Human megakaryocytes possess intrinsic antiviral immunity through regulated induction of IFITM3.

Evolving evidence indicates that platelets and megakaryocytes (MKs) have unexpected activities in inflammation and infection; whether viral infections upregulate biologically active, antiviral immune genes in platelets and MKs is unknown, however. We examined antiviral immune genes in these cells in dengue and influenza infections, viruses that are global public health threats. Using complementary biochemical, pharmacological, and genetic approaches, we examined the regulation and function of interferon-induced transmembrane protein 3 (IFITM3), an antiviral immune effector gene not previously studied in human platelets and MKs. IFITM3 was markedly upregulated in platelets isolated from patients during clinical influenza and dengue virus (DENV) infections. Lower IFITM3 expression in platelets correlated with increased illness severity and mortality in patients. Administering a live, attenuated DENV vaccine to healthy subjects significantly increased platelet IFITM3 expression. Infecting human MKs with DENV selectively increased type I interferons and IFITM3. Overexpression of IFITM3 in MKs was sufficient to prevent DENV infection. In naturally occurring, genetic loss-of-function studies, MKs from healthy subjects harboring a homozygous mutation in IFITM3 (rs12252-C, a common single-nucleotide polymorphism in areas of the world where DENV is endemic) were significantly more susceptible to DENV infection. DENV-induced MK secretion of interferons prevented infection of bystander MKs and hematopoietic stem cells. Thus, viral infections upregulate IFITM3 in human platelets and MKs, and IFITM3 expression is associated with adverse clinical outcomes. These observations establish, for the first time, that human MKs possess antiviral functions, preventing DENV infection of MKs and hematopoietic stem cells after local immune signaling.

Quality of life improvement in Latinas receiving combined substance use disorders and trauma-specific treatment: a cohort evaluation report.

BACKGROUND: This study evaluates the benefits of integrating behavioral health and trauma services for Latinas with a history drug use. Changes in quality of life (QOL) domains were documented after participation in a manualized intervention in a cohort of Latinas. METHODS: Participants were part of a prospective cohort study of 136 Latinas with co-occurring disorders (COD) who may have experienced trauma and receiving services in our outpatient treatment facility in Bayamón, Puerto Rico. The WHOQOL-BREF Spanish version was used to score physical, psychological, social, and environmental QOL domains, at intake and after six months. Sociodemographic variables, alcohol, drug use, mental health disorders, and severity of substance use disorders (as defined by the DSM-5) were also tabulated. Descriptive statistics and paired t test or the Wilcoxon signed-rank test were computed for comparison. RESULTS: A median age of 39 years was seen and with 76% high school education or higher degree. The majority were unemployed (95.9%). A diagnosis of severe cocaine use (51.4%) was present and almost half (49.5%) had three or more DSM-5 diagnoses. Mean QOL scores were higher at six months with statistically significant differences in each domain. Women with neurodevelopmental disorders and schizophrenia yielded higher mean QOL scores for each domain at six months except for the social domain. Women with polydrug use and women who reported exposure to trauma and depressive disorder experienced statistically significant increments in the physical, psychological and social domains in comparison to counterpart women. CONCLUSIONS: Significant and positive changes in QOL were found in each domain. Latinas who reported traumatic events had lower scores in the physical and psychological QOL domains. There was a high prevalence of diminished physical and mental functioning in Latinas with COD. The exposure to trauma and the lack of social support negatively affect treatment access and retention for Latinas.

Late HIV Testing in a Cohort of HIV-Infected Patients in Puerto Rico.

OBJECTIVE: Late HIV testing (LT), defined as receiving an AIDS diagnosis within a year of one's first positive HIV test, is associated with higher HIV transmission, lower HAART effectiveness, and worse outcomes. Latinos represent 36% of LT in the US, yet research concerning LT among HIV cases in Puerto Rico is scarce. METHODS: Multivariable logistic regression analysis was used to identify factors associated with LT, and a Cochran‒Armitage test was used to determine LT trends in an HIV-infected cohort followed at a clinic in Puerto Rico specialized in the management and treatment of HIV. RESULTS: From 2000 to 2011, 47% of eligible patients were late testers, with lower median CD4 counts (54 vs. 420 cells/mm3) and higher median HIV viral load counts (253,680 vs. 23,700 copies/mL) than non-LT patients. LT prevalence decreased significantly, from 47% in 2000 to 37% in 2011. In a mutually adjusted logistic regression model, males, older age at enrollment and past history of IDU significantly increased LT odds, whereas having a history of amphetamine use decreased LT odds. When the data were stratified by mode of transmission, it became apparent that only the category men who have sex with men (MSM) saw a significant reduction in the proportion of LT, falling from 67% in 2000 to 33% in 2011. CONCLUSION: These results suggest a gap in early HIV detection in Puerto Rico, a gap that decreased only among MSM. An evaluation of the manner in which current HIV-testing guidelines are implemented on the island is needed.

