The Use of Therapy Dogs in the Pediatric COVID-19 Vaccination at the University of Puerto Rico Medical Sciences Campus.

Pet ownership and therapy dogs as companion animals and emotional support have potential health benefits. We report the experiences at a COVID-19 vaccination center after authorizing children's vaccines. When the Pfizer-BioNTech vaccine for children aged 5 to 11 years was authorized for emergency use, we adapted the center's space to receive children, adding cartoon posters and balloons and using children's adhesive bandages, among others. Located at a Campus with six health professional schools, medical students dressed as storybook or movie characters. Children were asked to make drawings during the post vaccination observation period. We incorporated therapy dogs as part of our strategy for a child-friendly center during vaccination activities. Parents expressed that the COVID-19 immunization seemed to be better accepted by children as the dogs in the center entertained them. Many children were in close contact with the dogs while receiving the shots, caressing them, or having the small dogs on their laps. Children's drawings reflected colors, flowers, families, images of happiness, dogs with their names, their own pets, and superhero characters. There were no negative images of syringes, injections, or germs. To our knowledge, this was the only vaccine center in Puerto Rico that implemented therapy dogs as a strategy to create a friendly environment for COVID 19 immunization efforts targeted for children. Based on this experience, we encourage the use of therapy dogs in other immunization activities and will further gather prospective data in the future.

Prevalences of Hypertension, Type 2 Diabetes Mellitus, and Cardiovascular Disease in a Cohort of Puerto Ricans with Non-alcoholic Fatty Liver Disease.

BACKGROUND & OBJECTIVES: Patients with non-alcoholic fatty liver disease (NAFLD) have high prevalences of hypertension (HTN), type 2 diabetes mellitus (T2DM), and cardiovascular disease (CVD), and vice versa. The mechanism of this development is unknown but appears to be related to an underlying metabolic derangement that affects multiple organs. This study aimed to determine the prevalences of these conditions in patients with diagnosed NAFLD. METHODS: Our cohort study aimed to determine the prevalences of HTN, T2DM, and CVD in NAFLD patients registered in the liver database of the University of Puerto Rico School of Medicine; this information is recorded in their medical records. Patients whose liver disease had a different etiology were excluded. The study was approved by the UPR Medical Sciences Campus Institutional Review Board. RESULTS: Our final sample consisted of 141 NAFLD patients; 64.5% (n = 91) of them were females. The average age was 69 (±10.2 years). The prevalences of HTN, T2DM, and CVD were 53.9%, 57.5%, and 7.8%, respectively. In patients with NAFLD, there was a significant association between T2DM and being 65 years old or older (P < 0.001). CONCLUSION: Our data indicate that HTN and T2DM are highly prevalent in NAFLD patients in PR; however, CVD prevalence was lower than expected. Additional, studies are required to further define the associations. We recommend metabolic condition screening for all NAFLD patients.

Resilience, Self-Efficacy, and Symptoms of Anxiety and Depression in Older Adults during COVID-19 Confinement.

OBJECTIVE: This study examined the relationship between resilience, self-efficacy, anxiety, and depression to test whether self-efficacy affected anxiety and depression and compared how the participants in different age groups experienced anxiety, as well as the differences in anxiety between employed and unemployed participants. METHOD: A cross sectional web-based survey study that included adults aged 60 years or older living in Puerto Rico was performed during April and May 2020. RESULTS: A total of 299 older adults completed the online questionnaire (14% men, 83.6% women). Of the total sample, 25.4% reported having moderate to severe symptoms of anxiety, while 20.8% reported having moderate to severe symptoms of depression. Our path analysis model suggested that while self-efficacy did not directly affect anxiety, it had an impact on resilience, thereby reducing anxiety symptoms. The participants who were 71 years old or older had lower anxiety levels than their younger counterparts did. We also confirmed that work might serve as a protective factor against anxiety. CONCLUSION: Our findings underscore the importance of resilience, self-efficacy, and working later in life to promote well-being and successful aging.

Helicobacter Pylori and Gastric Cancer: An Update in the Literature.

