[Septic knee arthritis caused by Pseudomonas aeruginosa after anterior cruciate ligament reconstruction in an adolescent athlete]. / Artritis de rodilla por Pseudomonas aeruginosa posterior a reconstrucción de ligamento cruzado anterior en un adolescente deportista.

Anterior cruciate ligament reconstruction is a very frequent procedure. Postoperative infection after this procedure is a catastrophic, although infrequent, complication. According to the literature, it occurs in less than 1% of all reconstructions done in the United States. We present herein a case report of septic arthritis of the posterior knee associated with anterior cruciate ligament reconstruction.

Plasma ascorbate in a population of children: influence of age, gender, vitamin C intake, BMI and smoke exposure

The objective of this study is to determine the influence of several personal and lifestyle factors on the levels of circulating vitamin C in a population of children. To accomplish this objective, blood samples were collected from 511 healthy children residing in the Greater San Juan area. The population was stratified into 4 percentile groups (approaching quartiles) according to plasma ascorbate levels from lowest to highest concentrations. Comparisons were made between percentile groups on the basis of age, gender, body mass index (BMI), dietary intake of vitamin C (corrected and uncorrected for energy intake) and exposure to environmental tobacco smoke (ETS). Smoke exposure was determined using urinary cotinine, which is a highly sensitive bioindicator for ETS. Dietary vitamin C was determined via one 24hr recall questionnaire. When all 4 percentile groups were used as a basis of comparison, no differences were noted for any of the factors between groups, however when comparing percentile group 1 (lowest blood ascorbate) to an aggregate value of percentile, groups 2-4, it was found that vitamin C intake (corrected for energy intake) paralleled blood values with a statistically significant association. Among personal and environmental factors only exposure to ETS showed a significant difference in blood levels between groups 2-4 and group 1. No differences between percentile groups were noted for age gender or BMI. These results emphasize that ETS is strongly associated with lowered blood ascorbate levels with the obvious implication of reduced antioxidant protection and increased risk of adverse health consequences.

Improving access to liver transplantation: the University of Puerto Rico experience

Liver transplantation is the only treatment for end-stage liver disease. It is costly, difficult, and not performed in Puerto Rico. For these reasons, it has been a limited option for Puerto Ricans with advanced cirrhosis, especially for those with no medical insurance to cover for the procedure. In an effort to improve access to the procedure and offer this chance of life to more Puerto Ricans facing death from complications of advanced liver disease, the Gastroenterology and Liver Diseases Division of the University of Puerto Rico, in collaboration with LifeLink Transplant Institute in Tampa, Florida and the Office of Catastrophic Funds of the Commonwealth of Puerto Rico, opened a clinic for liver transplant evaluation at the Medical Sciences Campus. The purpose of this clinic is to coordinate the pre-transplant evaluation of candidates for this therapy, provide the evaluation by the transplant surgeon in Puerto Rico, expedite the process in seriously ill patients, and offer post-transplant follow-up upon the patient's return to Puerto Rico. The purpose of this article is to describe the experience in this clinic from 1999 to 2003. One hundred ninety-three patients were seen from September 1999 to January 2003. The most common causes for liver disease were hepatitis C and alcohol, alone or in combination. One hundred thirty four were accepted as candidates for evaluation. Of these, 63 had completed the process, 33 were listed for transplantation and 21 had been transplanted by January 2003. Neither education level, marital status, health insurance nor Child score were associated with successful outcome. This clinic offers Puerto Ricans, especially those with limited resources, with a viable access to liver transplantation.

Comparative study of the effectiveness of thyroxine and steroids on reduction of neonatal morbidity: outcome at 20 months follow-up

This study analyzes health, growth and neurodevelopmental outcome of infants who received prenatal corticosteroids with or without thyroxine for fetal lung maturation. During a 12 month period infants from a prospective double blind study who received either steroids or steroids combined with thyroxine for pulmonary maturation and who had reached 18 months of age were recalled for evaluation of health status, growth parameters and neurodevelopmental outcome using the Bayley Scales 2nd edition (BSID-II). Mental developmental index (MDI), psychomotor developmental index (PDI), language developmental age (LDA), cognitive developmental age (CDA), and behavioral rating scales (BRS) were compared for the two treatment groups. The Hollingshead Socioeconomic Status Index was determined for each infant. Of a total of 134 patients enrolled during the study period, 66 patients return for follow up. Data from 60 patients was included in the final analysis. Of these, 32 had received the combination regimen and 28 had solely received only steroids. Demographics and neonatal morbidity were similar in both groups. No statistical differences in growth parameters, hospital admissions, respiratory problems, surgical procedures or frequency of infections were found. Neurodevelopmental parameters (MDI, PDI) were similar in both treatment groups, although, below normal in both groups. Language delay was more common in infants who received prenatal corticosteroids. There were no difference in the incidence of neurologic abnormalities. The addition of thyroxine to steroids did not affect growth or neuro-developmental outcome of the infants at 18 to 22 postnatal age.

