Lourdes García-Fragoso - Academia.edu (original) (raw)
Papers by Lourdes García-Fragoso
PubMed, 2013
There is controversy on the most advantageous management for infants with patent ductus arteriosu... more There is controversy on the most advantageous management for infants with patent ductus arteriosus (PDA) and whether to favor actively closing the PDA or to conservatively observe. We aimed to describe the outcome of infants with PDA based on three management strategies used for its closure (conservative, indomethacin, ligation). Methods: Retrospective medical record review of data from LBW infants (< 2000 with PDA admitted to NICU-SJCH. Results: The prevalence of PDA was 16%. Based on management strategies: 31% did not require treatment. 19% resolved with conservative measures, 38% resolved with omethacin treatment, and 12% required ligation. There was no difference in birth weight, gestational, clinical criteria, morbidities and mortality in patients managed with the strategies evaluated. Conclusion: Results are consistent with previous reports. Development of PDA management guidelines will help standardize the definition of PDA and management criteria instead of treating on a case-by-case basis.
PubMed, 2013
Healthcare associated influenza is a serious public health problem that contributes to patient mo... more Healthcare associated influenza is a serious public health problem that contributes to patient morbidity and mortality. Objective: To determine the seasonal influenza vaccination rate and reasons for its acceptance among healthcare workers in a hospital located at the metropolitan area of Puerto Rico. Methods: Self-administered, anonymous questionnaires were distributed to 120 volunteer healthcare workers and ancillary staff. Results: Immunization rates for the 2009 Influenza A (H1N1), seasonal vaccines 2009 and 2010 seasonal influenza vaccine were 50%, 53% and 65%, respectively. Determinant factors for acceptance of vaccination in 2010 included obtaining the 2009 vaccines, not knowing someone with adverse effect to the vaccine, and believing the vaccine should be mandatory for all healthcare workers. Conclusion: Influenza immunization rate is below the recommended rate to decrease healthcare associated influenza infection. Our results serve to confirm that education is needed to improve immunization rates among these healthcare workers and eliminate misconceptions about the vaccine.
PubMed, 2013
Influenza vaccination is the most effective method to prevent influenza virus infection and its p... more Influenza vaccination is the most effective method to prevent influenza virus infection and its potentially serious complications Objective: To determine fac tors associated to parents willingness to accept the influenza vaccine for their children. Methods: An anonymous questionnaire was administered to 297 volunteer parents/caregivers during 2011. Results: Only 40% of the parents planne to have their children vaccinated agains influenza. Most subjects had medical insurance (52% government, 44% private, 4% no insurance). Factors associated to parents willingness to accept the vac cine were having the vaccine previously. thinking that the vaccine was safer this year. not knowing someone who had an influenza vaccine side effect and having a family member who had influenza. Conclusion: The 40% planned vaccinatio rate lies below the 80% Healthy Peopl 2020 goal and seems to be unassociated to access to healthcare services. Establishing campaigns that reassure parents of vaccine safety could attain a higher vaccination rate.
PubMed, 2013
In 2004, the American Speech and Language Association (ASHA) established the primary roles and re... more In 2004, the American Speech and Language Association (ASHA) established the primary roles and responsibilities of the speech and language pathologists (SLP) in the Neonatal Intensive Care Unit (NICU) breaking down the skills and knowledge needed to become a member of the neonatal team. It establishes as main parameters the evaluation and intervention in communication, feeding and swallowing: parents and caregivers counseling and education: as well as the collaboration and education of the neonatal team. In the NICU, the SLP works in the preparation to initiate the nutritive sucking process and describes maturation levels for nutritive sucking with bottle and breastfeeding The SLP establishes an intervention plan for the development of safe feeding and swallowing skills as well as for the training of parents and caregivers during the process. Research should be promoted to support these interventions and establish the standards for the field.
