Association between fine needle aspiration cytology and final pathology in the diagnosis of thyroid nodules with surgical indications.

Fine needle aspiration of thyroid (FNA) is broadly used as the preferred preoperatory test to evaluate thyroid nodules. The clinical importance of this procedure is primarily related the need to exclude Thyroid Cancer. There are few studies investigating the association between FNA and final pathology in patients with thyroid nodules with surgical indications. There is no evidence from studies in the southern area of Puerto Rico that investigate this association. This was a randomized cross-sectional study, 82 medical records were evaluated. Data were obtained for FNA diagnosis, demographics, body mass index, findings on ultrasound and histopathology results. In this study the sensitivity of FNA was 73.53% and specificity of 100%. The accuracy of the study was 78%. The study reported a prevalence of 83% malignant tumors in the final pathology and 61% in the FNA. The positive predictive value was 100% and negative 43.75%, suggesting that FNA is a good diagnostic test to detect thyroid nodules suspicious for malignancy. FNA of 33 patients was reported with undetermined cytopathology. The measure of agreement and correlation coefficient showed a moderate agreement between both studies with a Kappa value of 0.487, suggesting that the test results of FNA and final pathology are associated. Of the indeterminate nodules, final pathology reported 15 benign and 18 malignant. This study demonstrated that the FNA is reliable in identifying thyroid nodules in patients with surgical indications.

Evaluation of a systematic approach to pediatric back pain: the utility of magnetic resonance imaging.

BACKGROUND: Several studies have suggested that back pain in the majority of pediatric patients does not have an identifiable cause. Many children undergo extensive diagnostic workup that ultimately results in a nonconfirmative diagnosis. The purpose of this study was to (1) describe the prevalence of back pain seen in a pediatric orthopaedic clinic; (2) evaluate the efficacy of a systematic approach dependent on magnetic resonance imaging (MRI) in the diagnosis of pediatric back pain; and (3) analyze sensitivity, specificity, positive predictive value, and negative predictive value of various clinical signs and symptoms. METHODS: For a 24-month period, all patients that presented with a chief complaint of back pain were prospectively enrolled in this study and evaluated in a systematic approach which utilized MRI for patients with constant pain, night pain, radicular pain, or abnormal neurological examination after an initial history, physical examination, and negative radiographic examination. RESULTS: The prevalence of chief complaint of back pain was 8.6% (261/3042 patients). Of the 261 patients, 34% had an identifiable pathology following the systematic approach. In 8.8% of patients, the diagnosis was established with the history, physical examination, and plain radiographs. MRI yielded a definitive diagnosis in another 25% of patients. It is noteworthy that of the 89 patients with a confirmed pathology, 26% were identified with plain radiographs and 74% with MRI. CONCLUSIONS: A systematic approach to diagnose pediatric back pain demonstrated that 34% of pediatric patients that present to an outpatient orthopaedic clinic complaining of back pain will have identifiable pathology. The diagnostic yield increased from 8.8% with the history, physical examination, and plain radiographs to 22% with the TCN Bone Scan to 36% with the use of the MRI. The clinician should be aware that the presences of lumbar pain or constant pain are red flags for the presence of underlying pathology. LEVEL OF EVIDENCE: Level III.

Role of Helicobacter pylori infection in Hispanic patients with anemia.

Pernicious anemia represents the final phase of a process that begins with Helicobacter pylori-associated gastritis and evolves through progressive levels of atrophy until loss of parietal cell mass. Numerous studies have suggested an association between H. pylori infection, unexplained iron deficiency anemia and cobalamin deficiency. Our research question was to determine whether there is an association between with H. pylori infection and development of anemia in Hispanic patients. This cross sectional pilot study involved data analysis of individual from years 2010-2012 examining the association between H. pylori infection and hemoglobin levels in patients with Hispanic ethnicity. A total of 189 records were evaluated, of which 33 fulfilled the inclusion criteria. The study sample was divided in two groups. Group-A: 5 subjects with H. pylori infection and anemia; Group-B: 28 patients with H. pylori without anemia. Fisher exact test applied between categorical variables to determine the statistical significance of symptoms comparing anemic vs. non-anemic H. pylori infected patients yielded a p = 0.0027. In addition, restoration of anemia in two subjects following eradication therapy without previous iron or cobalamin replacement therapy suggested a potential role of this bacterium in the development of anemia in Hispanics. In conclusion, from the results of this study a potential association between Helicobacter pylori infection and anemia in Hispanic patients is suggested. Restoration of hemoglobin after eradication of bacteria further supports this concept.

