HCV genotype analysis in HCV-HIV-co-infected Puerto Ricans who are injecting drug users: undetermined and mixed infections.

Direct percutaneous exposure is the main route of HCV transmission. In Puerto Rico half of people infected with HIV use illicit drugs. The effects of HCV in the course of HIV infection and vice versa have been extensively studied, but remain highly controversial. This may be due to HCV genetic heterogeneity. Therefore, a complex classification into genotypes has emerged that prompted us to determined how this impacts a population of intravenous drug users (IDUs) co-infected with HIV-1. Using Inno-LiPa II technique, we analyzed samples from 171 HCV-HIV-1-co-infected IDUs and 375 from a general HCV population of unknown HIV or source of infection status. Similar HCV genotype distribution was detected in these populations. HCV genotype 1a was the most frequently in IDUs-co-infected with HIV-1, followed by 1b and 3a. Twenty mixed infections and 5 undetermined genotypes were reported. A reduced HCV viral load was observed in HIV-1 positives with wasting syndrome. Individuals with a high HIV-1 viral load presented a low HCV viral load. There were no correlation between HCV genotypes and AIDS-related event. Patients with genotype 1b showed a higher HCV viral load. Males presented higher HCV viral load than females. Females were predominantly affected by genotype 1a, and men by 1a and 1b. Neither the HCV viral load nor the frequency of genotypes were influenced by the antiretroviral modality. The importance of continuous genotype monitoring is stressed.

Her-2/neu oncogene expression in Puerto Rican females with breast cancer.

Her-2/neu belongs to the family of tyrosine kinase transmembrane proteins whose overexpression has been associated with a poor prognosis in patients with breast cancer. The product of this proto-oncogene is overexpressed in 25-30% of human breast cancer and is the target of selective immunotherapy. Concerned about the ethnic differences on the expression of this oncogene, we have evaluated 143 consecutive specimens of primary breast cancer diagnosed in San Pablo Hospital, Puerto Rico. The specimens were analyzed for Her-2/neu expression using immunohistochemistry assays (Hercept test). We have related the expression of hormone receptor status, percent cells in S phase, DNA ploidy, tumor size, nodal status and menopausal state with the Her2/neu expression. Out of 143 specimens, 28 overexpressed the Her-2/neu (19.6%). Of the Her/2 negative 30/114 (26%) were estrogen receptor negative as compared to 9/27 (33%) (p = 0.464). The degree of aneuploidy was abnormal in 25/104 (24%) in the Her-2/neu negative vs 11/27 (41%) p = 0.083. The percent cell in DNA synthesis was high in 16/77 (21%) in Her-2/neu negative vs 4/15 (27%) p = 0.613. The tumor size was greater than 2 cm in 35/106 (33%) in Her-2/neu negative vs 9/23 (39%) p = 0.575. In the progesterone specimens negative for Her2, 44/114 (39%) were Her2/neu negative vs 15/27 (56%) p = 0.108. No differences were seen regarding menopausal status, age and nuclear grading. A trend favoring abnormal aneuploidy in Her2/neu positive was seen. Nodal involvement was significantly associated with Her2/neu overexpression. (p = 0.037). Although the incidence of Her2 overexpression found in this database was somewhat lower than the one reported in the literature, this might also be due to the small cohort examined or to the technique utilized.

A strategic supportive model for health prevention in the elderly: profile of a Puerto Rican geriatric population in a public health sector