PubMed, Jul 14, 2012
Rotavirus is the most common viral etiology of acute gastroenteritis in children. Oral rotavirus ... more Rotavirus is the most common viral etiology of acute gastroenteritis in children. Oral rotavirus vaccine administration to infants was incorporated in 2007. The objective of this study is to determine the frequency of acute rotavirus gastroenteritis (ARGE) after the initiation of the rotavirus immunization schedule. Methodology: The study included children younger than 5 years of age admitted to San Jorge Children's Hospital from 2005-2008 with ARGE. Results: There were 7,686 cases of acute gastroenteritis during the study period with 15% caused by Rotavirus. The peak season occurred from January through June. Rotavirus accounted for 22% of the acute gastroenteritis cases in the years pre-vaccination (2005-2006) and only 8.5 % in the post-vaccination years (2007-2008) (p < 0.01) with a 68% reduction in ARGE hospitalizations after vaccination. Conclusions: Our study supports the significant decline in ARGE after routine administration rotavirus vaccine in Puerto Rico.
PubMed, 2013
Studies have identified fathers' attitude as the strongest indicator of whether her partner will ... more Studies have identified fathers' attitude as the strongest indicator of whether her partner will breastfeed. Objective: To determine the attitudes and knowledge of fathers toward breastfeeding. Methods: The study included 84 volunteer fathers who answered a survey. Results: Mean age of participants was 27 years. Most fathers (88%) would like their partners to breastfeed. Most men (56%) reported that it is acceptable for a woman to breastfeed in public. Negative attitudes included feeling jealous about breastfeeding (10%), thinking that breastfeeding is bad for breasts (17%), breastfeeding makes breasts look ugly (26%), and breastfeeding separates the baby from the father (7%). A few misconceptions about breastfeeding were identified. Conclusions: Most fathers have positive attitudes towards breastfeeding. We should emphasize the importance of exclusive breastfeeding and clarify misconceptions that may cause early discontinuation of breastfeeding. Programs directed toward educating fathers will help them serve as sources of support for their partners.
PubMed, Dec 1, 2018
Objective: Zika virus (ZIKV) infection was identified in Puerto Rico on December 2015, and the ou... more Objective: Zika virus (ZIKV) infection was identified in Puerto Rico on December 2015, and the outbreak encouraged us to characterize clinical manifestations and laboratory findings of intrauterine exposed infants. Methods: Retrospective medical record review of infants born to mothers with confirmed ZIKV infection during pregnancy was performed from January 2016-June 2017. We included patients admitted to UPH Neonatal Intensive Care Unit or referred for follow-up at UPH High Risk Clinics. The database was approved by the University of Puerto Rico, Medical Sciences Campus, IRB. Results: 191 infants born to ZIKV positive mothers during pregnancy were identified. Normal head sonogram was found in 93% of the normo cephalic infants. Ocular findings were reported in 50% of the patients with microcephaly and 31% of the normo-cephalics. Fifteen newborns (7.8%) presented with microcephaly, of which 73% showed calcifications in head sonogram, and had severe anomalies on brain MRI. Auditory brainstem response test was performed on all newborns, 80% were within normal limits. Conclusion: Among the group of infants born to mothers with Zika positive test 4% had microcephaly. Of concern to us is the fact that 31% of normo cephalic infants had ocular manifestations and 7% of them had findings on head sonogram. While microcephaly is the severest form of Congenital Zika Syndrome, ocular manifestations might characterize the spectrum of disease. These findings reiterate the importance of detailed neonatal evaluations of exposed infants.
PubMed, Jul 14, 2012
Working outside the home is related to lower rates of breastfeeding initiation and duration. Enac... more Working outside the home is related to lower rates of breastfeeding initiation and duration. Enacted laws promote and support breastfeeding in working places. Objective: To determine factors associated to breastfeeding after returning to work. Methods: Anonymous questionnaires distributed among breastfeeding working mothers. Results: The study subjects were 100 mothers. Most of them (77%) worked for the government. Fifty-six percent continued breastfeeding after returning to work. In 33% of the workplaces there was an area designated for milk extraction.Thirty-six percent of employers allowed the 30 minute periods mandated by law for extraction. Factors associated to continuing breastfeeding were: working in the private setting, having a place designated for extraction, knowing that employers were mandated to have such a place, being allowed time for extraction, and knowing the laws protecting breastfeeding. Conclusions: There is need for more education to working mothers about their rights to continue breastfeeding after returning to work.