Eptifibatide: gender related complications in a Hispanic population.

UNLABELLED: One of the most common indications of Eptifibatide, a GP IIb/IIIa inhibitor, is non-ST segment elevation myocardial infarction (NSTEMI) due to its great antiplatelet activity. The aim of this study was to find out if there are gender discrepancies when comparing complications in Hispanics treated th Eptifibatide. METHODS: A cross-sectional study. 116 medical records with diagnosis ofNSTEMI managed with Eptifibatide during 2010-2012 were included. Bleeding, thrombocytopenia, new ischemia, anemia and death were variables compared. RESULTS: The most common complication was death. There were four cases of bleeding, all of them occurred in the female gender, reaching a statistically significant difference compared to male gender (p = 0.0173); 8% of patients had thrombocytopenia; 9% had new ischemia during hospitalization; 13% died; 19% of patients developed anemia including the four cases of bleeding. CONCLUSION: Bleeding occurred only in women, and this difference was statistically significant when compared to males. More studies emphasizing the differences in Eptifibatide complications by gender are needed. Furthermore, it would be important to compare these results to non-Hispanic women. The difference found in the other complications analyzed was not statistically significant.

Vitiligo, jaundice and cholestasis in a middle aged woman: a case report.

Primary biliary cirrhosis with autoimmune hepatitis (PCB/AIH) overlap is characterized by uncertain behavior and no standardized treatment. A 35 year-old-woman with vitiligo, jaundice and cholestasis fulfilled serological, biochemical and histological criteria for PBC/AIH overlap. Treatment was initiated with conventional doses of corticosteroid and ursodeoxycholic acid. Her condition worsened with poor biochemical hepatic response. The course of action was altered to institute high doses of ursodiol, azathioprine and corticosteroids for extended periods of time. This case illustrates how increased understanding of the overlap PBC/AIH leads to new interventions. Recognition of these variant forms is critical for institutional management of both disease entities.

Relation between serum vitamin D level and asthma.

UNLABELLED: Asthma is a chronic multifactorial condition racterized by inflammation, bronchial hyperresponsiveness, narrowing of airway associated with wheezing and shortness of breath, where trials have evidenced that approximately 50% despite being on adequate treatment don't achieve optimal control. Asthma has been related to vitamin D deficiency, where lower levels have been correlated to an increased hyperreactiveness and lower measures in pulmonary function test. Up to our knowledge, no studies have been conducted in Hispanic patients for this association. METHODS: Cross-Sectional pilot study in the setting of a pneumology office practice. Population consisted of asthmatic patients with no past medical history or risk factors for lower vitamin D levels. Variables studied included Peak-Flow s a measurement of the maximal velocity of air expelled in a forced exhalation adjusted for height and age; Serum vitamin D levels where optimal was > 30, and deficient < 30. Data coIlection period occurred between January 2010 and May 2011. RESULTS: A direct proportion relation between vitamin D levels and asthma control test (ACT) questionnaire was noted. An inversely direct proportion between vitamin D and peak flow was evidenced, while no relation noted between peak flow and asthma. DISCUSSION: An 80% prevalence of vitamin D deficiency was noted in our population. Higher levels of vitamin D were associated with higher punctuation on ACT questionnaire, evidencing that most patients felt better during the last month. Peak flow measurements resulted to be lower when vitamin D was higher, though this measure could be influenced by a variety of external conditions.

The epidiemiologic profile of HCV infected Hispanic patients from the southern area of Puerto Rico since 2005.