Of the chronic bacterial infections that affect humans, Helicobacter pylori (H. pylori) infection is one of the most common. It inhabits the stomachs of half of the adult human population. In Puerto Rico, a US territory, it has an overall prevalence of 33%, similar to the prevalence reported in the population of the US as a whole. Helicobacter pylori infection is responsible for mucosal inflammation that may lead to chronic gastritis, most peptic ulcers, gastric adenocarcinoma, and mucosa-associated lymphoid tissue lymphoma. The International Agency for Research on Cancer identified H. pylori as a definite carcinogen in 1994, the only bacterium to be given such a classification. Its oncogenic effect has been postulated to be caused by different mechanisms, including bacterial characteristics and host factors. Epidemiologic studies have shown that gastric cancer risk differs among regions. One of the top 10 causes of cancer death in Puerto Rico is gastric cancer. Although the eradication of H. pylori has well-known benefits, there are some concerns when considering mass screening and treatment of infected patients. These include the fact that such eradication could provoke an increase in antibiotic resistance rates, the disturbance of the gut microbiota, an increase in body weight, and the aggravation of existing gastroesophageal reflux symptoms. Gastric cancer is a major health concern, and we should understand the role of H. pylori eradication in its prevention. This article is geared to summarize current knowledge and controversies.

Ophthalmologic Findings in a Premature Infant leading to a Zika Diagnosis during the COVID-19 Pandemic: A Case Report.

We report on the first case of congenital Zika syndrome to be identified during the COVID-19 pandemic in Puerto Rico. The Zika virus (ZIKV) infection was first seen in Puerto Rico in December 2015. It is a flavivirus with vertical transmission, spreading from infected mothers to their fetuses and having a broad spectrum of clinical manifestations, of which microcephaly is the most worrisome. In Puerto Rico, routine ZIKV screening during pregnancy was implemented in October 2016. However, this practice has become less frequent over time. Nevertheless, the transmission of ZIKV continues, so it is important to ensure routine ZIKV screening in endemic regions, such as Puerto Rico.

Neonatal Abstinence Syndrome and Corresponding Pharmacotherapy Approaches from 2 University-affiliated Neonatal Intensive Care Units in Puerto Rico (2018-2020).

OBJECTIVE: Neonatal abstinence syndrome (NAS) is a set of drug withdrawal symptoms suffered by neonates exposed to drugs in utero. Several studies have widely described NAS incidence and treatment approach; however, little is known regarding the incidence and manifestations of this disease in Puerto Rico (PR). The principal aim of this study was to describe NAS incidence in the neonatal units of hospitals affiliated with the University of PR in terms of occurrence, clinical manifestations, and treatment approaches. METHODS: Our study evaluated the medical records of NAS babies diagnosed from 2018 through 2020 at 2 hospitals affiliated with the University of PR Medical Sciences Campus. Descriptive and inferential statistics were employed to analyze trends. RESULTS: We identified 12 neonates diagnosed with NAS, 5 with low birthweights (<2500 g); for a NAS incidence of 2 cases per 1000 admitted for the 3 years of recollected data. The urine toxicology results revealed that 9 had experienced intrauterine polydrug exposure. Phenobarbital loading dose were determined on the day of diagnosis (indicated by Finnegan score). The first manifestation of NAS symptoms varied: 8 neonates showed symptoms within 48 hours after birth, whereas 4 had withdrawal symptoms within 72-120 hours of their births. Differences between dosing practices and guidelines were observed, ranging from a 0.69% to a 25% difference during treatment initiation. CONCLUSION: Further research on the incidence of NAS in PR (national level) is needed for a deeper understanding that we hope will lead to the development of enhanced treatment protocols in PR.

Perceptions of the Zika Virus, Contraceptive Access, and Motivation to Participate in the Zika Contraception Access Network Program: Qualitative Analysis of Focusgroup Discussions with Puerto Rican Women.