Pediatric Infectious Disease Journal, Oct 1, 2016
PubMed, Mar 1, 2010
Congenital heart defects (CHD) are among the most common birth defects. There is evidence suggest... more Congenital heart defects (CHD) are among the most common birth defects. There is evidence suggesting that polymorphisms in folate metabolism could alter susceptibility to CHD. The MTHFR 677TT genotype has been associated with the development of structural congenital heart malformations. The objective of this study was to identify common polymorphisms in the MTHFR gene in children with isolated CHD and their mothers. The DNA analysis for the C677T and A1298C mutations was performed. The study group included 27 mothers, 27 children with CHD, and 220 controls. The prevalence of the TT polymorphism was higher in mothers (22%) than in controls (10%). Compound heterozygosity for both polymorphisms was 3.7 times more common in children with CHD than in the newborn controls. Mothers of children with CHD were more likely to be compound heterozygotes. The higher prevalence of C677T polymorphisms in mothers of children with CHD and of compound heterozygosity for both polymorphisms suggests the possible role of folic acid in the prevention of CHD. Due to the relation of this enzyme to folate metabolism, current folate recommendations for women in childbearing age in Puerto Rico to reduce neural tube defects may need to be extended to the prevention of CHD.
Lesbian, gay, bisexual, transgender and queer (LGBTQ) individuals face health disparities linked ... more Lesbian, gay, bisexual, transgender and queer (LGBTQ) individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights which impact reproductive health. Previous pregnancy, induced abortion, and hormonal contraceptive use are common among women who report sex with women, regardless of self-identification as lesbian. LGBTQ have higher risk of smoking, use illicit drugs or have alcohol related problems. Methods: A faculty development training addressed methods and skills for teaching cultural competence and eliminate health disparities. Faculty facilitated a small group active learning activity, including a vignette and a reflective self-evaluation, for medical students to provide better health care services to LGBTQ women in childbearing age. A pre-test and post-test were administered. Analysis was performed using Statistix8.0. Results: A total of 115 second year medical students were included in the educational activity. Subjects included 101 students (87%) on the pretest and 104 students (90%) on the post-test. Subjects showed an overall improvement in knowledge (89% correct answers pre-test, 100% post-test).
InTech eBooks, Mar 16, 2012
Open Forum Infectious Diseases, Oct 1, 2020
improvement. Describing anchoring milestones and evaluating fellows in accordance to stage in fel... more improvement. Describing anchoring milestones and evaluating fellows in accordance to stage in fellowship (i.e. early first year fellow) can help standardize responses. Further exploration on improving the evaluation process is warranted. Disclosures.
Disaster Medicine and Public Health Preparedness, Aug 19, 2019
PubMed, Dec 1, 2018
Objective: After the outbreak in January 2016, researchers in Brazil reported the first cases of ... more Objective: After the outbreak in January 2016, researchers in Brazil reported the first cases of ophthalmic abnormalities in infants with microcephaly and presumed Zika virus (ZIKV) intrauterine infection. Screening for ocular lesions in all newborns exposed to ZIKV prenatally has been emphasized because of a chorioretinal macular scar found in a number normocephalic patient exposed to ZIKV. Methods: A retrospective review of the medical records of infants born to mothers found to be ZIKV-positive during their pregnancies (January 2016-July 2017) was performed. We included all newborns and infants admitted to the NICU and/or receiving ambulatory care at the high-risk clinics at the University Pediatric Hospital, San Juan, Puerto Rico. The creation of this database was approved by the IRB of the University of Puerto Rico, Medical Sciences Campus. Results: Records from 234 newborns born to Zika-positive mothers were identified. The ophthalmic evaluations of 95 patients were available. Sixty-three of them had normal findings (66%). Twelve of the 95 patients had microcephaly (12.6% of the cohort). Of the microcephalic group, half had normal ophthalmological findings. Of the normocephalic group (83/95), almost 31% had ocular findings: a small optic nerve in 3%, a double-ring sign in 10%, macular stippling in 8%, mottling in 4%, an oval optic nerve in 2%, a tilted nerve in 1%, and blunted foveal reflex in 1%. Conclusion: We report herein ZIKV associated ophthalmologic findings, similar to those published, in 34% of the infants with suspected/confirmed ZIKV fetal exposure. These data underline the importance of ocular examination in patients with suspected congenital Zika but without other findings on physical exam.
