Ponce Health Sciences University

Purpose Surgical site infections following certain hand surgery procedures are inherently low; however, the utility of prophylactic antibiotics in such scenarios remains a point of controversy. This study aimed to evaluate postoperative infection rates among patients who were prescribed antibiotics before surgery compared with those who were not following distal radius fracture (DRFx) repair surgery, using a large multi-institutional database. The study hypothesis was that the administration of preoperative antibiotics would not impact the rate of postoperative infection. Methods A retrospective matched cohort study was performed using the TriNetX Research Network, a large multicenter de-identified patient database. Adult patients undergoing DRFx repair were identified using procedural codes. Patients who received preoperative antibiotics were propensity score matched to those who did not, controlling for demographics and clinical variables. Outcomes analyzed included documentation of a postoperative infection, administration of oral antibiotics, and reoperation within 1 and 3 months after surgery. Results Among DRFx patients, postoperative infection within 1 month occurred significantly more frequently in those receiving antibiotics compared with those who did not (0.9% vs 0.2%; risk ratio [RR] = 5.7, P = .001), but no difference at 3 months. Administration of oral antibiotics within 3 months was significantly higher among those who received antibiotics prior to DRFx repair (13.7% vs 3.4%; RR = 4.0, P < .001). Reoperation rates within 3 months of DRFx repair were significantly higher among those who received antibiotics as well (1.4% vs 0.9%; RR = 1.6, P = .004). Conclusions In this matched cohort analysis, patients who received preoperative intravenous antibiotics had higher observed rates of 30-day postoperative infection, subsequent oral antibiotic use, and reoperation compared with those who did not. These differences most likely reflect baseline risk differences between groups rather than a true effect of antibiotic administration. Overall postoperative infection rates were low in both cohorts, and a causal conclusion regarding the efficacy of routine antibiotic prophylaxis in this setting cannot be drawn. Type of study/level of evidence III

Dengue remains a major public health challenge, particularly in endemic areas like Puerto Rico, where its economic burden is substantial. This study aimed to update the economic burden of dengue in Puerto Rico using recent data from patients, hospitals, and insurance companies, providing a clearer picture of the current situation. We estimated the total number of dengue cases with fever who sought care by adjusting for underreporting through a robust statistical framework linking island-wide passive surveillance data to sentinel acute febrile illness surveillance. We obtained cost data from hospitals and conducted interviews with a random sample of people diagnosed with dengue (n = 101) from December 2021–November 2022, collecting detailed information on direct medical costs, non-medical costs, and indirect costs. We analyzed median, epidemic and long-term dengue incidence patterns from 2010–2023. We conducted a cost-of-illness analysis using Bayesian multiplier methods to adjust for underreporting, followed by a bottom-up costing approach during a typical median incidence year and an epidemic year to illustrate the current economic burden of dengue in Puerto Rico. In the median incidence year (2014), from 597 reported dengue cases we estimated 4500 [95

The integration of artificial intelligence (AI), particularly large language models (LLMs), into education, marks a profound shift in how knowledge is accessed, processed, and applied. These tools offer clear advantages—including improved efficiency, immediate support, and high productivity—but it may simultaneously weaken foundational skills. This Perspective examines the dual impact of AI on education, arguing that over-reliance on AI may displace essential cognitive processes that reinforce professional competence. Emerging evidence points to troubling associations between frequent AI use and diminished critical reasoning. We propose a model of critical alliance, in which AI augments but does not replace core intellectual processes. Unlike existing AI competency or digital literacy, this model centers on preserving human cognitive agency, judgment, reflection, and intellectual ownership, as primary educational outcomes. This framework not only emphasizes cognitive independence, but also equitable access, ethical vigilance, and faculty development as cornerstones of AI literacy. Addressing these questions is essential to safeguard both intellectual growth and educational equity in an AI-augmented era. Unlike existing digital literacy or AI competency frameworks, the critical alliance explicitly centers on preserving human cognitive agency and intellectual ownership as educational priorities, particularly in environments increasingly shaped by high-performing generative systems.

This article explores the impact of energy insecurity on chronic disease management among older adults (≥ 50 years) in rural areas of Puerto Rico. It documents their lived experiences during power outages and assesses the role of community-driven solar energy initiatives led by the community-based organization Casa Pueblo in enhancing health resilience in a disaster-prone region. An exploratory-descriptive qualitative approach was employed, incorporating semi-structured interviews with 60 participants across three levels of solar energy access (direct, indirect, and no access) and key stakeholders. Thematic analysis was conducted using NVivo to explore the health impacts of energy insecurity and the resilience strategies used to address it. Energy insecurity exacerbated health vulnerabilities by disrupting the use of critical medical equipment and the refrigeration of medications, worsening chronic conditions such as diabetes and respiratory ailments. Participants reported significant psychological stress, including elevated anxiety during blackouts. Casa Pueblo’s solar initiative proved essential, mitigating immediate health risks while fostering a sense of security and well-being. Yet systemic challenges—such as insufficient government support—highlighted the urgent need for scalable, sustainable solutions that ensure equity. Reliable energy access is crucial for managing chronic diseases among older adults and strengthening public health resilience in disaster-prone settings like Puerto Rico. Community-driven solar initiatives, exemplified by Casa Pueblo, offer scalable models to enhance health outcomes in vulnerable populations. Realizing their full potential will require coordinated efforts, including public-private partnerships, policy reforms, and measures to overcome structural barriers. This study provides actionable insights for disaster-prone regions worldwide, emphasizing the integration of energy resilience into public health planning.

Identifying molecular biomarkers of pulmonary fibrosis (PF) would improve monitoring the disease progression and response to treatment. Hermansky-Pudlak syndrome (HPS)PF is an inherited type of progressive PF with accelerated onset of PF in patients with HPS type 1 (HPS-1). HPSPF could serve as a model to study biomarkers of progressive PF, given that all individuals with HPS-1 eventually develop HPSPF. We used a multiomics strategy to discover progressive blood biomarkers that can recognize factors contributing to the fibrotic cascade in the lungs of individuals with HPS. Metabolomic and cytokine/chemokine profiling were performed on serum samples from patients with HPS-1, HPS-1 with PF (HPSPF), HPS-3, HPS-5, or idiopathic PF and healthy volunteers. Metabolomics, cytokine/chemokine, pulmonary function, and age data from subjects with HPS-1 and HPSPF were integrated into a multiomics network. The analysis highlighted alterations in the transsulfuration pathway, arginine metabolism, and redox balance with the progression of PF in HPS-1. Among those, CCL22 and choline were significantly elevated in HPSPF compared with HPS-1 in two independent cohorts together with age and were associated with decline of pulmonary function. In receiver operating characteristic curve analysis, both CCL22 and choline demonstrated high accuracy in predicting PF in subjects with HPS-1 and therefore could serve as prognostic blood biomarkers of HPSPF. We noted similarity in molecular signatures of CCL22 in progressive idiopathic PF and HPSPF. We found that inducible nitric oxide synthase is an upstream regulator of releasing profibrotic mediators (CCL22, CCL24, IL-18, IL-1α, IL-1β), suggesting the therapeutic potential of inducible nitric oxide synthase inhibition in progressive HPSPF.