UNLABELLED: Seroprevalence studies in adults done in San Juan and Puerto Rico have showed 6.3% and 2.2% of the population respectively, are positive for antibodies to Hepatitis C Virus (anti-HCV). It is been suggested that Hispanics have a lower sustained virological response to current therapy. The epidemiologic profile, the response to treatment and the risk factors to the poor response to treatment of HCV patients have not been studied in the southern area of Puerto Rico. METHODS: This is a cross-sectional analysis of data from 46 medical records from January 2005 to March 2011. We search for sociodemographic variables, comorbidities, the HCV genotype, the human immunodeficiency virus profile, history of alcoholism and the patients who were treated with peginterferon alpha 2b and ribavirin, and their response to treatment. RESULTS: Our HCV infected population is male predominant (63%), and the most common route of transmission were intravenous drug abuse (37%) and blood transfusions (33%). Only 37% reported alcoholism. The most common comorbidities found in our population were hypertension (35%), diabetes mellitus (20%), hypothyroidism (7%) and dyslipidemia (7%). Most common genotype found in our population was type 1 (61%). From the 46 patients, 10 patients were treated, being genotype 1 the most common. DISCUSSION: Overall, our population showed an epidemiological profile similar to other Hispanic groups in the literature, which should motivate us to continue exploring these associations, in an effort to improve the management of these patients.

Correlation between body mass index and need for total knee replacement in a group of Latin patients with knee osteoarthritis.

UNLABELLED: Osteoarthritis (OA) of the knee has been linked to obesity. Clinical observations suggested that there is a direct relationship between the degree of obesity and the severity of knee OA in the Latin community. This study associates the risk of requiring total knee replacement (TKR) attributable to being obese on a subset of Latin patients. METHODS: 112 Latin patients ages 21 to 89 years were evaluated by an orthopedic surgeon and enrolled in a pilot case-control study. The charts of these patients were reviewed and sociodemographic data, body mass index (BMI), and initial management, whether it was medical or TKR were reviewed. Patients were segregated according to their BMI in different categories: normal, overweight, obesity class I, obesity class II, and obesity class III. Severity of OA was then compared between the patients in the different BMI classifications. Analyses were further adjusted for age, sex and hometown. RESULTS: 100 subjects were successfully included into the study. Of the non-obese patients, neither underweight nor normal weight patients were managed with TKR, and only 9% of overweight patients were managed with TKR. Overall, 48% of the obese patients were managed with TKR. This included 43% of the obese class 1, 58% of the obese class I, and 33% of the obese class III patients. CONCLUSION: There seems to be a direct relationship between obesity and risk of TKR in the Latin community.

Outcomes associated with conventional management of severe sepsis at Damas Hospital.

UNLABELLED: Severe sepsis and septic shock have become one of the leading causes of medical intensive care unit (MICU) mortality as well as one of the greater consumers of healthcare resources. Several institutions in the United States have reported positive outcomes after following the Severe Sepsis Campaign (SSC) recommendations. Current management of severe sepsis and septic shock at Damas Hospital's MICU follows no specific protocols or recommendations. This study report data regarding outcomes associated with ongoing management of severe sepsis at our institution. METHODS: Historical controls with ICD-9 diagnosis of Severe Sepsis and/or Septic Shock hospitalized between January 2007 and August 2009 were randomly selected. Data regarding survival, length of stay (ICU/ In-hospital), and disease severity was gathered through record review. Measured outcomes as well as sociodemographic data were compared to those reported in the literature. RESULTS: Thirty patients were studied with a mean age of 62 years; 50% male and 50% female. Mean APACHE II score was 21 (40% mortality) with average MICU length of stay of 5.2 days and overall hospital stay of 12.9 days. Overall mortality was 66%. CONCLUSION: There is a high mortality rate associated with conventional management of severely septic patients in Damas Hospital ICU. Studies with similar populations had significantly lower mortality rates based on conventional management of severe sepsis/septic shock. Starting protocoled care of patients with severe sepsis as recommended by the SSC could have a positive impact in the overall mortality at Damas Hospital.

Lowest safe hematocrit level on cardiopulmonary bypass in patients undergoing coronary artery bypass grafting.