Late HIV Testing in a Cohort of HIV-Infected Patients in Puerto Rico.

OBJECTIVE: Late HIV testing (LT), defined as receiving an AIDS diagnosis within a year of one's first positive HIV test, is associated with higher HIV transmission, lower HAART effectiveness, and worse outcomes. Latinos represent 36% of LT in the US, yet research concerning LT among HIV cases in Puerto Rico is scarce. METHODS: Multivariable logistic regression analysis was used to identify factors associated with LT, and a Cochran‒Armitage test was used to determine LT trends in an HIV-infected cohort followed at a clinic in Puerto Rico specialized in the management and treatment of HIV. RESULTS: From 2000 to 2011, 47% of eligible patients were late testers, with lower median CD4 counts (54 vs. 420 cells/mm3) and higher median HIV viral load counts (253,680 vs. 23,700 copies/mL) than non-LT patients. LT prevalence decreased significantly, from 47% in 2000 to 37% in 2011. In a mutually adjusted logistic regression model, males, older age at enrollment and past history of IDU significantly increased LT odds, whereas having a history of amphetamine use decreased LT odds. When the data were stratified by mode of transmission, it became apparent that only the category men who have sex with men (MSM) saw a significant reduction in the proportion of LT, falling from 67% in 2000 to 33% in 2011. CONCLUSION: These results suggest a gap in early HIV detection in Puerto Rico, a gap that decreased only among MSM. An evaluation of the manner in which current HIV-testing guidelines are implemented on the island is needed.

Adjuvant effect of dendritic cells activator Imiquimod in genetic immunization with HIV-1 p55 Gag.

Dendritic cells (DC) are important antigen-presenting cells that have abilities to induce and maintain T-cell immunity, or attenuate it during hyperimmunization. Additional activation of DCs may be useful for vaccination purposes. Imiquimod is known to be a specific agonist of the Toll-like receptors (TLR7), which are located mainly on DCs. To study the effect of DC stimulation on the effectiveness of an HIV-1 p55 gag DNA vaccine in a mice model, we employed 25, 50, and 100 nM of Imiquimod as an adjuvant. Subsequently, Western blot analysis was used to quantify p55 protein production after the immunization. To characterize T-cells immune response, both the frequency of IFN-γ -secreting cells and IFN-γ and IL-4 production were measured, via an ELIspot assay and ELISA, respectively. Low concentrations of Imiquimod were found to effectively stimulate Gag production and the magnitude of the T-cell immune response, whereas higher concentrations reduced vaccination effects. Our results show that the adjuvant effects of Imiquimod depend on concentration. The use of Imiquimod may be helpful to study DC to T cell communication, including possible induction of immunotolerance.

Soy and Frequent Dairy Consumption with Subsequent Equol Production Reveals Decreased Gut Health in a Cohort of Healthy Puerto Rican Women.

The U.S. Hispanic female population has one of the highest breast cancer (BC) incidence and mortality rates, while BC is the leading cause of cancer death in Puerto Rican women. Certain foods may predispose to carcinogenesis. Our previous studies indicate that consuming combined soy isoflavones (genistein, daidzein, and glycitein) promotes tumor metastasis possibly through increased protein synthesis activated by equol, a secondary dietary metabolite. Equol is a bacterial metabolite produced in about 20-60% of the population that harbor and exhibit specific gut microbiota capable of producing it from daidzein. The aim of the current study was to investigate the prevalence of equol production in Puerto Rican women and identify the equol producing microbiota in this understudied population. Herein, we conducted a cross-sectional characterization of equol production in a clinically based sample of eighty healthy 25-50 year old Puerto Rican women. Urine samples were collected and evaluated by GCMS for the presence of soy isoflavones and metabolites to determine the ratio of equol producers to equol non-producers. Furthermore, fecal samples were collected for gut microbiota characterization on a subset of women using next generation sequencing (NGS). We report that 25% of the participants were classified as equol producers. Importantly, the gut microbiota from equol non-producers demonstrated a higher diversity. Our results suggest that healthy women with soy and high dairy consumption with subsequent equol production may result in gut dysbiosis by having reduced quantities (diversity) of healthy bacterial biomarkers, which might be associated to increased diseased outcomes (e.g., cancer, and other diseases).