OBJECTIVE: To introduce the ASSUME study with the presentation of a clinical, socio-demographic, preventive and psychological profile of a geriatric population of patients who receive their health care in the General Internal Medicine Ambulatory Sector of our institution. METHODS: The Assume study is a prospective, randomized trial which is directed at increasing the participation of patients in preventive health care strategies at a primary, secondary and tertiary level. In this paper we focus on the initial stage of the process which aims to define and synthesize predisposing risk factors in the geriatric patient which would be amenable to primary, secondary and tertiary preventive strategies. Through a process of patient interview profiles of a physical, social and psychological nature are have been constructed. With the availability of this profile a clearer definition of the potential benefit of preventive strategies could be established. In this paper we present the initial profile of patients of all patients randomized to the study as of Sept. 01, 1997. RESULTS: A total of 123 patients have been enrolled with 48(39) males and 75(61) females. The mean age of patients is 70 years with a median of 68 years. Cardiovascular disorders establish the leading disease events in our population of patients with Hypertension in 85, Ischemic heart disease in 50, Myocardial Infarction in 19 and 40 with a history of Congestive Heart failure. Diabetes and Heart Failure were seen in 40. An average of 4.4 prescribed drugs per patient was documented. A minority of patients took more than 7 drugs and none took more than 9 medications. Most patients (67 or 55) had not required hospitalizations in the preceding 12 months and none of the patients required more than 4 hospitalizations. The average LOS was 8.60 days. The Preventive Medicine profile reveals a large number of un-vaccinated adults. Regular cigarette smoking was seen in 12. We have used the body mass index as a measure of adequacy of weight. We highlight the number of patients who have a BMI equivalent to an obese, severely obese or morbidly obese category (41). The number of patients who follow a prescribed diet was found to be 54 patients for 44 of the study group. With regards to the interventions primarily designed for early cancer detecting, approximately half of the patients undergo the recommended annual screening interventions. The screening of visual accuracy was reported in 54, dental

A strategic supportive model for health prevention in the elderly: profile of a Puerto Rican geriatric population in a public health sector.

OBJECTIVE: To introduce the ASSUME study with the presentation of a clinical, socio-demographic, preventive and psychological profile of a geriatric population of patients who receive their health care in the General Internal Medicine Ambulatory Sector of our institution. METHODS: The Assume study is a prospective, randomized trial which is directed at increasing the participation of patients in preventive health care strategies at a primary, secondary and tertiary level. In this paper we focus on the initial stage of the process which aims to define and synthesize predisposing risk factors in the geriatric patient which would be amenable to primary, secondary and tertiary preventive strategies. Through a process of patient interview profiles of a physical, social and psychological nature are have been constructed. With the availability of this profile a clearer definition of the potential benefit of preventive strategies could be established. In this paper we present the initial profile of patients of all patients randomized to the study as of Sept. 01, 1997. RESULTS: A total of 123 patients have been enrolled with 48(39%) males and 75(61%) females. The mean age of patients is 70 years with a median of 68 years. Cardiovascular disorders establish the leading disease events in our population of patients with Hypertension in 85%, Ischemic heart disease in 50%, Myocardial Infarction in 19% and 40% with a history of Congestive Heart failure. Diabetes and Heart Failure were seen in 40%. An average of 4.4 prescribed drugs per patient was documented. A minority of patients took more than 7 drugs and none took more than 9 medications. Most patients (67 or 55%) had not required hospitalizations in the preceding 12 months and none of the patients required more than 4 hospitalizations. The average LOS was 8.60 days. The Preventive Medicine profile reveals a large number of un-vaccinated adults. Regular cigarette smoking was seen in 12%. We have used the body mass index as a measure of adequacy of weight. We highlight the number of patients who have a BMI equivalent to an obese, severely obese or morbidly obese category (41%). The number of patients who follow a prescribed diet was found to be 54 patients for 44% of the study group. With regards to the interventions primarily designed for early cancer detecting, approximately half of the patients undergo the recommended annual screening interventions. The screening of visual accuracy was reported in 54%, dental screen (24%) and auditory screening (15%). Nearly a quarter of patients have severe depression. The CAPE testing reveal that in the information and orientation section most patients presented none or light dysfunction(87%). In the conductual phase marked or severe impairment was detected in 12% of patients. In the mental ability section 22% of patients presented marked or severe impairment. CONCLUSION: The geriatric population studied would benefit from modalities which would increment the modern modalities for primary and secondary prevention of disease. Follow-up studies will allow the evaluation of the effectiveness of the conceptual model proposed, which would increment the patient participation in these preventive modalities.