UNLABELLED: Coronary artery bypass grafting (CABG) is the most common cardiothoracic surgical procedure performed in the United States. The majority of patients undergoing CABG are placed on cardiopulmonary bypass (CPB) to support the circulation. CPB hemodilutes the patient imposing extremes in the hemostatic system, requiring careful assessment of pre-surgical hematologic values. Recent clinical data suggests that patients who receive blood transfusions while hospitalized for CABG have an increased morbidity and mortality. Women have a greater risk of transfusions than men with CABG and are thus at greater postoperative risk. The purpose of the present study was to determine the lowest safe hematocrit level achievable on CPB during CABG surgery where no transfusion and no post-operative complications were identified. METHODS: Inpatient record review evaluation including socio-demographic data, hematocrit values (pre-pump and on pump), red blood cell transfusion administration and Surgery, postoperative complications. RESULTS: Collected data from 136 first-time, single CABG patients demonstrated 68% had no postoperative complications. Of this non-complicated group 60% were transfused while only 40% were non-transfused. The non-complicated, non-transrusea group nematocrit vaiues averagea 25.1% +/- 2.8 with a minimum of 19%. (P = 0.003). 68% of the patients had no postoperative complication. Transient acute renal insufficiency was the most common complication observed. CONCLUSION: The lowest safe hematocrit level on CABG in non-complicated and non-transfused patients was 19% corresponding to an average of 25.1% +/- 2.8. A preoperative patient profile has been identified where age, weight, height, BSA, BMI, and pre-pump and on pump hematocrit values can aid medical staff about transfusion decision making.

Preoperative clinical and demographic characteristis in Puerto Rico patients referred to inpatient cardiac rehabiliation after cardiac surgery.

UNLABELLED: Patients with coronary artery disease (CAD) or cardiac valve disease who have undergone cardiac surgery are prime candidates for cardiac rehabilitation. Cardiac rehabilitation is a multidisciplinary activity that aims to facilitate physical, psychological and emotional recovery. Multiple studies have evaluated preoperative characteristics of patients who undergo rehabilitation to predict improvement and prolonged length of stay after CAD surgery. This research aimed to establish which preoperative clinical and demographic characteristics are present in Puerto Rico patients that require inpatient rehabilitation after cardiac surgery. METHODOLOGY: Record review evaluating clinical and sociodemographic variables of patients with cardiac surgery and it relationship with or without cardiac rehabilitation referral. A total of 65 records were selected: 17 records referred for inpatient rehabilitation and 48 records of patients who were discharged home. RESULTS: Older patients > 65 y/o, living alone with no caregiver availability, impaired functional status, surgical status (urgent/ emergency surgery), concomitant valve surgery, BMI > 24.9, HgbA1C > 7.0%, female gender, CVA history, COPD history, PVD history, and prior weakness contribute to a functional decline, and are more likely to be associated with a referral to inpatient rehabilitation. CONCLUSION: An identification of these variables before surgery could lead to early intervention by skill nursing facility departmental team. This early intervention can diminish later complications, postoperative and intensive care stay.

Independent association of LDL-C and non HDL-C with acute coronary syndrome in a Hispanic population.

UNLABELLED: There is an identified relationship between increasing plasma cholesterol and the incidence of Acute Coronary Syndrome (ACS). The National Cholesterol Education Program Adult Treatment Panel identified low-density lipoprotein--cholesterol (LDL-C) as the first target of therapy and non high-density lipoprotein cholesterol (Non HDL-C) as the second target. However, in epidemiologic studies non-HDL is a superior predictor of cardiovascular risk compared with LDL-C. We don't know the independent association of non HDL-C and LDL-C in Hispanic population with ACS. METHODS: We evaluated patients with acute coronary syndrome admitted to Damas Hospital CCU, ICU & Telemetry Unit during a five months period and previous criteria of uncontrolled lipid levels. We compared the independent association of uncontrolled lipids levels with subsequent acute coronary syndrome. RESULTS: Of 26 patients with ACS, 58% had independently association with non HDL-C elevation and 42% with LDL-C elevation. Regardless the categorization of the cardiovascular event, 6 of the 8 female patients had predominantly elevated blood levels of LDL as an independent factor. On the other hand, 15 of 18 male patients had Non-HDL elevated blood levels. DISCUSSION: The association of ACS with independent lipid levels of LDL and non-HDL seems to be equivalent in our population. Interestingly there seems to be a female predominance in elevated LDL levels and a male predominance elevated blood levels of Non-HDL associated with cardiovascular events.

Parapharyngeal space tumor: undifferentiated sarcoma of the parotid gland. A case report.