Pediatric and Developmental Pathology, Nov 1, 2004
We present the case of a 28-hold female infant born at 37 weeks of gestation with a rare congenit... more We present the case of a 28-hold female infant born at 37 weeks of gestation with a rare congenital malformation consisting of a pentad of findings: ectopia cordis, a midline supraumbilical wall defect, a defect of the lower sternum, absent pericardium, and an anterior diaphragmatic defect. This constellation of defects is known as the pentalogy of Cantrell. Additional autopsy findings included a bilateral cleft lip and palate, bilateral pulmonary hypoplasia, an atrial septal defect, and a patent ductus arteriosus. We present this case because of its rarity and discuss the pathologic findings.
Pediatric Critical Care Medicine, 2021
Boletín de la Asociación Médica de Puerto Rico
Thrombocytosis in infants exposed in-utero to illicit drugs has been associated to methadone expo... more Thrombocytosis in infants exposed in-utero to illicit drugs has been associated to methadone exposure. Although is reported to present in the first two weeks, few studies address its duration and timing of resolution. This study evaluated the presence, duration, and complications of thrombocytosis in newborns exposed to illicit drugs. A retrospective review of medical records of newborns with intrauterine drug exposure admitted to the San Juan City Hospital from 1999 to 2001 was performed. Thirty-one newborns were included. Eighty-seven percent (87%) presented abstinence syndrome. Of these, 96% presented thrombocytosis. All infants exposed to methadone presented thrombocytosis and 75% of those exposed to heroin and cocaine. Thrombocytosis presented at ten days of life with a median resolution at 26 days. In this group of newborns, thrombocytosis was associated to intrauterine exposure to methadone, heroin, and cocaine. Thrombocytosis presented at ten days of life and resolution was ...
Journal of Perinatology, 1999
Cancer during pregnancy is infrequent. It presents an ethical dilemma-remission may be obtained w... more Cancer during pregnancy is infrequent. It presents an ethical dilemma-remission may be obtained with chemotherapy, but it has potential harmful effects to the fetus. We report a case of a very low birth weight preterm female infant born to a 21-year-old mother diagnosed with leukemia and given chemotherapy up to 1 week before delivery. In the laboratory, initial findings included severe pancytopenia, and bone marrow aspiration demonstrated complete aplasia. She was given blood product transfusions, erythropoietin, and granulocyte colony stimulating factor. The hematologic derangement was resolved without documented infections. The second case is a preterm male infant whose 30-year-old mother was diagnosed with lymphoma and had received chemotherapy during the third trimester. The infant presented with moderate leukopenia. He had an uneventful course without documented infection. Exposure of the fetus to transplacental chemotherapy must be considered when evaluating therapy options and timing of delivery in hematologic malignancies diagnosed during pregnancy.
Boletín de la Asociación Médica de Puerto Rico, 2013
Cytomegalovirus is a common cause of congenital infection in developed countries, affecting appro... more Cytomegalovirus is a common cause of congenital infection in developed countries, affecting approximately 1% of live births. We report the case of a baby boy born with Cytomegalovirus pneumonitis dying from complications of persistent pulmonary hypertension of the newborn.
