Prognostic factors of severe asthma in Puerto Rico

Asthma in Puerto Rico is a serious Public Health Problem. This study extends our cross-sectional self-reported asthma prevalence survey of 3,000 volunteers. The purpose of the present study was to analyze the importance of known prognostic factors of asthma severity among 486 self-reported participants. Patients with more than one visit to the emergency room in the previous 12 months due to asthma exacerbations were classified as cases of "severe asthma", and those asthmatic patients who did not visit emergency rooms were classified as "non-severe asthmatic subjects". Severe cases and non-severe asthmatic subjects were compared regarding age, sex, family history of asthma, presence of household pets, and in the previous 12 months: history of hospitalization due to asthma, respiratory infections, tobacco smoking, exposure to passive smoking, and avoidance of passive smoking. Crude and logistic regression adjusted odds ratio was used as a measure of association between each prognostic factor, and the outcome namely severe asthma, while adjusting for all confounders simultaneously. The results clearly showed that previous hospitalizations due to asthma (OR = 7.3, p < 0.0001) and frequent of respiratory infection (OR = 2.5, p = 0.0003) were prognostic factors associated with increased asthma severity. A statistically significant, two percent less likelihood to have severe asthma for each year of age was found. Weak associations were found between asthma severity and male gender, family history of asthma, passive smoking, and presence of household pets. Avoidance of environmental tobacco exposure (passive smoking) was found to be an important and statistically significant protective factor associated with a 47 less likelihood for severe asthma. In conclusion, appropriate management of patients with history of hospitalization due to asthma is very important. The correct management of respiratory infection in asthmatic patients may result in a reduction of up to 60 percent of the odds of having asthma severe enough to require emergency treatment, and may reduced by 86.3 percent hospitalizations.

Age, gender and seasonal patterns of asthma in emergency departments of southern Puerto Rico

We report findings derived from 55,547 emergency department records of asthmatic patients in the city of Ponce, Puerto Rico over a period of six years. The analysis of the data revealed that mean age of the asthmatic cases were 18.7 +/- 17.8 years, with 45 percent of the patients in the 1-9 years age range, and proportionally decreasing with age. In children 1-9 years the percent of males was 1.5 times that of females, and in 10-19 year-old group, admissions to the emergency room for males and females was identical, and between 20-69 years of age, the female ratio ranged from 1.5-2.12. The data also demonstrated that there is a seasonal variation in the asthma attacks reaching its peak in December, and the lowest in June. In conclusion, in the city of Ponce, Puerto Rico, emergency department usage due to asthma attacks show a seasonal variation, and males are more affected by asthma at younger ages while females are more affected at older ages. These findings strongly suggest that emergency department usage due to asthma attacks is highly common and represents an important place where specialized health care delivery is needed. With the implementation of dedicated asthma centers, specialized health care delivery can be easily accomplished. In addition, our data supports the that asthma should be declared a public health problem and a reportable disease.

Tratamiento de tumores anexiales por laparoscopía / Laparoscopic treatment of adnexial tumors

En este trabajo se presenta la experiencia obtenida en 61 pacientes con tumoraciones anexiales en el período de junio de 1988 a junio de 1994. Las pacientes provienen de la consulta privada y semiprivada a las cuales se les practicó una laparoscopía diagnóstica y operatoria (56/61) en el mismo tiempo quirúrgico. Los criterios de inclusión y exclusión fueron determinados por la historia clínica (antecedentes, edad, síntomas, tamaño, etc.), estudio ultrasosnográfico vaginal (ascitis, papilas, contenido del quiste, etc.) exámen de laboratorio (CA 125 en pacientes postmenopáusicas), la valoración macroscópica del tumor durante la laparoscopía diagnóstica, y se practicó una biopsia transoperatoria 19/61 para confirmar los datos de benignidad encontrados en el diagnóstico preoperatorio, dando los resultados encontrados según la proporción que guardan con los 61 casos estudiados. El motivo de consulta fue en 24/61 por esterilidad,de los cuales 18/61 pacientes eran por esterilidad primaria y 6/61 por esterilidad secundaria; en estas pacientes se realizaron 22 quistectomías y 2 ooforectomías; y se lograron embarazar 10. Por dolor consultaron 37 de 61, de las cuales a nueve se les realizó ooforectomía, dos por accidente de torsión, tres por ruptura de quiste hemorrágico y cuatro por ovario residual. En las 28 restantes se realizó quistectomía con franca mejoría de su sintomatología. Los diagnósticos de los tumores en el postoperatorio: quistes luteínicos 13/61, quistes funcionales 17/61, quistes hemorrágicos 8/61, endometriomas 9/61, cistoadenomas serosos 3/61, cistoadenomas mucinosos 1/61 fibroma ovárico 1/61, teratoma quístico maduro 2/61, ovarios residuales 4/61, paraovario 2/61, hidátide de Morgagni 1/61. En este trabajo se demuestra que si se siguen los parámetros correctos para la evaluación de las tumoraciones anexiales, el procedimiento endoscópico puede ser seguro con los beneficios que se obtienen al efectuar estos métodos