Impact of thrombolytic therapy for myocardial infarction in the Bayamón Public Health Care Sector--1993-1995 experience

The study was designed to evaluate the compliance of general management guidelines, determine the effectiveness of Thrombolytic therapy (TTX), determine the complications, statistics and the [quot ]Door to Needle[quot ] time (DTN) in the management of Myocardial Infarction (MI) in the Bayamón public health care sector. METHODS: Retrospective record review and SPSS statistical calculations were performed. RESULTS: 66 cases (49m, 17f) discharged with MI from January 1993 to June 1995 were included. 27 received TTX. 80 were between 30-69 y/o, while 20 from 70-87 y/o. Past hx and habits; smoker 62, ETOH 45. Labs in adm; hypoMG 15, hypoK 11. The Q MI = 63, Non Q = 38. The sinoatrial and ventricular arrhythmias were seldom seen (7.5 SVT, AIVR 3). Intra and atrioventricular block (3). The most frequent cardiac complication was CHF 10 and the non cardiac; BKP 16.5. The mortality was (6.1). The mean stay was 9.34 days. Therapy used; IV NTG 97, ASA 84, beta B 39, TTX 42.2, ACE inhibitors 32. Absence of TTX was usually due to absence of EKG criteria (63). TTX complications; hypotension 10.5. The mean DTN was 1hr 58m,. 91 were discharged home, 23.3 cath, deaths 6. The ER MD assessment of MI was correct in only 29. CONCLUSIONS: The complications of patients with MI in the TTX era are below the ones before TTX. Mortality and morbidity have improved with the use of TTX. The medical therapy guidelines of MI are generally followed in HURRA. Improvement in the DTN is needed. The prolonged DTN and the inconsistency of the admission assessment by the ER personnel establishes the need to develop a training program which would regulate this abnormality

Trends in the utilization of blood components in San Pablo Hospital; 1991-1996

OBJECTIVE: The purpose of this paper was to evaluate the trends in the use of blood products in our hospital during the last six years. We selected for the study packed red cells and platelet products since they are the most frequently used, on a unit per unit basis they represent a larger component of the transfusion service budget and finally are the most frequent units involved in transfusion reactions. METHODS: The variables in the data bank that were utilized to study included, patients transfused, patients operated, units transfused, units prepared, and units discarded. From these variables we constructed the following new variables, Cross match to Transfusion ratio, units transfused to patients transfused ratio, units transfused to patients operated ratio, and finally patients operated to patients transfused ratio. The data was then organized by year and transported to SPSS software where the null hypothesis was tested through an analysis of the variance (ANOVA). RESULTS: The number of patients who underwent coronary artery bypass surgery increased over the last six years. An average increase of six additional patients per month was documented. An increase in the total number of packed Red Cells units transfused was seen with a mean of 167 units per month in 1992, 182 units in 1994 and 187 units in 1996. (p = .425). A mean of 45 patients per month were transfused in 1992 as compared to 55 and 56 in 1994 and 1996 respectively. (p = .009). The ratio of patients operated to patients transfused decreased from 1.65 in 1992 to 1.3 and 1.4 in 1992 and 1996. (p = .021) The intensity of Red Cell use in patients undergoing surgery was analyzed by using the ratio of number of red cell units transfused by the number of patients operated and transfused. This ratio was 3.7 in 1992, 3.2 in 1994 and 3.3 in 1996. (p = .032) The use of platelets transfusion in the cardiovascular surgery arena appears to have changed very slightly over the five years in our institution. A non-significant trend in the number of patients who are operated and are transfused with platelets is noted, along with a mild decrease in the intensity of platelet use per patient transfused. NON CARDIOVASCULAR SERVICE: The number of patients transfused with packed Red Cells has not changed significantly in this service since 1992. The mean number of units transfused per month in 1992 and in 1994 was close to 222. In 1996, a mean number of 230 units per month were transfused. (p = .172) The mea

Trends in the utilization of blood components in San Pablo Hospital; 1991-1996.

