Cynthia Rivera

Iron-deficiency anemia as presentation of pouchitis.

Goals This study sought to describe the percentage and cause of anemia in patients who underwent ileal pouch with anal anastomosis (IPAA) for ulcerative colitis (UC), and to compare the distribution of complications in patients with and without anemia, especially pouchitis, after IPAA. Background IPAA is the surgical procedure of choice for UC. Complications include pouchitis (40%), strictures (30%), small bowel obstruction (10%), pelvic sepsis (<5%), and urinary and sexual dysfunctions (<5%). Few studies have described the prevalence of anemia after IPAA, but no conclusive findings have been reported. Study Patients who had undergone IPAA for UC were recruited from the UPR Inflammatory Bowel Disease Clinic and the Gastroenterology Research Unit. Demographic and medical data were obtained. Anemia was diagnosed using standard hematologic criteria. Serum iron, ferritin, transferrin, folate, vitamin B12, erythropoietin, total iron-binding capacity, reticulocyte count, peripheral smear, and bone marrow aspirate were evaluated in patients with anemia. Data analysis was performed with EPI Info version 6.4d. Results Iron-deficiency anemia was identified in 55.5% (10/18) of patients and pouchitis was found in 77% (14/18). All 10 patients with anemia had pouchitis, whereas only 4 of the 8 without anemia had pouchitis. In half of the anemic patients, pouchitis was asymptomatic. Conclusions Iron-deficiency anemia may be a clinical presenting sign of pouchitis. Hemoglobin levels may be considered as surveillance tools for pouchitis in patients with IPAA.

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, mothers 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.

Concentraciones totales de homocisteína plasmática en pacientes puertorriqueños con cardiopatía isquémica

Introduccion y objetivos En Puerto Rico se ha comprobado que, a pesar de que la enfermedad coronaria es la principal causa de muerte, la poblacion tiene una incidencia menor de estas enfermedades que en los EE.UU. y posee una incidencia menor de taquicardia ventricular y muerte subita. Un factor que puede contribuir a la menor incidencia de enfermedades coronarias en Puerto Rico es que las concentraciones totales de homocisteina plasmatica (tHcys) en nuestra poblacion sean menores que en la poblacion de los EE.UU. Nuestro objetivo era medir tHcys en la poblacion puertorriquena con cardiopatia isquemica. Metodos Se midio aleatoriamente la tHcys en 70 pacientes puertorriquenos hospitalizados en el Centro Cardiovascular de Puerto Rico y el Caribe (Division UPR). Resultados La concentracion promedio de tHcys en estos pacientes resulto similar a la comunicada por el estudio de Framingham cuando es ajustada por edad (11,2 frente a 11,8 mmol/l). En la poblacion puertorriquena, los varones tenian una concentracion mayor de tHcys que las mujeres (11,7 frente a 9,5 mmol/l; p = 0,07). Ademas, no observamos un aumento en la concentracion de tHcys en pacientes diabeticos cuando se compararon con los pacientes no diabeticos (10,1 frente a 11,2 mmol/l; p = 0,74). Tampoco observamos una correlacion directa entre la concentracion de tHcys y las condiciones cardiacas medidas por angiografia coronaria (normal = 11,1 mmol/l; leve = 10,5 mmol/l; moderado = 10,9 mmol/l; severo = 10,5 mmol/l; Kruskal-Wallis = 0,45). Conclusion Estos resultados sugieren que la concentracion de tHcys no predice fiablemente la gravedad de las lesiones de cardiopatia isquemica en la poblacion puertorriquena.

Iron deficiency anemia as a presentation of pouchitis

Purpose: Ileal pouch with anal anastomosis (IPAA) has become the surgical procedure of choice in Ulcerative Colitis (UC) patients. Among its described complications are pouchitis (40%), strictures (30%), small bowel obstruction (10%), pelvic sepsis (<5%), and urinary and sexual dysfunctions (<5%). Few studies have described the prevalence of anemia after IPAA but no conclusive findings have been reported at present. Anemia may serve as a follow up screening tool for pouchitis surveillance. This study sought (1) to determine the prevalence and cause of anemia in patients undergoing IPAA for UC, and (2) to correlate anemia with complications after IPAA.