P R Health Sci J
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The world has encountered a new and serious epidemic which has disproportionately affected fetuses and infants. What makes the Zika virus (ZIKV) epidemic such a threat in our times, is that a whole generation can be affected by birth defects caused by a seemingly innocuous maternal infection, which in most cases go unnoticed and undiagnosed. Spreading to over 80 countries and affecting millions, it is associated with severe birth defects known as congenital Zika syndrome (CZS), which include fetal brain development abnormalities (microcephaly and brain calcifications), retinal abnormalities, and contractures and hypertonia of the extremities. ⋯ If the ZIKV can infect, multiply in, and persist in diverse placental cells, then movement across the placenta, the fetal brain, and the maternal peripheral blood is possible. There is a sense of urgency, and we need safe and effective vaccines and treatments, particularly for pregnant women. If we do not expand testing and develop methods for early diagnosis and treatment, thousands of infants will be exposed to a neurotropic virus that causes severe birth defects and that could also affect the lives of those who form the next generation.
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Dengue represents an increasingly important public health challenge in Puerto Rico, with recent epidemics in 2007, 2010, and 2012-2013. Although recent advances in dengue vaccine development offer hope for primary prevention, the role of health professionals in the diagnosis and management of dengue patients is paramount. ⋯ An understanding of dengue epidemiology and surveillance in Puerto Rico provides context for clinicians in epidemic and non-epidemic periods. This review aims to improve health professionals' ability to diagnose dengue, and as highlight the relevance of recent advances in dengue prevention and management in Puerto Rico.
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Renal cell carcinoma is the most common cancer of the kidney and is among the tumors that are the most resistant to systemic therapy. Until recently, long term survival of this disease when it was not confined to the kidney was dismal, with the use of drugs such as interleukin-2 resulting in a 5-year survival rate of less than 10% for patients with advanced disease. Nearly 30% of patients present with metastatic disease, and recurrence develops in approximately 40% of patients with localized tumors. ⋯ Small molecule tyrosine kinase inhibitors are the prototype of cancer therapy in this century, causing fewer toxic effects in the normal cells and with targeted inhibition of malignant cell proliferation. These therapies have emerged from the understanding of the molecular genetics and biology of this tumor. Further elucidation of the mechanisms of action of these drugs and those in development will lead to more effective therapies and increase the understanding of the best ways to combine them.
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Genital human papillomavirus (HPV) infection is one of the most commonly diagnosed sexually transmitted infections world-wide. Over the last two decades, research has established a strong causal link between specific types of HPV infection and cancer, particularly cervical, anal, vulvar/vaginal, penile, and oropharyngeal cancer. Limited epidemiological studies of anogenital HPV infection have been conducted in Hispanic populations (including Puerto Rico), and population-based incidence and prevalence estimates of HPV infection among Hispanics are limited. ⋯ This review article summarizes existing research on HPV infection and HPV-related morbidities in men, with a particular emphasis on Hispanic men in the United States and Puerto Rico. Three major areas are discussed: (1) genital warts, (2) HPV and related cancers and (3) biobehavioral and psychosocial factors related to HPV infection and vaccination. Specific recommendations for advancing HPV research and knowledge among Hispanic populations also are suggested.
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Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the central and/or peripheral nervous systems, including infection, trauma, metabolic abnormalities, and nerve compression, and is typically accompanied by hyperalgesia and allodynia. Neuropathic pain can be mild to excruciating, debilitating, difficult to manage, cause depression, decrease the quality of life, require extremity amputations, and has a variety of clinical symptoms. It effects up to 5% of the population, 70% of patients with advanced cancer and inflammatory pathologies, and 95% of patients with spinal cord injuries. ⋯ Alternative treatments to pharmacology include peripheral or neuraxial nerve blockade, and implanted cortical or spinal cord stimulators. However, the great need remains for development of new and more effective approaches to reducing neuropathic pain. This review examines various approaches currently used for treatment of neuropathic pain and potential new and more effective approaches.