OBJECTIVE: The purpose of this paper was to evaluate the trends in the use of blood products in our hospital during the last six years. We selected for the study packed red cells and platelet products since they are the most frequently used, on a unit per unit basis they represent a larger component of the transfusion service budget and finally are the most frequent units involved in transfusion reactions. METHODS: The variables in the data bank that were utilized to study included, patients transfused, patients operated, units transfused, units prepared, and units discarded. From these variables we constructed the following new variables, Cross match to Transfusion ratio, units transfused to patients transfused ratio, units transfused to patients operated ratio, and finally patients operated to patients transfused ratio. The data was then organized by year and transported to SPSS software where the null hypothesis was tested through an analysis of the variance (ANOVA). RESULTS: The number of patients who underwent coronary artery bypass surgery increased over the last six years. An average increase of six additional patients per month was documented. An increase in the total number of packed Red Cells units transfused was seen with a mean of 167 units per month in 1992, 182 units in 1994 and 187 units in 1996. (p = .425). A mean of 45 patients per month were transfused in 1992 as compared to 55 and 56 in 1994 and 1996 respectively. (p = .009). The ratio of patients operated to patients transfused decreased from 1.65 in 1992 to 1.3 and 1.4 in 1992 and 1996. (p = .021) The intensity of Red Cell use in patients undergoing surgery was analyzed by using the ratio of number of red cell units transfused by the number of patients operated and transfused. This ratio was 3.7 in 1992, 3.2 in 1994 and 3.3 in 1996. (p = .032) The use of platelets transfusion in the cardiovascular surgery arena appears to have changed very slightly over the five years in our institution. A non-significant trend in the number of patients who are operated and are transfused with platelets is noted, along with a mild decrease in the intensity of platelet use per patient transfused. NON CARDIOVASCULAR SERVICE: The number of patients transfused with packed Red Cells has not changed significantly in this service since 1992. The mean number of units transfused per month in 1992 and in 1994 was close to 222. In 1996, a mean number of 230 units per month were transfused. (p = .172) The mean number of patients transfused increased slightly from 74.5 patients per month in 1992 to 77.5 in 1994 and 77.7 in 1996. (p = .585) The intensity of Red Cell transfusion support decreased somewhat with 2.98 in 1992 to 2.87 and 2.95 in 1994 and 1996. (p = .806) A marked increase in the number of platelet transfusion was documented. A mean number of 192 units were transfused in 1992 per month as compared to 333 and 360 in 1994 and 1996. (p = .27) This increase in platelet use was associated to an increase in the number of patients who were transfused with 9 per month in 1992 and 16.5 and 16.4 in 1994 and 1996. (p = .005) The mean number of platelet transfused per patient decreased in a non significant fashion with 19.9 units and 20.6 units per transfused patient in 1992 and in 1994 to 19.2 units in 1996. (p = .861). CONCLUSION: We have been able to define distinct changes in the trends of blood product utilization in our institution.

Impact of thrombolytic therapy for myocardial infarction in the Bayamón Public Health Care Sector--1993-1995 experience.

