Diego Zavala

Patients’ report on how endometriosis affects health, work, and daily life

The objective of this study was to assess the burden of endometriosis by obtaining patient-reported outcome data describing the experience of living with this disease. Survey data from 107 women with self-reported, surgically diagnosed endometriosis showed that living with this disease may be characterized by physical limitations that disrupt health, work, and daily life.

Comparative prevalence of sensitization to common animal, plant and mould allergens in subjects with asthma, or atopic dermatitis and/or allergic rhinitis living in a tropical environment

Background and objectives Current information suggests that the expression of allergic diseases is determined by the exposure and nature of the allergen. The objectives of the present study were to determine if the nature of allergenic exposition to animal, plant or fungal allergens influenced the clinical manifestations of atopic dermatitis (AD), allergic rhinitis (AR) or asthma (AS) in patients living in a tropical environment. The prevalence and degree of sensitization to these allergens were analysed by age and gender.

Exposure Levels of Asthmatic Children to Allergens, Endotoxins, and Serine Proteases in a Tropical Environment

A cross‐sectional study was conducted in Bayamón, Puerto Rico, to identify and quantify indoor allergens, serine proteases, and bacterial endotoxin present in homes of asthmatic children. A total of 126 dust samples from houses were obtained from the entire mattress and bedside floor. Most of the patients had detectable levels of mite, cockroach, cat, and dog allergens. Mold allergens were found only in bedside floor dust samples. Mouse allergens were not detected. Forty‐two percent, 36.5%, and 1.8% of the patients demonstrated exposures to sensitizing levels of mite, Bla g 1 and cat allergens, respectively. The percentage of patients exposed to high levels of allergens capable of triggering asthma symptoms was 33.3% and 26.4% for mite and Bla g 1 allergens. Only dog allergen, bacterial endotoxin, elastase, and trypsin were associated with asthma symptoms. Eighty‐nine percent of the asthmatic children were exposed to endotoxin concentrations greater than 100 EU/mg dust, and more than half of the patients were exposed to high levels of serine proteases. Our study indicates that indoor concentrations of allergens traditionally associated with asthma symptoms and severity may not be applicable in tropical environments and highly ventilated households. In fact, in the study population, endotoxins, dog allergen, and serine proteases may play a dominant role in the induction of asthma symptoms.

Measuring asthma disparities in Hispanics: adherence to the national guidelines for asthma treatment in emergency departments in Puerto Rico

BACKGROUND Puerto Rico has the highest prevalence of asthma in the United States. Currently, there are no data on actual care given to asthmatic patients. OBJECTIVE To determine the prevalence of documented adherence to the 1997 National Asthma Education Prevention Program guidelines regarding care given in emergency departments (EDs) in Ponce, Puerto Rico. METHODS A case series was conducted using 6,002 ED records with a physician-based diagnosis of asthma for 1999 through 2001. RESULTS A history of asthma attack was documented in 82.0% of the cases and in all age groups. In-home beta-agonist use was recorded in only 5.7% of the medical records. Documentation of previous admissions to the ED and the intensive care unit were found in 3.5% and 0.33% of the records, respectively. Nocturnal symptoms before the ED visit were found in only 6.4% of the records, and asthma treatment at home was found in 39.9%. Accessory muscle retraction was documented in 99.1% of the cases, and oxygen saturation was found in 23.2%. Treatment with nebulized beta-agonist was found in 72.1% of the records, and intravenous or oral corticosteroid use was found in 84.1%. Follow-up appointments were detected in 64.8% of the cases, and referrals to specialists were given in only 5.3%. Rate ratios between our data and those of other researchers indicate that there are geographical differences in compliance with the guidelines. CONCLUSION Of the variables tested, only one had acceptable levels of compliance, as evidenced in the patients records, indicating that there are alarming differences in ED evaluation and treatment compared with the 1997 National Asthma Education Prevention Program guidelines.

Implementing a hospital based injury surveillance system in Zambia: a preliminary report

The University Teaching Hospital in Lusaka, Zambia, is the nations premier tertiary referral hospital and a teaching centre for the University of Zambia as well as a research centre of excellence. It was one of the five sites chosen as part of a multinational injury surveillance project conceived to provide preliminary data in response to observations made by public health agencies such as the World Health Organization, and the United States Centres for Disease Control and Prevention (CDC) on the paucity of such data from third world settings. The study covering a period of 6 months from January 2007 to June 2007, used a pre-tested survey instrument crafted by the Ponce School of Medicine in Puerto Rico in close consultation with the CDC and the Pan-American Health Organization (PAHO). A 24-hour system collected a total of 2714 cases, with due care taken to ensure that all the parameters were entered as required.