OBJECTIVE: During the 2016-2017 Zika virus outbreak in Puerto Rico, the Zika Contraception Access Network (Z-CAN) provided client-centered contraceptive counseling and access to the full range of reversible contraceptive methods at no cost to prevent unintended pregnancies and thereby to reduce Zika-related birth outcomes. METHODS: To understand how Puerto Rican women's perceptions of the Zika virus affected contraceptive decisions and assess how they heard about the Z-CAN program and what influenced their participation, or lack thereof, 24 focus-group discussions were conducted among women of reproductive age who did and did not participate in Z-CAN. RESULTS: Women who participated in the discussions often had heard about Z-CAN from their physician or friends; non-participants had heard about Z-CAN from Facebook or friends. Women expressed satisfaction on finding a Z-CAN clinic and valued the same-day provision of contraceptives. When a preferred contraceptive method or a first appointment was not readily available, women reconsidered accessing the program. Women's perceptions and trust of reproductive healthcare providers, their engagement in social networks, and their ability to choose a contraceptive method that best meets their needs can influence participation in contraception-access programs. CONCLUSION: Focus groups can be used to understand women's knowledge of the Zika virus, barriers and facilitators to contraception access, and motivations for participation in the Z-CAN program.

Investigation of the Relationship of Nesfatin-1, Adropin Levels and Claudin-2, Renalase Immunoreactivity with Kidney Function in an Experimental Hypertension Model.

OBJECTIVE: Hypertension is one of the cardiovascular diseases that causes the most mortality, and 95% of the causes are unknown. The aim of the study was to examine the possible correlation of nesfatin-1 levels, adropin levels, claudin-2 immunoreactivity (claudin-2 expression in the renal proximal tubule), and renalase immunoreactivity (renalase expression in the renal proximal tubule) with arterial blood pressure, kidney function, and kidney damage. METHODS: Adult male Sprague Dawley rats were divided into control and hypertension groups (8 per group). Angiotensin II vehicle was given to the control group and angiotensin II (0.7 mg/kg/day) to the hypertension group, both via an osmotic mini pump for 7 days. The animals blood pressures were measured by tail cuff plethysmography on days 1, 3, 5, and 7. On day 7, 24-hour urine, blood, and tissues were collected from the rats. RESULTS: In the hypertension group compared with the control group, there was an increase in systolic blood pressure levels after day 1. While claudin-2 immunoreactivity was reduced in the kidneys, renalase immunoreactivity was increased. There was a decrease in creatinine clearance and an increase in fractional potassium excretion (P < .05). CONCLUSION: Our results showed that claudin-2 and renalase are associated with renal glomerular and tubular dysfunction and may play discrete roles in the pathogenesis of hypertension. We believe that these potential roles warrant further investigation.

The Role of Sirtuins in Cell Life and their Potential Therapeutic Uses.

Sirtuins (SIRTs) constitute a family of enzyme-type proteins dependent on nicotinamide adenine dinucleotide. These enzymes are considered cellular metabolic sensors since the cell's energy level can regulate their activity to compensate for energy fluctuations. They constitute an evolutionarily conserved family of deacetylases class III enzymes, with a recognized role in prolonging life expectancy. Sirtuins are related to the development of age-associated pathologies, such as cancer, diabetes, neurodegeneration, and metabolic disorders. This group of enzymes has become a possible therapeutic target due to their capacity for modulating cellular processes, such as genome repair and maintenance, and for regulating metabolic pathways, homeostasis, and cell proliferation. In addition, SIRTs are associated with pathologies such as cancer and COVID-19. There is a need for future studies that will clarify the relationship between these enzymes group and the prevention and development of diseases.

Tobacco Use and Depression: A Hidden Epidemic among Smokers 18 Years and Older, Puerto Rico, 2018-2020.

OBJECTIVE: According to the literature, depression and tobacco use are closely linked. This study's main objectives were to provide the first population-based epidemiological profile of smokers with depression (SWD) who were 18 years and older and living in Puerto Rico (PR) from 2018 to 2020 and identify any statistically significant differences between SWD and smokers without depression (SWOD). METHODS: A descriptive cross-sectional study was carried out using PR Behavioral Risk Factor Surveillance System (PRBRFSS) data (2018-2020). Univariate analysis was performed to obtain an epidemiological profile of smokers who had depression. Likewise, using bivariate analysis, SWD and SWOD were compared to identify statistically significant differences in terms of chronic conditions, risk factors, and quit attempts. RESULTS: Depression prevalence among smokers 18 years and over in PR from 2018-2020 was 23.7%. Smokers with depression were more likely to be physically inactive (P < .001), overweight or obese (P < .001), have arthritis (P < .001), chronic obstructive pulmonary disease (P < .001), asthma (P < .001), high cholesterol (P < .001), hypertension (P < .001), coronary heart disease (P < .001), diabetes (P < .001), stroke (P < .001), and heart attack (P < .001) compared with SWOD. Likewise, SWD made more quitting attempts in the past year than did SWOD (P < .001). CONCLUSION: Our results indicate that SWD should be targeted in any health-based tobacco-control efforts to develop evidence-based strategies to reduce or eliminate tobacco use in this same population.