The morbidity and mortality associated with kidney disease in an HIV-infected cohort in Puerto Rico.

INTRODUCTION: Nephropathy in HIV-infected patients has been associated with progression to AIDS and death. The virus, several comorbid conditions and certain medications may contribute to the development and progression of kidney disease. METHODS: This study analyzed data collected from HIV-infected persons enrolled in a HIV registry in Puerto Rico during January 1998 through September 2006. Demographic factors, clinical manifestations, laboratory findings at enrollment, and antiretroviral therapy (ART) prescriptions were compared between patients with and without kidney disease. Death status and cause of death by December 2006 were also evaluated and compared. RESULTS: The study included 1,283 subjects, 69.0% male, 39.7% injecting drug users, 19.5% hepatitis C infected, 6.5% with diabetes mellitus (DM-2), 11.6% had hypertension (HTN) and 9.0% had kidney disease. Patients with kidney disease had significantly higher (P < .05) HIV viral load mean (273,499 vs. 202,858 copies/mL), CD4 T-cell count < 200 (57.0% vs. 44.4%), underweight (22.9% vs. 10.9%), DM-2 (13.9% vs. 5.8%), HTN (27.8% vs 10.0%) and mortality (15.9 vs 5.7 deaths per 100 years of follow-up) than those without it. Cox proportional hazard analysis showed that patients with kidney disease had a higher mortality risk (2.1) after controlling for age, sex, HIV risk factor, ART prescription in the last year and HIV disease duration. CONCLUSIONS: This study demonstrated a substantial disparity in mortality for Puerto Rican HIV-infected patients with nephropathy. Kidney disease preventive strategies that include aggressive control of HIV-infection and chronic medical conditions, such as hypertension and diabetes, are recommend as an approach to reduce this health disparity.

The effectiveness evaluation of a multimedia hepatitis C prevention program for Hispanic HIV-infected individuals.

INTRODUCTION: With the introduction of highly active antiretroviral therapy, the hepatitis C virus (HCV) infection has become a primary health problem among individuals suffering from HIV/ AIDS in Puerto Rico, principally those who are injecting drug users (IDUs). A multimedia educational intervention, based on the Health Beliefs Model and Social Cognitive Theory was developed and implemented to reduce HCV-associated risk behaviors among IDUs. METHODS: A pre- and post- intervention study evaluated the knowledge and behavioral changes in a group of HIV-infected persons recruited from February 2006 through December 2008. RESULTS: A total of 110 participants were recruited: all were IDUs; 82% were men; 86.3% were HIV/HCV co-infected and 24.5% had active injected drugs in the month prior to recruitment. The group mean age was 42.2 +/- 9.2 years and mean educational level was 10th grade. Knowledge of HCV risk behaviors, perception of HCV susceptibility, and perception of disease severity increased after the intervention. Knowledge of HCV clinical manifestations and HIV co-infection complications and treatment also improved. In addition, HCV risk behaviors and injecting drug practice decreased significantly among IDUs. CONCLUSIONS: This new multimedia intervention captured and maintained the participants' attention and interest, facilitating their educational process. Thus, greater attention and interest leads to greater knowledge and prevention improvement.

Changes in developmental factors and HIV risk behaviors among early adolescents in Puerto Rico.