Determinants of environmental tobacco smoke in a population of Puerto Rican children.

This study was designed to determine among various personal, socioeconomic, and environmental factors those which had the greatest influence on exposure to environmental tobacco smoke (ETS) in a population of children residing in a tropical environment and to compare these results with those obtained in the literature of tobacco exposed children in temperate climates. Urine specimens were collected from 606 healthy Puerto Rican children (2-12 years) living in an industrial area and analyzed for cotinine, a quantitative biomarker for exposure to ETS. Parents completed a questionnaire covering smoking habits and socioeconomic information. Seventy per cent of the children were reported to be exposed to ETS, 50% resulting from exposure to smoke from either or both parents. Major determinants to ETS exposure were found to be presence of smoker, number of smokers, identity of smoker, number of cigarettes smoked in the household and child age with the youngest children suffering twice the exposure of older children. Non-determinants were exposure to smoke other than from the parent, sex of the child, season of the year and several socioeconomic factors including civil and employment status of the mother, mother's age and educational background and whether food stamps were being received. Results of a multiple regression analysis showed that our predictors accounted for 40% of cotinine appearing in the urine. Reasons for this relatively low value may be due in part to precision of our analytic method and lower levels of ambient smoke in our population vs. others that reported higher R(2) values. Predictions from questionnaire information for high ETS exposure were not always the same as those indicated by urinary cotinine emphasizing that the bioindicator, which indicates the actual inhalation of ETS, is a better predictor of exposure than responses from a questionnaire.

Surgical versus interventional procedures in patients with multivessel coronary artery disease.

OBJECTIVE: This study examined the clinical characteristics, risk factors, indications and post-intervention complications of patients with multivessel coronary artery disease (CAD) submitted to either percutaneous transluminal coronary angioplasty (PTCA) and/or stent placement versus isolated coronary artery bypass grafting (CABG). BACKGROUND: Several studies have examined the relative safety and outcome of patients submitted to those interventional procedures compared to CABG. Limited information is available regarding that subject in Puerto Rico. METHODS: We performed a retrospective analysis of the clinical, angiographic, operative, interventional, post-operative and post-interventional data of patients submitted to those procedures in our institution from January 1998 to August 1998. There were 53 patients in the interventional group and 206 patients in the CAGB group. Comparison of quantitative variables by procedure was based on Student t test or Mann-Whitney-Wilcoxon test; categorical variables were compared using Pearson's chi-square or Fisher's exact test. RESULTS: There were no significant differences in age, body surface area, or cardiac risk factors. The most common pre-existing cardiovascular diagnosis was unstable angina. Three-vessel disease was the most common angiographic finding among CABG patients (61.7%). Two-vessel disease without left anterior descending coronary artery obstruction was significantly more common in the PTCA/Stent patients (58.5%). The vast majority (97.6%) of patients in the PTCA/Stent group and 52.4% of the CABG group had two-vessel intervention. A significantly higher frequency of complications occurred in the CABG group. However, the incidence of major complications, in both groups was not statistically different. Atrial arrhythmias were significantly more frequent in the CABG group. CONCLUSION: A larger prospective study should be conducted in order to corroborate these preliminary findings and seek effective solution to any identifiable problem.

CCR5 and beta-chemokines in HIV-1 infected children.

The duration from initial infection with HIV-1 to CD4 lymphocyte depletion and progression to AIDS varies among infected individuals. Despite treatment with highly active antiretroviral therapy (HAART), patients still show different stages of disease progression. We examined the role of beta-chemokines and its receptor, CCR5 in HIV-1 infected children in order to define determinants of HIV progression among treated individuals. Population was divided in two groups: Group 1--Long Term Non Progressors (LTNP) includes 10 patients with B1-B2 CDC disease classification and with a less aggressive therapy (only 2 in HAART); Group 2--Rapid Progressors (RP) includes 9 patients with C3 disease classification. All the patients had a CCR5 wild type (wt) genotype indicating that they do not have the 32 base-pair deletion associated with slower progression. There was an increased production of MIP 1-beta in 8/10 LTNP but only in 4/9 Progressors (Paired t-test/Wilcoxon Sign test, p-value < 0.05). The change in the levels of MIP-1 beta after PHA stimulation was statistically significant in both groups. The levels of RANTES increased in LTNP and RP and the change of the levels after mitogen stimulation was statistically significant for both groups included. The production of RANTES and MIP-1 beta in response to stimulation between both groups was not statistically significant. The production of MIP-1 alpha was variable in both groups and the difference in the levels after mitogen stimulation between the groups was not statistically significant. These results suggest that beta-chemokines do not play an important role in HIV-1 progression in children undergoing HAART.