Comparison of Corticotomy and Micro-osteoperforation during Canine Retraction: A Split-Mouth Design.

OBJECTIVE: Compare the efficacy of the micro-osteoperforation (MOP) and corticotomy techniques in terms of maxillary canine retraction. METHODS: Thirteen patients (5 females, 8 males; mean age, 18.07 ± 6.74 years) with healthy permanent dentition and requiring the extraction of maxillary first premolars were included in a split-mouth randomized clinical trial. Those subjects with previous orthodontic or endodontic treatment of the canines were excluded. At least 3 months post-extraction, MOPs and corticotomies were performed distal to the canines. Mini-screws with closed-coil springs (150 g) were used for the canine retraction. Dental casts were made at baseline (T0) and 3 months post-intervention (T1). Trained and calibrated examiners measured the distances from the canines to the second premolars on both sides. A signed-rank sum test was used to compare the amount of canine retraction achieved in 3 months (T0-T1) on the 2 sides. RESULTS: Retraction (mm) at the incisal level was similar in the corticotomy (3.34 ± 1.01) and MOP patients (2.74 ± 1.10) (P = 0.11); furthermore, there were no differences in the degree of medial retraction between the corticotomy (2.56 ± 0.67) and MOP (2.27 ± 0.82) (P = 0.31) procedures. No adverse events were observed. CONCLUSION: There were not any clinically or statistically significant differences in retraction between the interventions. At 3 months, a MOP is as effective as a corticotomy in accelerating the rate of tooth movement.

Evaluating Alterations in Breast Cancer Patients after Recovery Via A PET/CT-Assisted Metabolomics Approach.

OBJECTIVE: Breast cancer is a mortal disease that causes many deaths, especially in women. Improved therapies could contribute positively to survival rates. Metabolomics is an important tool for monitoring the alterations of several metabolites in clinical cases. This study aimed to develop a metabolomics model to observe (via mass spectroscopy) metabolic alterations in patients who suffered from breast cancer (BC), both before and after their recovery. MATERIALS AND METHODS: Grades 1 and 2 invasive ductal carcinoma patients were evaluated based on their positron emission tomography/computed tomography results. Fourteen patients who had fully recovered from BC were subjected to metabolomics analysis. Plasma samples were extracted and analyzed via quadrupole time-of-flight mass tandem spectroscopy. A chemometrics analysis was performed in order to determine the statistically significant metabolites. All the metabolites were annotated via the mummichog algorithm. RESULTS AND DISCUSSION: According to the data analysis, glucose, ornithine, phenyalanine, some vitamins, and metabolites in the fatty acid metabolism were statistically altered after recovery of each patient. CONCLUSION: Untargeted metabolomics studies can be used to understand the etiopathogenesis of breast cancer, finding new biomarkers and alterations of metabolic pathways. After the tumor burden was removed, homeostasis was restored and the concentration of several metabolites began to normalize. This study elucidated the effects of breast cancer at the molecular level.

Compliance with Influenza Vaccination and Cervical, Breast, and Colorectal Cancer Screening in a Sample of Women in Puerto Rico: Community Engagement Efforts from PR-CEAL.

OBJECTIVE: There are an estimated 5,570 yearly cancer deaths in Puerto Rico. Breast and colorectal are the most common malignancies among Puerto Rican women. Therefore, prevention and early detection of these cancer types are critical to reducing morbidity and mortality. This study assessed whether women who received the influenza vaccine had increased adherence to cervical, breast, and colorectal cancer screening. METHODS: The Puerto Rico Community Engagement Alliance (PR-CEAL) against COVID-19 Disparities team attended community outreach events throughout Puerto Rico and completed a face-to-face survey among women 18 years or older. The survey gathered demographic information and adherence to influenza vaccination and cervical, breast, and colorectal screening in the past year. The initial sample included 400 women, of whom 347 met the age inclusion criteria (21-74 years). Chi-square tests were used to compare cancer screening adherence according to influenza vaccination status. A p-value <0.05 was considered statistically significant. RESULTS: Of all participants, 47.0% received the influenza vaccine in the past year. Cancer screening rates among vaccinated and non-vaccinated women were as follows: 64.5% vs. and 13.0% vs. 8.0% for colorectal cancer (p-value=0.19). CONCLUSION: Adherence to cervical, breast, and colorectal cancer screening in the past year did not differ by influenza vaccination status. Influenza vaccination appointments may therefore represent a missed opportunity to promote preventative cancer screening in Puerto Rico.