Parapharyngeal space tumors are extremely uncommon. A 43-year-old man presents with a painless upper neck and face mass, airway obstruction and dysphagia. Physical evaluation revealed a firm, non-mobile mass extending from the right auricular region to the mandibular region of the neck. Radical parotidectomy was scheduled and muscle biopsy was done yielding undifferentiated sarcoma of the parotid gland. Parapharyngeal space tumors represent a problem for physicians in making an accurate diagnosis and determining management options available. Extensive knowledge of the anatomical boundaries of the parapharyngeal space, diversity of pathological problems and common clinical manifestations should help avoid delayed diagnosis and improve patient's outcome.

Ventricular fibrillation as the first manifestation of primary hyperaldosteronism.

50 years old female patient, with history of diabetes mellitus and hypertension, receiving metformin (500 mg BID) and atenolol (50 mg BID), presented to the Emergency Room with asthenia and dizziness. The patient was also receiving alternative medication (Dragon Blanco) which contains no licorice. During the emergency workup she developed syncope and three episodes of ventricular fibrillation. She was electrically defibrillated and treated with amiodarone and potassium replacement. The patient was admitted to the Intensive Care Unit. Physical exam: BP: 160/90 mm Hg, RR: 15, Pulse: 83: Cardiovascular: grade II systolic murmur which irradiated to the neck. The rest of the examination was unremarkable. Labs: Na: 138 meg/dl, K: 1.6 meg/dl, Cl: 84 meg/dl, BUN: 17 mg/dl, Creat.: 1.1 mg/dl, Gluc.: 148 mg/dl, Renin: < 0.15 mcgr/ml, Aldosterone: 20.1 mcg%. Aldosterone-Renin ratio: 133. Chest X-Ray: cardiomegaly. EKG: RBBB, long QT segment and prominent broad "u" waves compatible with severe hypokalemia. A CT SCAN of the Abdomen/Pelvis showed a 3.2 cm right adrenal mass, most likely adenomatous. The patient was discharged with the diagnosis of primary aldosteronism. Due to the diagnosis of diabetes mellitus, hypertension and the three episodes of ventricular fibrillation, surgical treatment was postponed until stress tests and eventual coronary angiographic studies were performed. We found in our review of the medical literature 9 reports of fibrillation associated with hyperaldosteronism. Of those, only two were associated with primary aldosteronism, one of them with a fatal outcome. This case is highly unusual and emphasizes the importance of an adequate diagnosis of secondary hypertension.

Apache II as a predictive tool of intubation length in critical care unit patients.

INTRODUCTION: There are some areas of uncertainty when it comes to determine how long a patient is going to require assisted ventilation. Our study uses Acute Physiologic and Chronic Health Evaluation (APACHE II) score to determine how many days a patient might require assisted ventilation. METHODS: All patients admitted to the Cardiac Critical Care unit and Intensive Care Units at Damas Hospital who were placed on mechanical ventilation were evaluated. Patients were evaluated from December 2003 to March 2004. During evaluation, the patient record was reviewed to obtain APACHE II score prior to mechanical ventilation placement. Exclusion criteria were patients who were not evaluated in the first 24 hrs. of admission. RESULTS: 11 patients were examined. Patients that had less than 3 day intubation (mean 2.4 days +/- .54) had lower APACHE II (mean 21.20). Patient with intubation longer than 3 days (mean 14.7 +/- 10.25) had higher APACHE II score (mean 27.5). CONCLUSION: Based in our aims, general as well as specific, we conclude that lower APS do correlate with lower intubation days. Working on this data, with APACHE we could predict length of intubation and preventive actions. We think that APACHE II scoring system can be used as a prognostic factor to be discussed with family members and can also be added to current weaning indexes to predict weaning success. We recommend that APACHE II be calculated to every admitted patient to the Critical Care Units and that it should be added to weaning indexes to predict probability of extubation. We recommend a follow-up of this study with a wider population.

High blood pressure risk factors in a community of students in the south area of Puerto Rico.