INTRODUCTION: Teenagers are the fastest growing group of newly HIV-infected persons. Consequently, a support model for HIV risk reduction was designed and implemented for early adolescents in Puerto Rico. OBJECTIVE: The purpose of this article is to assess changes in developmental factors and HIV risk behaviors among early adolescents after three years of follow-up of an intervention and a non-intervention group. METHODS: This prospective cohort study followed 135 early adolescents who were enrolled in the ASUMA (A Supportive Model for HIV Risk Reduction in Early Adolescents) Project. The study was performed in two public and two private junior schools. Baseline and three follow-up self-administered questionnaires were given. We examined sociodemographic factors, HIV risk behavior and developmental factors. RESULTS: 48% were in the intervention group and 51.1% were controls. Most adolescents were aged 12 years; 47.4% were males; 75.6% reported not having risk behaviors and 24.4% reported having risk behaviors at anytime in their lifespan. A significant decrease in the HIV risk behaviors median was observed among the intervention group (P < .05), while a nonsignificant increase was found among adolescents in the control group. At the end of the implementation phase, positive improvement in the developmental factors were observed in the intervention group (P < .05). CONCLUSIONS: Our study suggests that the ASUMA project curriculum had a positive effect on developmental factors and HIV risk behaviors, as proposed in our conceptual framework. Also, this study illustrates the importance of the creation of culturally appropriate instruments and interventions to reach the goal of HIV/AIDS reduction.

Knowledge and implementation of the DNR in internal medicine teaching programs.

BACKGROUND: The knowledge and implementation skills of the DNR (do not resuscitate) order amongst physicians in training appears to be quite variable. METHODS: We constructed, validated and implemented an instrument which evaluates knowledge and implementation skills of medical residents regarding the DNR in the 8 accredited teaching hospitals in Puerto Rico. RESULTS: Participation of 136 residents from 240 approved positions was seen. Most thought (93.3%) the DNR should be written in the medical record. And 88.1% thought appropriate to suggest a DNR to the patient or family for a terminally ill patient. For a patient with an uncertain prognosis who insisted on a DNR, 78.5% believed the attending physician and 21.5% thought the ethics committee was responsible for determining the propriety of the order. When the patient and the treating physicians agreed on the appropriateness of a DNR order most residents in the North of Puerto Rico thought the writing of the order was the purview of the resident while residents in the South-West thought this to be the responsibility of the attending physician. In the absence of a DNR order, more than 77.4% of the residents in the North and South would initiate CPR in a comatose patient with terminal cancer, multiple organ failure and sepsis in contrast to 15% of the residents in the West. CONCLUSIONS: Implementation and knowledge skills of medical residents in the health regions of Puerto Rico differ. Knowledge and implementation of the DNR merits improvement in all training programs.

Changes in the socio-demographics, risk behaviors, clinical and immunological profile of a cohort of the Puerto Rican population living with HIV: an update of the Retrovirus Research Center (1992-2008).

OBJECTIVES: We describe the changes in the socio demographic, risk behavior, immunological and clinical trends profiles of a cohort HIV patients followed at the Retrovirus Research Center, at baseline and study periods interval by periods intervals: 1992-1997, 1998-2003, and 2004-2008. METHODS: This is a cross-sectional study of a longitudinal cohort comprised of 4016 HIV/AIDS patients admitted to the RRC since January 1992. Data collected include socio-demographic variables; risk related variables; psychological variables; and clinical variable by periods of study. RESULTS. The most common AIDS defining conditions observed in patients were: Pneumocistis Cariini pneumonia (PCP), toxoplasmosis of brain (TP), and wasting syndrome (WS). Chronic conditions are more prevalent than AIDS-defining conditions in the cohort of patients. CONCLUSIONS: Understanding the socio demographic, HIV risk behavior profile; and the immunological and clinical trends among HIV patients is critical for redesigning services and programs oriented in HIV patient care.

AIDS-defining neoplasm prevalence in a cohort of HIV-infected patients, before and after highly active antiretroviral therapy.

