Fungal infections represent a serious complication for immunosuppressed patients resulting in an increased morbidity and mortality. A non-concurrent prospective study was performed to evaluate the factors associated to invasive fungal infection (IFI) in patients with hematological malignancies admitted to the University Hospital in San Juan, Puerto Rico from January 1st, 2011 through June 15th, 2014. The medical records of 84 patients were evaluated. Fifty-nine patients with IFI and twenty-five without IFI. The majority were men between 35 to 55 years old. The main hematological diagnosis was acute myelogenous leukemia (AML) followed by acute lymphoblastic leukemia (ALL). Seventy-percent developed IFI. The most common fungi were C. albicans followed by non-albicans species, Fusarium and, Aspergillus species, respectively. About 63% of the patients with AML and 81% without AML had IFI. Those who received steroids were more likely to develop IFI. After adjusting for AML and age, the odds of IFI among patients using steroids were 3.33 higher than those not using steroids. Patients who were exposed to different antifungal medication had 72% lower odds to develop IFI.
A twenty-eight years old patient with phaeochromocytoma in pregnancy is reported. In the second trimester, she was admitted to hospital for complaints of headache, fever, palpitation and weakness. A phaeochromocytoma was diagnosed. Alpha and beta blockers were given to regulate arterial blood pressure until foetal maturity was reached. Delivery was by caesarean section and the operation was continued with a right adrenalectomy. Pathological examination revealed a phaeochromocytoma.
Eighty year old male patient with heart failure preserved ejection fraction (EF),Obstructive sleep apnea, peripherovascular disease admitted with increasingshortness of breath and found with pulmonary emboli. Baseline 2D-echo-cardiogramperformed demonstrated preserved ejection fraction and a rightthrombus in transit. Anticoagulation with weight based-low molecularweight heparin was given for six days. Follow-up echo performed demonstratedcomplete dissolution of right heart thrombi. Since there was complete dis-solution of thrombi seen on right atrium, anticoagulation with Rivaroxabanwas given instead.
Methicillin-resistant Staphylococcus aureus (MRSA) is a strain of S. aureus thatshows resistance to multiple antibiotics. Up to 30% of S. aureus strains isolatedfrom nosocomial infections are MRSA, and it has become a growing problemfor public health. The cost of MRSA infection is also having a huge impactfinancially and results in considerable resource utilization. Puerto Rico’sLegislature passed Law # 298 on October 19, 2012 for the control and preventionof MRSA infections in medical installations in Puerto Rico. In order to complywith the law we conducted a pilot study to identify possible setbacks of theimplementation of the MRSA decolonization protocol as standard of care therapy inour institution while contributing to the process of quality improvement andpatient safety. Nasal swabs were taken at the Pre-admission Department andprocessed through a PCR-based MRSA detection assay. A protocol of decolonizationin patients with positive results was implemented. The study showedthat patients without apparent risk factors could be colonized either withMRSA or Methicillin-sensitive S. aureus (MSSA). The time between pre-admission and surgery was less than the indicated for a proper decolonizationprocedure. Therefore, 50% of the scheduled surgeries could have beenpostponed in case of positive MRSA or MSSA. In our experience patient’s educationwas crucial to guarantee compliance and adherence to treatment. Inorder to decrease risk of wound infection we recommend that both, screeningprocess and decolonization if required, be performed before the preadmissionappointment for elective surgery. This study provided a framework for MRSApre-admission screening and decolonization in our Institution.
INTRODUCTIONPrevious studies have described Klinefelter syndrome as a geneticdisorder characterized by at least one extra X chromosome and at least 47chromosomes. It is the most common sex chromosome aneuploidy among men.Patients may present with large height, gynecomastia, low testosterone levels,infertility, hypogonadism and diseases usually more common in females suchas osteoporosis, breast cancer and auto-immune disorders. Other rare ophthalmicassociations have been described, such as diffuse choroidal atrophy, microphtalmia,cataracts, juvenile glaucoma, choroid colobomas and goniodysgenesis.OBJECTIVESTo report on the ocular findings in a Puerto Rican patient withKlinefelter syndrome (XXXXY/XXXY). PATIENTS AND METHODS: A patient with Klinefelter syndrome with revious history of elevated intraocularpressure underwent a comprehensive ocular examination, Humphrey visualfields and Stratus optical coherence tomography (OCT) tests. Patient had inreased intraocular pressure, visual field loss and OCT findings compatible withglaucoma. After laser YAG laser iridotomies, high IOP persisted. Brimonidine0.2 % drops three times a day drops were prescribed to lower IOP.CONCLUSIONSA patient with Klinefelter syndrome had poor visual acuity, high intraocular pressure, visual fields and OCT results, all compatible with angle closureglaucoma as part of the syndrome.