Motor Vehicle Accident Fatalities Trends, Puerto Rico 2000-2007

Abstract:  Motor vehicle accident fatalities (MVAF) are an important cause of death that affects millions of people worldwide. Using the Puerto Rico Institute of Forensic Science database, this study accessed the mortality trends of MVAF in Puerto Rico from 2000 to 2007. Descriptive statistics, age‐adjusted mortality rates, geographical analysis, and annual percentage change were calculated. An annual mean of 559 MVAF occurred during the study period. The overall MVAF mortality rate declined from 2000 to 2007 (16.6 and 12.4 per 100,000 population, respectively)—mortality rates annually decreased 3%. Most MVAF (80.2%) occurred in men, showing a risk four times higher than women (23.6 and 5.4 deaths per 100,000 populations, respectively). Drivers aged 20–24 years and pedestrians older than 75 years had the highest risk of death. This study emphasizes the need of public health efforts to focus on the prevention of MVAF in the most affected groups.

Mortality Analysis in People Diagnosed with HIV/ AIDS in Puerto Rico from 2003-2011

HIV epidemic are still a global public health concern. In the HIV history is well documented through scientific literature, the effectivity of the antiretroviral therapies (ART). ART has dramatically improved the life expectancy of HIV. Even though, it’s necessary to monitor the causes of death of people with HIV/AIDS. The objective of this study was to estimate mortality risk in people diagnosed with HIV/AIDS in Puerto Rico (PR) from 2006 through 2011. We used a population-based study from the PR AIDS Surveillance System, a total of N=2,290 deaths were reported for the study period. The Cox Proportional Hazards Regression Method was used to identify determinants of mortality. The 71% were males. The 23.5% of deaths were related to HIV/AIDS. Age and Sex adjust death rates was 4.9 deaths per 1,000 population and a fatality rate was 22.2%. The Hazard Ratio [HR] for a HIV/AIDS cause of death in intravenous drug user [IDU] was HR=1.53; 95% confidence interval [IC], 1.37, 1.70 (p<0.001); in AIDS stage HR=7.53; 95% IC, 2.42, 23.4 (p<0.001); and with CD4 cell count ≥ 500 copies HR= 0.20; 95% IC, 0.16, 0.26 (<0.001). Deaths of people with HIV/AIDS in Puerto Rico were not related to the traditional HIV/AIDS causes of death. IDU population, males, AIDS stage of the disease and with low CD4 cell count has higher risk to die to HIV/AIDS cause of death. We recommended designing specific tertiary prevention strategies for IDU population.A cardiovascular disease (ACD) is the number one killer in adult population. South Asians have the highest rates of premature coronary artery diseases. At least 25% of coronary patients have sudden death or nonfatal myocardial infarction without prior symptoms. However, understanding coronary heart disease risk (CHDR) of people with subclinical ACD is critically important for initiating intensive primary prevention. We conducted a cross-sectional cluster survey of 752 subjects in a semi-urban population in India. Smoking status, total Cholesterol, HDL, LDL, TG, blood pressure and anthropometric was collected. 10-year CHDR of the population was estimated using Framingham criteria. Univariate and multivariate analysis was done to test the association between variables and CHDR. We found that 62.0%, 28.5% and 9.5% men; and 97.1%, 2.5% and 0.4% women respectively were at mild, moderate and severe CHDR. Of men <40 years 0.8%, 40-60 years 14.4%, and >60 years 27.3% were at high CHDR; and among women, only the postmenopausal group were high CHDR. TG, LDL and systolic BP correlated directly; and height and biceps skinfold inversely with the CHDR in men. Systolic BP and TG correlated directly and height inversely with the CHDR in women. To conclude, men of all the age groups and women >60 years were at high risk for CHD over next 10-years. WHR was the best anthropometric predictor for CHD risk in both genders. Smoking and low HDL levels attributed significantly to the CHD risk in men compared to women. Further studies are warranted for implementing CHDR reduction intervention program in the population.Chronic kidney disease (CKD) is increasing globally and in Saudi Arabia it affects approximately 8% annual increment of dialysis population. It is associated with a high symptom burden. Previous studies have largely reported on the prevalence of symptoms only in the haemodialysis population. This study examined symptom burden across disease stages and treatment groups in advanced CKD, and their correlation with demographic and clinical factors. Using a cross-sectional design, a convenience sample of 436 patients with CKD was recruited from three hospitals in Saudi Arabia. The CKD Symptom Burden Index (CKD-SBI) was used to measure 32 CKD symptoms. Demographic and clinical data were also collected. Of the sample 