INTRODUCTION: Malignant disorders have been linked to the HIV epidemic from its onset. Implementation of highly active antiretroviral therapy (HAART) has resulted in a dramatic reduction in the HIV/AIDS morbidity and mortality. The present study evaluates the neoplasm prevalence before and after the implementation of HAART. METHODS: A cross-sectional study was conducted in 171 HIV-infected adults who were followed in Puerto Rico from May 1992 through December 2005. Neoplasm prevalence was measured, and the difference in AIDS- and non-AIDS-defining neoplasms was analyzed before and after the HAART era. Between-group differences were explored by using chi2, Fisher exact test, analysis of variance, and student t test. RESULTS: Malignant neoplasms were detected in 171 patients (4.8%). Of these, 51.5% were AIDS-defining neoplasms, and 68% were established before HAART. AIDS-defining neoplasms accounted for 62.4% of those detected before the availability of HAART and 25.9% of those detected after HAART. Except for cervical carcinoma, the prevalence of AIDS-defining neoplasms decreased after HAART. Non-AIDS lymphomas and prostate neoplasms were more frequent after HAART. DISCUSSION: Our study found a significant reduction of Kaposi sarcoma and AIDS-related lymphoma in the HAART era of the AIDS epidemic. A higher prevalence of non-AIDS-defining lymphomas, prostate carcinoma, and cervical carcinoma was seen in the HAART era. These findings suggest that factors other than severe immunosuppression are involved in the neoplasms' pathogenesis. Preventive strategies that include screening tests, vaccination, and lifestyle modification should be routinely applied in HIV-infected patients.

Changes in profile and colorectal cancer stage over 15 years in Puerto Rico.

INTRODUCTION: The stage of a malignant tumor defines how advanced the malignant process is at the time of diagnosis. In many clinical scenarios it is an indirect measurement of the efficacy of screening interventions used for early detection. We have evaluated changes in the tumor-node-metastasis (TNM) stage of colorectal cancer across a 15-year period. METHODS: This was a retrospective study in which all patients who underwent colorectal cancer surgery at the HIMA San Pablo Medical Center in 1988-1990 (period 1) and 2002-2004 (period 2) had their pathological report examined. The TNM stage for all patients was examined by using standard criteria. RESULTS: A total of 285 patients were evaluated: 108 in period 1 and 177 in period 2. The number of patients > 71 years of age who underwent colon surgery increased (33% vs 46%). An increase in patients with stage one colon cancer was observed in period 2 (30% vs 10%) with a corresponding decrease in stage 2 and 3 (59% vs 83%). CONCLUSION: The pathologic and demographic profile of patients with colorectal cancer has changed over 15 years. Patients with colon cancer are younger and have an earlier stage of disease with a decrease in lymph node involvement. Patients with rectal cancer were older and more likely to be men.

The feasibility and acceptability of a multimedia hepatitis C prevention program for Hispanic HIV-infected persons.

INTRODUCTION: Hepatitis C (HCV) and HIV coinfection has emerged as a major health problem in Puerto Rico, particularly among injection drug users (IDUs). We developed and implemented a multimedia educational intervention for HIV-infected IDUs, based on the Health Belief Model and social cognitive theory. METHODS: To evaluate the program's acceptability, a group of 42 participants completed a written questionnaire immediately after each intervention component. RESULTS: Participants were 85% male, the mean age was 41.6 years (standard deviation 9.2 years), and mean educational level was ninth grade. More than 73% of respondents reported that the computer-based program was very easy to operate. More than 83% agreed that the audio and video tools highly facilitated their learning process, and > 71% agreed that the sessions were long enough. Additionally, they reported a high incremental increase in perceived knowledge regarding HIV/HCV co-infection, HCV infection risk behaviors, HCV complications, HCV preventive measures, and HCV diagnosis and therapy. Most of the participants favored the dissemination of this intervention. CONCLUSIONS: The study found a very good acceptability and feasibility of the computerized intervention in the study group. This new technology that includes audiovisual tools in its design kept the participants' attention and interest, while increasing HIV/HCV co-infection knowledge. Subsequent studies will evaluate the efficacy of this intervention, investigating changes in knowledge and risk behaviors among HIV-infected persons.

Suicide attempts among Puerto Rican men and women with HIV/AIDS: a study of prevalence and risk factors.