INTRODUCTION: The south area of Puerto Rico has a high density of a college student population. This population is exposed to a series of hypertension risk factors, for instance: they are exposed to the stress associated with their studies, they are the target of publicitary promotion of fast foods, alcoholic drinks, smoking, and they share with the rest of the Puertorican population predisposition to diabetes mellitus. We collected data about the risk factors for High Blood Pressure (HBP) to which this specific population was exposed. METHODS: This is an observational-descriptive, cross-sectional study with a data collection period from February to March 2004. SUBJECTS: students of a health science institution of the south area of Puerto Rico (N = 310). Sample availability (155). The Prediagnostic History of Francisco Fragachán (2002), High Blood Pressure Unit, questionaire Universitary Hospital, Central University of Venezuela was utilized. We also performed the questionnaire of Vulnerability Stress Test of Beech and Scheffield (adapted for a Hispanic community). The blood pressure was measured with an electronic calibrated Omrom 4M equipment. Measured anthropometric variables: Weight and height with a calibrated scale; Hip and waist circumference under the anatomical references of Siegell et al. RESULTS: Age Average: 25.4 +/- 3.19. Ninety three percent (93%) of the population had at least one risk factor for HBP. Of our population, 90% consider themselves vulnerable to stress at least in one of the items proposed. 45% of our subjects were overweight and 17% were obese. 94.8% of the study population had an adequate W/H ratio. Mean values for BP: 112/71; Pulse Presure: 41; Mean Blood Presure: 85,4; Heart Rate: 79,5. We found seven subjects with hypertension. CONCLUSION: In our study population the presence of risk factors (modifiable and non-modifiable) in an early stage of life (25.4 +/- 3.19 years) increases the possibility to develop hypertension.

Quantitative C reactive protein levels and acute myocardial infarction complications in a Hispanic population: an observational analytical pilot study.

INTRODUCTION: The association between ischemic cardiomyopathy and C reactive protein (CRP) as an acute-phase inflammatory reactant has been reported. Increased highly sensitive C-reactive protein levels have been associated with a higher cardiovascular risk. We found no appreciable structural differences between Quantitative CRP and Highly Sensitive CRP but we found differences cost of both tests. Data addressing a relationship between QtC reactive protein levels and acute post myocardial infarction complications in Hispanic population was collected. Our study aims to provide a new element of prediction for the diagnosis of acute post myocardial infarction omplications in a Hispanic population. Also we could identify the possible presence of a QtCRP predictor range associated with acute post MI complication. We determined the presence of the primary endpoint of sudden death and secondary endpoints of heart failure, reinfarction and revascularization (PTCA) acute post myocardial infarction complications in a Hispanic population and after an acute myocardial infarction correlated them with QtC reactive protein levels. METHODOLOGY: This was an observational analytic pilot study. After the consent form was signed, QtCRP blood levels were taken 24 hours after the cardiac event. We followed the patient for one month after the acute event identifying further visits to the Emergency Room and determined the presence of post acute infarction complications (chest pain, heart failure, reinfarction and cardiac death) during that period of time. Then, we determined the relationship between the QtCRP level and the type of acute postinfarction complication. RESULTS: We examined 20 acute myocardial infarction subjects and 14 of them developed secondary endpoints (all 14 of them had PTCA intervention). Two patients reinfarcted and 1 developed heart failure. There were no deaths. Levels of QtCRP of 6.07 mg/dl or more were associated with acute post infarction cardiovascular complications (secondary end points). Levels of QtCRP of 1.91 mg/dl or less were not associated with acute post infarction cardiovascular complications. Levels between 1.91 and 6.07 did not correlate well with the occurrence of complications. CONCLUSIONS: There seems to be a correlation between elevated QtCRP levels and secondary end points such as re-infarction, heart failure and PTCA. There is a probable identification range of QtCRP blood levels in patients with or without acute post IM complications.

Salt taste threshold and salt good taste sensitivity in a community of students of the southern area of Puerto Rico.