Comprehensive Preventive and Therapeutic Oral Health Care: A Case Report of Mucopolysaccharidosis Type IV A in a Pediatric Patient.

Mucopolysaccharidosis (MPS) is a metabolic disorder resulting from a deficiency of lysosomal enzymes. It is an autosomal recessive disorder with similar incidences in men and women. Mucopolysaccharidosis type IV A is caused by a deficiency of N-acetylgalactosamine-6-sulfatase, which deficiency is, in turn, caused by alterations in the GALNS gene. It is marked by a short stature, a pigeon chest, frontal bossing, kyphosis, and a flat nasal bridge. Intraorally, macroglossia, hypodontia, dentinogenesis imperfecta, a broad mouth, and an anterior open bite are some of the common features. The present paper reports on a case of MPS in a 5-year-old male patient, along with providing a review of the literature and insight into the oral manifestations related to MPS IV A, also called Morquio A syndrome, and its dental treatment. It aims to highlight the clinical recommendations for oral health care in such cases during different phases of MPS IV A treatment.

Successful Closure of a Persistent Enterocutaneous Fistula with a Myocutaneous Flap.

Enterocutaneous fistulas can present with significant morbidity and mortality for affected patients, as the abnormal connection can result in exorbitant loss of enteral fluids, electrolyte disturbances, and sepsis, among other complications. We present a patient with a chronic complex enterocutaneous fistula who underwent several surgeries, resulting in a considerable amount of bowel resection. Based on history and findings of high output fistula with diverting transverse colostomy, the fistula was closed with a left rectus myocutaneous pedicle flap to avoid entering the abdominal cavity and prevent the possibility of short bowel syndrome. This case contributes to the growing body of literature supporting the use of rectus myocutaneous flaps for the closure of intractable complex enterocutaneous fistulas in patients unable to undergo resection of the affected bowel.

A Novel Case of Legionnaire's Disease after Staying at Home Rentals.

Case of a 44-year-old woman with past medical history of dermatomyositis who had been on Methrotexate therapy who became infected with Legionella pneumophila after staying at a home rental, known commercially as an Airbnb. The patient presented to the ER with complaints of general malaise and subsequently developed sepsis with respiratory failure requiring intubation. CT scan confirmed the diagnosis of pneumonia and through extensive research L. pneumophila was identified using a pneumonia panel that works by identifying nucleic acids of fastidious organisms that are difficult and take long to grow by culture. As the patient's pneumonia progressed to ARDS and her clinical impression worsened, pronation technique was begun in addition to her course of antibiotics that were already being administered. The patient began showing significant improvement in her clinical picture and was extubated with progressive recovery.

An Unexpected Presentation of a Maxillary Non-Hodgkin Lymphoma in an Elderly Hispanic Patient.

Extranodal NK/T-cell lymphoma (ENKTL), nasal type and aggressive NK cell leukemia are rare in Western World been less than 1% in USA to 8% in Asia among Non-Hodgkin's lymphomas. It is aggressive, with poor outcome and optimal treatment is unclear. A combination therapy that includes Peg-Asparaginase (SMILE) has been employed in young patients. An 85-year-old Puerto Rican male presented with anorexia, epistaxis, vertigo and involuntary facial movements. He was treated with injectable Onabotulinum toxin A due to suspicion of a hemifacial spasm. However, a CT scan demonstrated a left maxillary sinus lesion extending into the left middle turbinate with biopsy consistent with ENKTL. We adjusted therapy to patient's age and performance receiving Gemcitabine-Oxaliplatin (Gemox) with radiation obtaining a complete response with persistent negative Epstein Barr DNA titers. ENKTL is a rare disease initially misdiagnosed in our elderly patient, who demonstrated adequate response with a modified therapeutic regime.