INTRODUCTION: Epidemiologic studies in the United States have estimated that 1.1%-4.3% of the general population attempt suicide at some time in their lives, but limited information is available on suicidal attempts within the HIV-positive population after the introduction of effective antiretroviral therapy. In this study, we evaluate the profile and trends of attempted suicide in a sample of HIV patients in Bayamón, Puerto Rico. METHODS: A retrospective cohort study design was employed to analyze data from the HIV/AIDS longitudinal data bank generated in the Retrovirus Research Center at the Universidad Central del Caribe, Puerto Rico, from 2000 through 2004. We analyzed cumulative self-reported suicide attempts from 714 individuals. Annual percentage changes were assessed by using general linear model with Poisson distribution. Adjusted odds ratios were estimated by using logistic regression. RESULTS: The prevalence of suicide attempts increased in the five-year period examined, from 9.0% to 22.0%. In our study, men were more likely to attempt suicide than were women. In addition, the risk factors most strongly related to suicide attempts after adjusting for age, sex, HIV/AIDS status at study entry, and injection drug use were stress factors related to filial relationships, use of psychoactive substance, and isolation. Changes in conducts related to depression, confusion and anxiety were positively associated with suicide attempts. CONCLUSIONS: Prevention and intervention programs should embrace a more comprehensive approach to care for HIV/AIDS. This approach should recognize the psychological needs and provide the support these patients desperately need.

Profile of Puerto Rican HIV/AIDS patients with early and non-early initiation of injection drug use.

BACKGROUND: Early initiation of injection drug use (IDU) increases the risk of HIV infection. METHODS: We compare the sociodemographic, psychosocial, and clinical profiles of HIV-positive IDU patients according to the age at which IDU was initiated. This is a cross-sectional study of 1308 patients seen from 1992 through 2005. We compared the profile of patients with early (age < 13 years) vs non-early (age > 13 years) initiation of IDU. The Fisher and chi2 differences in proportions were performed to assess difference among study groups with earlier IDU. The Mantel-Haenszel test was used to calculate the odds ratio. The Kaplan-Meier and log rank tests were used to assess the median survival. Differences were considered significant at alpha = .05. RESULTS: Early initiation of IDU was reported in 11% of our sample. The early initiation group was more likely to smoke tobacco, use alcohol, attempt suicide, have a history of incarceration, have economic problems, and have episodes of anxiety, confusion, depression, excitation, impulsivity, and violence (P < .05). The general survival time of patients was 36.9 months (95% confidence interval 31.9-42.0). A higher prevalence of candidial esophagitis and Pneumocystis jirovecii pneumonia and a lower prevalence of hepatitis C virus coinfection were seen in the early initiation group (P < .05). No differences in mortality, use of antiretroviral therapy, or CD4 T-cell count were seen. CONCLUSIONS: Differences in terms of lifestyle, stress factors, and history of psychological events were seen in the group of patients with early initiation of IDU seen in our facilities. Differences in the clinical scenario were documented.

Use of adjuvant chemotherapy in patients with stage III colon cancer in Puerto Rico: A population-based study.

OBJECTIVE: This study aims to examine factors associated with the use of adjuvant chemotherapy and the use of oxaliplatin after curative resection in stage III colon cancer patients and assesses the effect of their use in three-year survival. METHODS: This retrospective cohort study was conducted using Puerto Rico Central Cancer Registry-Health Insurance Linkage Database. The study cohort consisted of stage III colon cancer patients with a curative surgery in the period 2008-2012. Multivariate logistic regression was used to estimate adjusted odds ratios. Kaplan-Meier methods and Cox proportional hazards models were used to assess the association between adjuvant chemotherapy and oxaliplatin use and overall survival and risk of death, respectively. RESULTS: Overall, 75% of the study population received adjuvant chemotherapy during the study period. Factors statistically associated with receiving adjuvant chemotherapy within four months after resection included being married (adjusted odds ratio [AOR] 1.64; 95% CI 1.18-2.28; p = 0.003), and being enrolled in Medicare (AOR 1.68; 95% CI: 1.03-2.75; p = 0.039) or Medicaid and Medicare dual eligible (AOR 1.66; 95% CI: 1.06-2.60; p = 0.028). However, patients aged ≥70 years were less likely to receive adjuvant chemotherapy (AOR 0.22; 95%CI 0.14-0.36; p<0.001). DISCUSSION: We observed a significant reduction in mortality in adjuvant chemotherapy treated patients. Similarly, patients <70 years treated with oxaliplatin had significantly lower risk of death than those who did not, although for patients ≥70 years no statistical significance was achieved. Future studies should assess effective interventions to reduce barriers to access guideline-based recommended colon cancer treatment.

Factor V Leiden thrombophilia: presentation of three patients and a literature review.

