life decisions. These findings, although similar to previous published studies, are unique because the direction of discrepant responses is opposite to the findings of studies published elsewhere. These results could reflect religious, cultural and socioeconomic differences.
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Affiliation(s)
- K Príncipe-Rodríguez
- Department of Pulmonary Diseases, San Juan Veterans Affairs Medical Center, Puerto Rico.
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