Investigation of the IL7Rα Gene Polymorphism rs6897932 and the Expression Levels of the CDH1, TTPAL, and FHIT Genes in Patients with Breast Cancer.

OBJECTIVE: The aim of this study was to determine the expression levels of CDH1, FHIT, and TTPAL genes and to determine the genotype and allele frequencies of the IL7Rα gene polymorphism rs6897932 in patients with breast cancer. METHODS: The expression levels of genes and the distribution of the IL7Rα gene polymorphism rs6897932 were analyzed by real-time polymerase chain reaction. RESULTS: No differences in genotype ratios or allele frequencies were observed between the 2 groups for the IL7Rα gene polymorphism rs6897932. The frequency of the IL7Rα rs6897932 T risk allele was found to be similar between breast cancer patients and controls. CDH1 messenger RNA (mRNA) levels decreased (0.714-fold and 0.834-fold, respectively), and TTPAL mRNA levels increased (2.675-fold [P < .05] and 1.169-fold, respectively) in tumor tissues and peripheral blood samples. FHIT mRNA levels decreased (0.559-fold) in tumor tissue samples and increased (2.21-fold) in peripheral blood samples. CONCLUSION: Our results are compatible with those reported in the literature. It can be suggested that the upregulation observed in the TTPAL gene might be a marker for breast cancer. The downregulation of CDH1 and FHIT gene expression has been validated in our study. An increase in the copy numbers of FHIT mRNA in blood samples and a decrease in the tumor samples can also be considered an abnormal condition.

Knowledge of Obesity's Health Related Outcomes among Hispanic Women living in Puerto Rico.

OBJECTIVE: The primary aim of this cross-sectional study was to assess, according to previous cancer diagnosis, the knowledge Puerto Rican women have on the link between obesity-endometrial, -breast, and colon cancer, and determine women's most common source for medical information. METHODS: In this cross-sectional study, eligible female patients (n=234) from the Gynecology and Gynecology-Oncology Clinics completed a self-administered survey from October 2014 to March 2016. Participants were evaluated on sociodemographic, body mass index, knowledge of the obesity-cancer link, and source of medical information. RESULTS: About 49% and 31% of women in the study were obese and overweight, respectively. Less than 52% of the women knew about the link between obesity-breast,-colon, and/or -endometrial cancers. Women with previous cancer diagnoses were more likely aware of the association between obesity-colon cancer than women without previous cancer diagnoses (58% vs. 44%, p0.05). Higher incomes showed increased odds for the knowledge obesity-cancer link among women with a cancer history, but the odds decreased for women without previous cancer diagnoses (p>0.05). Higher education showed a trend towards a better knowledge of the obesity-cancer association. The most common sources of information were the primary doctor (80%) and the internet (54%). CONCLUSION: Counseling about preventable cancer risk factors through primary care to all women must be encouraged especially in young healthy females. Further studies should address qualitative aspects of the odds differences in the obesity-cancer link knowledge observed between income categories for women with/without previous cancer diagnoses.

Development and Content Validity of a Disability Self-Management Questionnaire for Hispanic Older Adults.

OBJECTIVE: There is no Spanish-language instrument for assessing the self-management strategies used by older adults with physical function disabilities to manage the difficulties that can occur in daily living activities. This study aimed to design and test the content validity of a Spanish version of the newly developed Self-Management of Function in Daily Living Activities Questionnaire (SF-DLAQ). METHODS: A methodological study, guided by the Person-Environment-Occupation-Performance (PEOP) model, was conducted to develop the SF-DLAQ. Stage 1 focused on designing the questionnaire, doing so using qualitative data obtained from 24 older adults and obtained from 10 existing scales that measure the self-management of chronic conditions. Stage 2 focused on expert judgement, which consisted of validating the questionnaire with 8 experts in aging using an item-level content validity index (I-CVI), a scale-level CVI (S-CVI), and the kappa statistic. RESULTS: All the scores that were attained in stage 2 were favorable, with those of the I-CVI for clarity ranging from 0.09 to 1.0 and those of the I-CVI for relevancy, the S-CVI, and the kappa all being 1.0. CONCLUSION: The scale and item validity for the SF-DLAQ, Spanish version, has been demonstrated but should be confirmed with further testing.