PubMed, 2013
There is controversy on the most advantageous management for infants with patent ductus arteriosu... more There is controversy on the most advantageous management for infants with patent ductus arteriosus (PDA) and whether to favor actively closing the PDA or to conservatively observe. We aimed to describe the outcome of infants with PDA based on three management strategies used for its closure (conservative, indomethacin, ligation). Methods: Retrospective medical record review of data from LBW infants (< 2000 with PDA admitted to NICU-SJCH. Results: The prevalence of PDA was 16%. Based on management strategies: 31% did not require treatment. 19% resolved with conservative measures, 38% resolved with omethacin treatment, and 12% required ligation. There was no difference in birth weight, gestational, clinical criteria, morbidities and mortality in patients managed with the strategies evaluated. Conclusion: Results are consistent with previous reports. Development of PDA management guidelines will help standardize the definition of PDA and management criteria instead of treating on a case-by-case basis.
PubMed, 2013
Healthcare associated influenza is a serious public health problem that contributes to patient mo... more Healthcare associated influenza is a serious public health problem that contributes to patient morbidity and mortality. Objective: To determine the seasonal influenza vaccination rate and reasons for its acceptance among healthcare workers in a hospital located at the metropolitan area of Puerto Rico. Methods: Self-administered, anonymous questionnaires were distributed to 120 volunteer healthcare workers and ancillary staff. Results: Immunization rates for the 2009 Influenza A (H1N1), seasonal vaccines 2009 and 2010 seasonal influenza vaccine were 50%, 53% and 65%, respectively. Determinant factors for acceptance of vaccination in 2010 included obtaining the 2009 vaccines, not knowing someone with adverse effect to the vaccine, and believing the vaccine should be mandatory for all healthcare workers. Conclusion: Influenza immunization rate is below the recommended rate to decrease healthcare associated influenza infection. Our results serve to confirm that education is needed to improve immunization rates among these healthcare workers and eliminate misconceptions about the vaccine.
PubMed, 2013
Influenza vaccination is the most effective method to prevent influenza virus infection and its p... more Influenza vaccination is the most effective method to prevent influenza virus infection and its potentially serious complications Objective: To determine fac tors associated to parents willingness to accept the influenza vaccine for their children. Methods: An anonymous questionnaire was administered to 297 volunteer parents/caregivers during 2011. Results: Only 40% of the parents planne to have their children vaccinated agains influenza. Most subjects had medical insurance (52% government, 44% private, 4% no insurance). Factors associated to parents willingness to accept the vac cine were having the vaccine previously. thinking that the vaccine was safer this year. not knowing someone who had an influenza vaccine side effect and having a family member who had influenza. Conclusion: The 40% planned vaccinatio rate lies below the 80% Healthy Peopl 2020 goal and seems to be unassociated to access to healthcare services. Establishing campaigns that reassure parents of vaccine safety could attain a higher vaccination rate.
PubMed, 2013
In 2004, the American Speech and Language Association (ASHA) established the primary roles and re... more In 2004, the American Speech and Language Association (ASHA) established the primary roles and responsibilities of the speech and language pathologists (SLP) in the Neonatal Intensive Care Unit (NICU) breaking down the skills and knowledge needed to become a member of the neonatal team. It establishes as main parameters the evaluation and intervention in communication, feeding and swallowing: parents and caregivers counseling and education: as well as the collaboration and education of the neonatal team. In the NICU, the SLP works in the preparation to initiate the nutritive sucking process and describes maturation levels for nutritive sucking with bottle and breastfeeding The SLP establishes an intervention plan for the development of safe feeding and swallowing skills as well as for the training of parents and caregivers during the process. Research should be promoted to support these interventions and establish the standards for the field.