Hypercoagulable states represent a condition with multiple etiologies in which an interplay of acquired and congenital coagulation defects contribute to abnormal clotting. Several of the thrombophilic disorders are relatively prevalent; one person may have multiple defects, leading to thrombosis without obvious external stimuli. Factor V Leiden thrombophilia is the most common inherited form of thrombophilia and it is occasionally associated with the anomalous prothrombin G20210A mutations. We presents three puertorrican middle-aged females diagnosed with Factor V Leiden after debuting with abnormal clotting events. They shared the common traits of being female, having been born in Puerto Rico, and having parents of European descent. The first two cases presented with deep venous thrombosis of lower and upper extremities, and both had the association of Factor V Leiden and prothrombin G20210A mutation. The third case presented with a cerebrovascular accident, evidencing arterial thrombosis, after receiving estrogen replacement therapy. This report adds Factor V Leiden as a cause of hypercoagulable states in puertorrican patients.

A clinico-pathologic presentation of a 23-year old-female with lymphangioleiomyomatosis and Wilm's tumor.

Lymphangioleiomyomatosis (LAM), is an uncommon, progressive, cystic lung disease which predominantly affects young women of childbearing age. Our patient is a 36-year-old female diagnosed with LAM by open lung biopsy in January 1995. Her past history included a spontaneous left-sided pneumothorax in June 1994 which required chest tube for resolution. The last episode occurred on October. 2002. A chest CT scan at this time presented multiple cystic lesions. Followup with pulmonary function studies every 6 months since 1997 have shown a decrease in force expiratory volume in 1 second (%FEV 1) from 100% to an actual of 53%. The force volume capacity (%FVC) decreased from 105% to 85%, with a FEV1/FVC ratio of 49%. The patient's past medical history also includes a Wilm's tumor, resulting in left nephrectomy at age 6, left adnexal abscess requiring surgery in 2002, complicated with iliac and femoral vein thrombophlebitis and left iliac artery stenosis. A small pericardial effusion occurred in 2003, which resolved spontaneously. Osteoporosis of the spine was documented with a T score of -4.9. A hysterectomy was performed during her first gestation in 1992 due to the presence of ruptured ovarian cysts. She required blood transfusions during this intervention, acquiring chronic hepatitis C infection. She has two brothers and three sisters. One brother and one sister have bronchial asthma; her paternal grandfather had stomach cancer and her grandmother was diagnosed with type II diabetes mellitus. No family history of pulmonary disorders was identified. The chest CT scan showeds many small lung cavities compatible with moderate LAM. Our patient is one of three patients living in Puerto Rico who is currently followed by the NIH sponsored LAM registry.

Trends in the HIV and AIDS epidemic in a Puerto Rican cohort of patients: 1992-2005.

The HIV epidemic is a significant global health care issue. With increasing knowledge and improved therapeutics the natural history of the infection has been modified. In this paper we aim to present the general socio-demographic profile and the clinical and therapeutic spectrum of patients with HIV infection who have visited the Bayamón Health Care facilities over the last 12 years and who are part of the Retrovirus Research Center (RRC). The objectives of the study are: 1) describe changes in the demographic, risk factors and clinical stage of patients with HIV infection initially seen in our center; 2) assess changing trends from the clinical and immunological perspective across time; 3) describe mortality risk of patients particularly after the introduction of antiretroviral therapy (ART). This is a cross-sectional study of 3,569 patients admitted to the RRC at the Universidad Central del Caribe between years 1992 through 2005. The variables studied were demographic, risk factors exposure, HIV status at baseline, clinical and immunological parameters, ART and the mortality risk. Chi square with Cramer's coefficient, Kaplan Meier and Cox proportional hazard ratio analysis were performed. The study revealed that individuals presenting at our health care facilities are older and that the proportion of females has increased. The risk factor profile shows increase in heterosexual contact with the disease. The study found that patients treated with ART had significantly lower mortality risk than those without ART. Patients who arrive to RRC with AIDS and Intravenous Drug Users (IDU) had a higher mortality risk than participants with HIV. The analysis of the trends showed changes in the demographic and clinical profile of patients across the years. HIV/AIDS prevention programs and policies need to be continued in Puerto Rico in order to better control the spread of the epidemic.