75.5% were receiving dialysis (haemodialysis, n = 287; peritoneal dialysis, n = 42) and 24.5% were non-dialysis (CKD stage 4, n = 69; CKD stage 5, n = 38). Average symptom reported was 13.01 ± 7.67. Fatigue and pain were common and burdensome across all symptom dimensions.Approximately one-third of participants experienced sexual symptoms. Dialysis patients reported greater symptom burden, especially patients on haemodialysis. Haemodialysis treatment, older age and being female were independently associated with greater total symptom burden. In conclusion, symptom burden is high among advanced stages of CKD, particularly among those receiving dialysis. Although fatigue, pain and sexual dysfunction are key contributors to symptom burden in CKD, these symptoms are often under-recognised and warrant routine assessment. The CKD-SBI offers a valuable tool to assess symptom burden, leading to the commencement of timely and appropriate interventions.Background: The literature demonstrated that stethoscope, the most used medical device, can be more contaminated than hands. There is a big concern on disinfecting the health professional hands, contrarily, lack of time and attention make the stethoscope disinfection quite rare, although it should be disinfected before every visit. This pilot study, evaluates an innovative solution for stethoscopes’ membrane disinfection in a real environment.H infections with Toxocaracanis and cati are clinically important subjects and a frequent cause of misdiagnosis or delayed diagnosis. Despite the recognition of toxocariasis as an important clinical illness there have been few reviews of therapy for these infections and no definitive treatment protocols have been published, especially in albendazole and mebendazole resistant cases. Only a handful of agents have been used in therapy, and the agents which are available may vary in significantly in efficacy and have adverse effects or be contraindicated in certain clinical situations. When evaluating the clinical efficacy of agents used against toxocara infections, it is difficult to compare studies. They vary as to entry methodology (whether randomization was done and if treatment was blinded or open), population studied (children, adults), syndromes treated: visceral larva migrans (VLM), covert toxocariasismilder version of VLM and ocular larva migrans (OLM), measures (clinical efficacy and/or blood results negativity), and duration of follow-up. Nevertheless, conclusions may be drawn from the studies when viewed as a whole, and statements can be made about the relative efficacy of the agents. In this paper we present our own experiences and initial results about the efficacy of agents currently used for the treatment of toxocariasis in albendazole and mebendazole resistant cases. The total of 58 patients primarily treated with albendazole and/ or mebendazole were treated with two of the medicines most commonly used for resistant cases of this infection. 26 with visceral larva migrans, 26 with covert toxocariasis and 6 with ocular larva migrans. Diethycarbamazine and thiabendazole were used in their usual posologic schedules. The total cure rates achieved with diethylcarbamazine and thiabendazole were, respectively: 75% and 70% in VLM patients, 85% and 80% in covert toxocariasis. We did not achieve any clinical efficacy or blood results negativity in patients with OLM. Side effects were of minor importance both in patients treated with thiabendazole and diethylcarbamazine.H avian influenza viruses (AIVs) have become endemic and circulated in poultry industries in Korea since the first outbreak in 1996. We surveyed H9N2 AIVs in Korean chicken farms and live bird markets from 2009 to 2014. A total of 156 H9N2 AIVs was isolated, and we compared the genetic characteristics of theAIV isolates withH5N1 and H5N8 highly pathogenic influenza viruses (HPAIVs) isolated in Korea. Phylogenetic analysis classified the H9N2 AIVs into three categories of genotypes and showed that genetic reassortment had occurred among H9N2 AIVs, HPAIVs and AIVs isolated from wild birds. The first group of H9N2 AIVs were closely related to A/chicken/Korea/01310/2001 H9N2 (01310) which has been used for an H9N2 vaccine strain in Korea. The other two groups showed there assortment of polymerase genes each other between H9N2 AVI and HPAIV. The PB1 genes were similar to H5N8 HPAIV isolated in 2014, and the PB2 genes were closely related to H5N1 HPAIs. The PA genes of the second group were from 01310-like lineage, but those of the third group from HPAIVlike lineage. Considering that many kinds of the similar genetic reassortants of H9N2 AIVs have been reported in the several East Asian countries and H9N2 AIVs are thought as one of the potential pandemic candidates, continuous surveillance and monitorings should be conducted and investigated for the control of further epidemics.