PubMed, Jul 14, 2012
Rotavirus is the most common viral etiology of acute gastroenteritis in children. Oral rotavirus ... more Rotavirus is the most common viral etiology of acute gastroenteritis in children. Oral rotavirus vaccine administration to infants was incorporated in 2007. The objective of this study is to determine the frequency of acute rotavirus gastroenteritis (ARGE) after the initiation of the rotavirus immunization schedule. Methodology: The study included children younger than 5 years of age admitted to San Jorge Children's Hospital from 2005-2008 with ARGE. Results: There were 7,686 cases of acute gastroenteritis during the study period with 15% caused by Rotavirus. The peak season occurred from January through June. Rotavirus accounted for 22% of the acute gastroenteritis cases in the years pre-vaccination (2005-2006) and only 8.5 % in the post-vaccination years (2007-2008) (p < 0.01) with a 68% reduction in ARGE hospitalizations after vaccination. Conclusions: Our study supports the significant decline in ARGE after routine administration rotavirus vaccine in Puerto Rico.
PubMed, 2013
Studies have identified fathers' attitude as the strongest indicator of whether her partner will ... more Studies have identified fathers' attitude as the strongest indicator of whether her partner will breastfeed. Objective: To determine the attitudes and knowledge of fathers toward breastfeeding. Methods: The study included 84 volunteer fathers who answered a survey. Results: Mean age of participants was 27 years. Most fathers (88%) would like their partners to breastfeed. Most men (56%) reported that it is acceptable for a woman to breastfeed in public. Negative attitudes included feeling jealous about breastfeeding (10%), thinking that breastfeeding is bad for breasts (17%), breastfeeding makes breasts look ugly (26%), and breastfeeding separates the baby from the father (7%). A few misconceptions about breastfeeding were identified. Conclusions: Most fathers have positive attitudes towards breastfeeding. We should emphasize the importance of exclusive breastfeeding and clarify misconceptions that may cause early discontinuation of breastfeeding. Programs directed toward educating fathers will help them serve as sources of support for their partners.
PubMed, Dec 1, 2018
Objective: Zika virus (ZIKV) infection was identified in Puerto Rico on December 2015, and the ou... more Objective: Zika virus (ZIKV) infection was identified in Puerto Rico on December 2015, and the outbreak encouraged us to characterize clinical manifestations and laboratory findings of intrauterine exposed infants. Methods: Retrospective medical record review of infants born to mothers with confirmed ZIKV infection during pregnancy was performed from January 2016-June 2017. We included patients admitted to UPH Neonatal Intensive Care Unit or referred for follow-up at UPH High Risk Clinics. The database was approved by the University of Puerto Rico, Medical Sciences Campus, IRB. Results: 191 infants born to ZIKV positive mothers during pregnancy were identified. Normal head sonogram was found in 93% of the normo cephalic infants. Ocular findings were reported in 50% of the patients with microcephaly and 31% of the normo-cephalics. Fifteen newborns (7.8%) presented with microcephaly, of which 73% showed calcifications in head sonogram, and had severe anomalies on brain MRI. Auditory brainstem response test was performed on all newborns, 80% were within normal limits. Conclusion: Among the group of infants born to mothers with Zika positive test 4% had microcephaly. Of concern to us is the fact that 31% of normo cephalic infants had ocular manifestations and 7% of them had findings on head sonogram. While microcephaly is the severest form of Congenital Zika Syndrome, ocular manifestations might characterize the spectrum of disease. These findings reiterate the importance of detailed neonatal evaluations of exposed infants.
PubMed, Jul 14, 2012
Working outside the home is related to lower rates of breastfeeding initiation and duration. Enac... more Working outside the home is related to lower rates of breastfeeding initiation and duration. Enacted laws promote and support breastfeeding in working places. Objective: To determine factors associated to breastfeeding after returning to work. Methods: Anonymous questionnaires distributed among breastfeeding working mothers. Results: The study subjects were 100 mothers. Most of them (77%) worked for the government. Fifty-six percent continued breastfeeding after returning to work. In 33% of the workplaces there was an area designated for milk extraction.Thirty-six percent of employers allowed the 30 minute periods mandated by law for extraction. Factors associated to continuing breastfeeding were: working in the private setting, having a place designated for extraction, knowing that employers were mandated to have such a place, being allowed time for extraction, and knowing the laws protecting breastfeeding. Conclusions: There is need for more education to working mothers about their rights to continue breastfeeding after returning to work.
