Impact of Hurricane Maria on the mortality of patients admitted to the MICU at the VA Caribbean Healthcare System in Puerto Rico.

Objective: This study aims to assess the impact of Hurricane Maria on mortality rates and patient conditions in the Medical Intensive Care Unit (MICU) at the Veterans Affairs Caribbean Healthcare Hospital in San Juan, Puerto Rico (PR). The focus is on the 2 months before and after the hurricane's landfall.

Design: This is a retrospective, transversal study.

Measuring Restrictive Lung Disease Severity Using FEV vs TLC.

Background: No clear parameters currently exist to grade severity in restrictive lung disease as for other ventilatory diseases. This article evaluates whether total lung capacity (TLC) or forced expiratory volume in 1 second (FEV) better correlates with the symptomatology of patients with restrictive lung disease.

Methods: A retrospective review of 6461 patient records at Veterans Affairs Caribbean Healthcare System in Puerto Rico was conducted, and 414 patients met the inclusion criteria.

5-HTP inhibits eosinophilia via intracellular endothelial 5-HTRs; SNPs in 5-HTRs associate with asthmatic lung function.

Background: Previous research showed that 5-hydroxytryptophan (5HTP), a metabolic precursor of serotonin, reduces allergic lung inflammation by inhibiting eosinophil migration across endothelial monolayers.

Objective: It is unknown if serotonin receptors are involved in mediating this 5HTP function or if serotonin receptor (HTR) single nucleotide polymorphisms (SNPs) associate with lung function in humans.

Methods: Serotonin receptor subtypes were assessed by qPCR, western blot, confocal microscopy, pharmacological inhibitors and siRNA knockdown.

Diagnosis and Management of a Massive Eight-Centimeter Acquired Tracheoesophageal Fistula.

Here, we present the case of a 61-year-old veteran Hispanic male with recurrent aspiration pneumonitis, aerophagia, tympanic abdominal bloating, and a positive Ono's sign; symptoms present were secondary to diagnosed tracheoesophageal fistulas (TEFs). TEFs are abnormal connections between the esophagus and the trachea. In adult cases, several risk factors have been identified for acquired cases, which include infection, trauma, and cancer.

Intrapleural Thrombolytics as First Line Therapy for Complicated Parapneumonic Effusions and Empyema in Patients with Prohibitive Surgical Risk: A Cases Series.

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.

Two Roads to Diagnose Primary Esophageal Adenoid Cystic Carcinoma in the Mediastinum.

Adenoid cystic carcinoma (ACC) is a malignant epithelial tumor that predominantly originates in the salivary glands of the head and neck. However, ACC arising in the thoracic cavity is a rare entity. Diagnosis of primary esophageal ACC (EACC) involves use of gastrointestinal endoscopic ultrasound fine-needle aspiration; however a low diagnostic yield has been reported in the literature.

Lung Cancer Screening in Community-Based Practice in Puerto Rico: A Survey of Puerto Rico Pulmonologists.

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.

Don't jump down my throat: gender gap in HPV vaccinations risk long term cancer threats.

Introduction: HPV is the most common sexually transmitted disease in the United States, the principal cause for cervical cancer, and the principal cause for the recent increase in head and neck squamous cell cancers. Current interventions and research goals fail to sufficiently address the need to prevent HPV, and continued stigmatization of HPV as a female disease further discourages young patients from seeking the vaccine.

Areas Covered: This paper will review the epidemiology of HPV, including the rise in male cases and cancers, the immunogenicity of the vaccine, results of efficacy and effectiveness trials, and the social and operational challenges to preventing HPV infection within the United States.

Hemophagocytic Lymphohistiocytosis: Early Treatment Leading to an Excellent Outcome.

HLH is a rare and deadly disease increasingly more present in adults, but following treatment protocol may yield favorable results.

Renal Replacement Therapy in a Patient Diagnosed With Pancreatitis Secondary to Severe Leptospirosis.

In areas where the zoonotic disease leptospirosis is endemic, reduced morbidity and mortality is strongly linked to quick initiation of renal replacement therapy.

Chronic cough and uncontrolled asthma: Ending a three year clinical course with successful foreign body removal.

Acute foreign body aspiration can cause severe damage to the respiratory system, leading to laceration and even death due to asphyxia. However, a foreign body that has been aspirated could go unnoticed acutely and lead to persistent shortness of breath symptoms. Most of the patients will be able to recall the acute aspiration event, but others do not.

Differential asthma odds following respiratory infection in children from three minority populations.

Rationale: Severe early-life respiratory illnesses, particularly those caused by respiratory syncytial virus (RSV) and human rhinovirus (HRV), are strongly associated with the development of asthma in children. Puerto Rican children in particular have a strikingly high asthma burden. However, prior studies of the potential associations between early-life respiratory illnesses and asthma in Puerto Rican and other minority populations have been limited.

When we sleep, where we sleep, and with whom we sleep are all important markers or indicators of social status, privilege, and health.

Cintron WR. When we sleep, where we sleep, and with whom we sleep are all important markers or indicators of social status, privilege, and health. .

Recurrent Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema Refractory to Fresh Frozen Plasma.

The case of a patient with refractory angioedema who was treated with fresh frozen plasma without success raises concern for its effectiveness.

Anterior and Posterior Mediastinum Leiomyomas Arising From the Parietal Pleura.

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.

An Unexpected Cause of Sepsis: Keep Pursuing the Source of Infection.

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.

Racial/Ethnic-Specific Differences in the Effects of Inhaled Corticosteroid Use on Bronchodilator Response in Patients With Asthma.

American Thoracic Society guidelines recommend inhaled corticosteroid (ICS) therapy, plus a short-acting bronchodilator, in patients with persistent asthma. However, few prior studies have examined the efficacy of this combination in children of all racial/ethnic groups. We evaluated the association between ICS use and bronchodilator response (BDR) in three pediatric populations with persistent asthma (656 African American, 916 Puerto Rican, and 398 Mexican American children).

Dying in the Intensive Care Unit.

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.

Flexible Bronchoscopic Removal of 3 Foreign Objects.

Consider flexible bronchoscopy as an option to retrieve aspirated foreign bodies in the airway.

A Forgotten Cause of Cardiac Tamponade.

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.