UNLABELLED: The study was designed to evaluate the compliance of general management guidelines, determine the effectiveness of Thrombolytic therapy (TTX), determine the complications, statistics and the "Door to Needle" time (DTN) in the management of Myocardial Infarction (MI) in the Bayamón public health care sector. METHODS: Retrospective record review and SPSS statistical calculations were performed. RESULTS: 66 cases (49m, 17f) discharged with MI from January 1993 to June 1995 were included. 27 received TTX. 80% were between 30-69 y/o, while 20% from 70-87 y/o. Past hx and habits; smoker 62%, ETOH 45%. Labs in adm; hypoMG 15%, hypoK 11%. The Q MI = 63%, Non Q = 38%. The sinoatrial and ventricular arrhythmias were seldom seen (7.5% SVT, AIVR 3%). Intra and atrioventricular block (3%). The most frequent cardiac complication was CHF 10% and the non cardiac; BKP 16.5%. The mortality was (6.1%). The mean stay was 9.34 days. Therapy used; IV NTG 97%, ASA 84%, beta B 39%, TTX 42.2%, ACE inhibitors 32%. Absence of TTX was usually due to absence of EKG criteria (63%). TTX complications; hypotension 10.5%. The mean DTN was 1hr 58m,. 91% were discharged home, 23.3% cath, deaths 6%. The ER MD assessment of MI was correct in only 29%. CONCLUSIONS: The complications of patients with MI in the TTX era are below the ones before TTX. Mortality and morbidity have improved with the use of TTX. The medical therapy guidelines of MI are generally followed in HURRA. Improvement in the DTN is needed. The prolonged DTN and the inconsistency of the admission assessment by the ER personnel establishes the need to develop a training program which would regulate this abnormality.

Essential thrombocythemia: a hypercoagulable state.

Essential thrombocythemia is an entity characterized by clonal proliferation of megakaryocytes and thrombocytosis. We have analyzed the presenting manifestation of 13 patients with Essential Thrombocythemia diagnosed in the last three years. The major findings include the frequent presence of symptomatology of a hypercoagulable state with prompt improvement of these symptoms once the thrombocytosis is controlled. Constitutional symptoms, organomegaly, modest Leukocytosis and eosinophilia were also often seen. No catastrophic events were detected with a mean follow up period of 17.5 months.

Prognostic factors in patients with IVDA and bacteremia.

The medical records of all the patients with bacteremia and recent use of illicit intravenous drugs admitted to Hospital Universitario Ramón Ruíz Arnau from January 1, 1988 to June 30, 1989 were reviewed. It consisted of 28 records, 21 of which were male patients and 7 females. The mortality rate among these patients was 46%. Staphylococcus aureus was the most common pathogen recovered from blood cultures. All the S. aureus were methicillin sensitive. The presence of clinical sepsis, a low Karnofsky performance status at the time of admission and multiorgan abnormalities were the most important prognostic factors that determined outcome in these patients.

Squamous cell carcinoma of the penis.

Squamous cell carcinoma of the penis (CA Penis) is not a rare disease in P.R. We have reviewed all cases of CA penis diagnosed in our institution from Jan. 79-Jan. 89. Pathology and hospital records were audited. The survival data on all patients was updated via telephone or record review up to May 89. A total of 18 pts were seen in the last decade. Of these 11. (61%) were seen in the last four years. Four of 18 patients were excluded from analysis due to lack of staging and therapy data. The median age 54.9 y (range 23-82y). The following risk factors were identified: phimosis 12/14 (86%) p = .05, leukoplakia 8/14 (57%); prior venereal disease 1/14 (7%). The primary lesion appeared in the prepuce 8/14 (57%) and glans 6/14 (43%). TNM staging was done in all pts. Most pts presented with T3 or T4 disease 10/14 (71%) and palpable regional adenopathy (N1-N3) 9/14 (64%). Of the nine pts with palpable adenopathy, in 5 (56%) microscopic malignant disease was confirmed. A correlation between T3 or T4 disease and the presence of palpable adenopathy was seen (80%). The Stage at diagnosis of the 14 pts: I: 0/14 (29%), II: 5/14 (7%), III: 3/14 (21%), IV: 6/14; (43%). All pts were treated with partial penectomy and 7/14 had unilateral or bilateral inguinal lymphadenectomy. Long term survivors (LTS), greater than 12 mo., were seen 3/4 pts with Stage II disease, 1/3 Stage III, and 2/5 in Stage IV. The most important prognostic factor for LTS was malignant involvement of regional lymph nodes with 0/5 in this group.(ABSTRACT TRUNCATED AT 250 WORDS)