Pediatric Infectious Disease Journal, Oct 1, 2016
PubMed, Mar 1, 2010
Congenital heart defects (CHD) are among the most common birth defects. There is evidence suggest... more Congenital heart defects (CHD) are among the most common birth defects. There is evidence suggesting that polymorphisms in folate metabolism could alter susceptibility to CHD. The MTHFR 677TT genotype has been associated with the development of structural congenital heart malformations. The objective of this study was to identify common polymorphisms in the MTHFR gene in children with isolated CHD and their mothers. The DNA analysis for the C677T and A1298C mutations was performed. The study group included 27 mothers, 27 children with CHD, and 220 controls. The prevalence of the TT polymorphism was higher in mothers (22%) than in controls (10%). Compound heterozygosity for both polymorphisms was 3.7 times more common in children with CHD than in the newborn controls. Mothers of children with CHD were more likely to be compound heterozygotes. The higher prevalence of C677T polymorphisms in mothers of children with CHD and of compound heterozygosity for both polymorphisms suggests the possible role of folic acid in the prevention of CHD. Due to the relation of this enzyme to folate metabolism, current folate recommendations for women in childbearing age in Puerto Rico to reduce neural tube defects may need to be extended to the prevention of CHD.
Lesbian, gay, bisexual, transgender and queer (LGBTQ) individuals face health disparities linked ... more Lesbian, gay, bisexual, transgender and queer (LGBTQ) individuals face health disparities linked to societal stigma, discrimination, and denial of their civil and human rights which impact reproductive health. Previous pregnancy, induced abortion, and hormonal contraceptive use are common among women who report sex with women, regardless of self-identification as lesbian. LGBTQ have higher risk of smoking, use illicit drugs or have alcohol related problems. Methods: A faculty development training addressed methods and skills for teaching cultural competence and eliminate health disparities. Faculty facilitated a small group active learning activity, including a vignette and a reflective self-evaluation, for medical students to provide better health care services to LGBTQ women in childbearing age. A pre-test and post-test were administered. Analysis was performed using Statistix8.0. Results: A total of 115 second year medical students were included in the educational activity. Subjects included 101 students (87%) on the pretest and 104 students (90%) on the post-test. Subjects showed an overall improvement in knowledge (89% correct answers pre-test, 100% post-test).
InTech eBooks, Mar 16, 2012
Open Forum Infectious Diseases, Oct 1, 2020
improvement. Describing anchoring milestones and evaluating fellows in accordance to stage in fel... more improvement. Describing anchoring milestones and evaluating fellows in accordance to stage in fellowship (i.e. early first year fellow) can help standardize responses. Further exploration on improving the evaluation process is warranted. Disclosures.
Disaster Medicine and Public Health Preparedness, Aug 19, 2019
PubMed, Dec 1, 2018
Objective: After the outbreak in January 2016, researchers in Brazil reported the first cases of ... more Objective: After the outbreak in January 2016, researchers in Brazil reported the first cases of ophthalmic abnormalities in infants with microcephaly and presumed Zika virus (ZIKV) intrauterine infection. Screening for ocular lesions in all newborns exposed to ZIKV prenatally has been emphasized because of a chorioretinal macular scar found in a number normocephalic patient exposed to ZIKV. Methods: A retrospective review of the medical records of infants born to mothers found to be ZIKV-positive during their pregnancies (January 2016-July 2017) was performed. We included all newborns and infants admitted to the NICU and/or receiving ambulatory care at the high-risk clinics at the University Pediatric Hospital, San Juan, Puerto Rico. The creation of this database was approved by the IRB of the University of Puerto Rico, Medical Sciences Campus. Results: Records from 234 newborns born to Zika-positive mothers were identified. The ophthalmic evaluations of 95 patients were available. Sixty-three of them had normal findings (66%). Twelve of the 95 patients had microcephaly (12.6% of the cohort). Of the microcephalic group, half had normal ophthalmological findings. Of the normocephalic group (83/95), almost 31% had ocular findings: a small optic nerve in 3%, a double-ring sign in 10%, macular stippling in 8%, mottling in 4%, an oval optic nerve in 2%, a tilted nerve in 1%, and blunted foveal reflex in 1%. Conclusion: We report herein ZIKV associated ophthalmologic findings, similar to those published, in 34% of the infants with suspected/confirmed ZIKV fetal exposure. These data underline the importance of ocular examination in patients with suspected congenital Zika but without other findings on physical exam.
