Clinical profile and quality of life of Puerto Ricans with hereditary angioedema.

Background: There is limited data on clinical characteristics and quality of life (QoL) of Hereditary angioedema (HAE) patients in Puerto Rico. Objective: Create an epidemiological and clinical profile of patients with HAE and assess the burden of this condition on the general health of Puerto Ricans suffering the disease. Methods: A cross-sectional study was performed in 32 Puerto Rican patients with HAE. To obtain data on sociodemographic characteristics, clinical symptoms and treatment, a clinical survey based on a Spanish adaptation of the "HAEA Patient Summit Questionnaire 2015" was used. To measure QoL, the SF-36v2 questionnaire was used. IBM SPSS 22.0 (IBM, NY, USA) and QualityMetric Health Outcomes™ Scoring Software 4.5 was utilized for statistical analysis. Results: The most common type of HAE was Type I (41.9%). In 1 year, 32.3% of patients present 2-3 attacks per month. The most common locations were: abdomen and face. Seventy-eight percent of patient developed laryngeal edema but only 6.5% needed tracheotomy. Fifty-eight percent of patients were using prophylaxis therapy; C1 esterase inhibitor (68.7%) being the most common. Eighty-one percent of patients were using rescue medication; Icatibant (80.8%) being the most common. Compared with US population norms of quality of life, patients with HAE in Puerto Rico reported significantly lower scores, both in the physical component (62%) and in the mental components (58%). The most affected parameters were emotional (38.52), physical (39.19) and social (39.79) components. Gender differences were observed in our sample; females scored below males in all components except for general health. Conclusion: Puerto Rican Hispanics showed a similar epidemiologic and clinical profile to previous studies, however; higher frequency of attacks was prominent. Our study demonstrates a substantial and noteworthy decrease in quality of life in HAE patients and an increase risk for depression, particularly among woman.

Recommendations to Improve the Influenza Immunization Rates of Respiratory Healthcare Professionals: A Survey Conducted in Puerto Rico.

OBJECTIVE: Influenza affects 5-15% of the worldwide population and is responsible for 4-5 million cases and 250,000-500,000 deaths. Despite established recommendations, vaccination rates continue to be low. Our study aimed to identify barriers to influenza immunization and attitudes toward the vaccine among respiratory health care (HC) professionals in Puerto Rico. METHODS: We conducted an anonymous written survey that was handed out to 130 HC professionals, including physicians, nurses and respiratory therapists, who attended the Annual Respiratory Disease Congress held in San Juan, Puerto Rico, on August 2018. RESULTS: A total of 68 health care professionals participated in the study. Nearly 34% of participants reported never receiving influenza immunization themselves, 13% reported intermittent immunization, and 53% received immunizations yearly. Approximately 82% and 87% of the participants believed the influenza vaccine to be safe and effective, respectively. Sixty- five percent of respiratory therapists considered the vaccine effective, as compared to 94% of physicians and 100% of nurses and other HC professionals (p=0.023). Most of the participants (87%) recommended influenza immunization, although 38% of participants indicated being concerned about potential side effects of the vaccine. Knowledge of current clinical indications for influenza immunization for medical conditions varied from 59% for patients on systemic steroids to 94% for patients with diabetes mellitus. CONCLUSION: This survey among respiratory HC professionals in Puerto Rico demonstrated barriers in knowledge about vaccination, its indications, and its safety. Addressing these barriers provides us with opportunities to improve influenza immunizations rates among HC workers and their patients.

Atypical antipsychotics in the management of behavioral symptoms associated with dementia.

Dementia is characterized by a progressive deterioration of memory and cognitive function that occurs mostly in the elderly population. In the United States nearly 4.5 million people suffers dementia. Behavioral and psychological symptoms of dementia (BPSD) are defined as agitation, delusions, hallucinations, anxiety, and aggressiveness in patients diagnosed with this condition. One of the most useful therapeutic approaches for behavioral symptoms is antipsychotic medications, though there is no ill-established evidence about their efficacy. This article review possible benefits as well as side effects of these drugs. A detailed orientation about antipsychotic side effects and risks should be given to patients and caregivers, to obtain an appropriate and informed consent decision.

Urticaria in the elderly.

Urticaria is a common disorder affecting approximately 15-25% of the population at some point in their life. We can assume that with the advancement of medical therapeutics, which have in turn prolonged the duration of life, the incidence of drug induced urticaria will increase in the geriatric population. Other common causes that need to be considered are allergy, autoimmune conditions and stress. Urticaria is characterized by transient pruritic wheals or erythematous patches on the skin. The signs and symptoms usually resolve in less than 24 hrs, leaving no residual scar or discoloration. Generally, the etiology of urticaria remains unknown in 75-90% of patients. In this article we discuss pathogenesis, clinical presentation, and treatment of urticaria in the elderly. A complete medical evaluation and age appropriate screening should be performed in all elderly patients in a primary care setting. We should also weigh risk versus benefits of each prescribed medication to decrease morbidity and improve the quality of life.

Contrast associated nephropathy in the elderly.

Contrast medium studies have become an important tool for management and diagnosis in many medical specialties. As we age, the need for such studies increase in presence of multiple comorbidities as coronary artery disease and diabetes mellitus. Nephropathy induced by iodine contrast medium is an important complication of radiological procedures, most common in the aged, and a potentially preventable one. For this reason, the understanding and prevention of contrast associated nephropathy is of prime importance to prevent morbidity and mortality in the geriatric population.