Sodium appetite reflects the importance of sodium homeostasis. The sodium ion is one of the most important risk factors in the development of hypertension. Humans, for various reasons, seem to have a specific preference for salt which is consumed in excess of need and this has been characterized as an important contributor to hypertension. Salt intake is related to the salt taste sensitivity threshold and the salt good taste level. Gustatory sensibility responds to various physiological mechanisms and salt taste is directly modified by cultural and socio-economical factors. We measured the salt taste sensitivity threshold and salt good taste level of a young student population. Air popped popcorn sprayed with different Molar concentrations of salt where given to students to taste and a questionnaire to evaluate diet salt intake preferences. Both salt taste sensitivity threshold and salt good taste level graph patterns are different from each other. Salt taste sensitivity threshold has a bell shape distribution with different molar salt concentrations. The major tendency of the salt umbral sensitivity of our population was the 0.5 M concentration. Salt good taste level has an exponential shape distribution with different molar salt concentrations. The tendency for the good taste level of our population was 3 M. Smoking does not seem to modify the salt taste sensitivity thresholds or the salt good taste level graphs. Also, salt shaker use does not seem to modify salt taste sensitivity thresholds or salt good taste level graphs in our population. Salt taste sensitivity threshold is probably associated to morpho-physiological factors. Salt good taste level is mainly associated with the cultural environment. The majority of subjects have a tendency to prefer foods with higher concentrations of salt increasing the possibility of exposure to the salt intake risk factor.

Temporal arteritis in Puerto Rico Hispanics.

Medical statements from previous epidemiologic studies consider temporal arteritis as extremely rare or absent in Hispanic patients. A probable genetic protective condition was proposed as an explanation for this. We performed a descriptive observational, retrospective, comparable and not randomized study in the southern region of Puerto Rico (Ponce Area). The period for recollection of data was July/2002 to March/2004. We reviewed all the information of the clinical charts of patients diagnosed with temporal arteritis who were seen in the medical offices of one internist and two rheumatologists of the teaching staff of Damas Hospital. The subjects of our study consisted of 11 patients (8 female and 3 male), between the ages of 70 to 90, all of Hispanic origin, with a diagnosis of temporal arteritis. Frequencies and percentages were used to describe the data of the study. Headache was the most common symptom. Other symptoms included the presence of fatigue, malaise, anorexia, scalp tenderness, amaurosis fugax and decreased vision. Laboratory results showed the presence of a mild leukocytosis and anemia in most of the patients. Renal and liver functions were observed to be well-preserved, and serum electrolyte levels were within normal limits. The increase of the ESR and C Reactive Protein values and positive unilateral and bilateral biopsy studies were statistically significant. All of the above characterization of Hispanic population with temporal arteritis cited in our study correlates well with the classic description of the disease in previous epidemiological studies conducted on non-Hispanic subjects. Our study confirmed the presence of temporal arteritis in a Hispanic population. The disease was more prevalent in women than men, with a female to male ratio of 2:6, which is the lowest ratio found for this disease compared to previous epidemiological studies. In our study group, the disease was found in patients over 70 years of age, with a mean age of 75.7. Arterial hypertension was the most commonly associated condition in our patients, probably due to its high prevalence in our community. The clinical characteristics of our patients correlate closely with the previous data from other ethnic groups.

Alteración del metabolismo glucídico: resistencia a la insulina en pacientes con hipertensión arterial primaria de una población negra venezolana / Altered of metabolism glucidico resistance the insulin in patients with (HTA) from nenezuelan black population

La hipertención arterial (HAT) se ha asociado con alteraciones del metabolismo glucídico, siendo la Resistencia a la insulina (RI) una de las más comúnmente encontradas y relacionadas con su etiopatogénesis. El propósito del siguiente estudio fue determinar si la alteración del metabolismo glucídico, a atrvés de la presencia de RI, está presente en pacientes con HAT de una población negra venezolana. Participaron 16 voluntarios masculinos, provenientes de pobalciones negras del Estado Miranda. Se dividieron en 2 grupos: hipertensos (HT,PAS>140/PAD>90mm de Hg) y normotensos (NT, PAS<130/PAD<80mm de Hg). Se excluyeron pacientes con diabetes mellitus y/o Obesidad. Aquellos incluidos se les realizó insulina sérica en ayunas y Clamp Euglicémico Hiperinsulinémico. Se evidenció RI en un 50 por ciento de los HT y en un 33,33 por ciento de los NT; no hubo diferencia estadísticamente significativa entre los grupos (Fisher, p=0,6329). Los NT con RI eran descendientes de HT. La RI, en estas poblaciones negras, tiende a prevalecer en pacientes con HTA y en sus descendientes normotensos