Pediatric and Developmental Pathology, Nov 1, 2004
We present the case of a 28-hold female infant born at 37 weeks of gestation with a rare congenit... more We present the case of a 28-hold female infant born at 37 weeks of gestation with a rare congenital malformation consisting of a pentad of findings: ectopia cordis, a midline supraumbilical wall defect, a defect of the lower sternum, absent pericardium, and an anterior diaphragmatic defect. This constellation of defects is known as the pentalogy of Cantrell. Additional autopsy findings included a bilateral cleft lip and palate, bilateral pulmonary hypoplasia, an atrial septal defect, and a patent ductus arteriosus. We present this case because of its rarity and discuss the pathologic findings.
Pediatric Critical Care Medicine, 2021
Boletín de la Asociación Médica de Puerto Rico
Thrombocytosis in infants exposed in-utero to illicit drugs has been associated to methadone expo... more Thrombocytosis in infants exposed in-utero to illicit drugs has been associated to methadone exposure. Although is reported to present in the first two weeks, few studies address its duration and timing of resolution. This study evaluated the presence, duration, and complications of thrombocytosis in newborns exposed to illicit drugs. A retrospective review of medical records of newborns with intrauterine drug exposure admitted to the San Juan City Hospital from 1999 to 2001 was performed. Thirty-one newborns were included. Eighty-seven percent (87%) presented abstinence syndrome. Of these, 96% presented thrombocytosis. All infants exposed to methadone presented thrombocytosis and 75% of those exposed to heroin and cocaine. Thrombocytosis presented at ten days of life with a median resolution at 26 days. In this group of newborns, thrombocytosis was associated to intrauterine exposure to methadone, heroin, and cocaine. Thrombocytosis presented at ten days of life and resolution was ...
Journal of Perinatology, 1999
Cancer during pregnancy is infrequent. It presents an ethical dilemma-remission may be obtained w... more Cancer during pregnancy is infrequent. It presents an ethical dilemma-remission may be obtained with chemotherapy, but it has potential harmful effects to the fetus. We report a case of a very low birth weight preterm female infant born to a 21-year-old mother diagnosed with leukemia and given chemotherapy up to 1 week before delivery. In the laboratory, initial findings included severe pancytopenia, and bone marrow aspiration demonstrated complete aplasia. She was given blood product transfusions, erythropoietin, and granulocyte colony stimulating factor. The hematologic derangement was resolved without documented infections. The second case is a preterm male infant whose 30-year-old mother was diagnosed with lymphoma and had received chemotherapy during the third trimester. The infant presented with moderate leukopenia. He had an uneventful course without documented infection. Exposure of the fetus to transplacental chemotherapy must be considered when evaluating therapy options and timing of delivery in hematologic malignancies diagnosed during pregnancy.
Boletín de la Asociación Médica de Puerto Rico, 2013
Cytomegalovirus is a common cause of congenital infection in developed countries, affecting appro... more Cytomegalovirus is a common cause of congenital infection in developed countries, affecting approximately 1% of live births. We report the case of a baby boy born with Cytomegalovirus pneumonitis dying from complications of persistent pulmonary hypertension of the newborn.