Boletín de la Asociación Médica de Puerto Rico
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Case Reports
Uncorrected tetralogy of Fallot with agenesis of the left pulmonary artery in a 70-year-old elderly female.
Tetralogy of Fallot is the most common cyanotic congenital heart disease in children. It is usually detected in early infancy due to symptoms related to cyanosis and right to left shunting of blood through a large ventricular septal defect. ⋯ Some rare reports of prolonged survival in patients with uncorrected ToF have been described in the medical literature with some patients living until late adulthood. Here we describe the rare presentation of an elderly female with uncorrected ToF and agenesis of the left pulmonary artery.
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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. ⋯ 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.
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Case Reports
Acute abdominal symptoms as the first presentation of a patient with mirror-image dextrocardia with situs inverus.
This is the case of a 63 years old female that was admitted with abdominal pain mainly localized in the left lower quadrant, with diffuse radiation to the rest of the abdomen. It persisted for two days and worsened on the day of admission. It was associated with two episodes of vomiting and fever. ⋯ The incidence of dextrocardia with situs inversus is 1:5,000 to 1:10,000. A review of the American medical literature from 1965 to the present revealed only 18 acute presentations of situs inversus with the following distribution: appendix (4 cases), trauma (4 cases), cardiovascular (3 cases), gastrointestinal (3 cases), gallbladder (3 cases), spleen (1 case). The case presented is a typical "after-the-facts-findings" were the initial evaluation overlooked a typical presentation, just side-reversed.
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To determine if a structured exercise program promotes improved performance on activities of daily living (ADL) and pain perception in patients with chronic low back pain (CLBP). ⋯ A well guided exercise program can decrease pain intensity perception and disability in patients with CLBP.
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Case Reports
Complex regional pain syndrome in pediatric sports: a case series of three young athletes.
Outpatient Sports Medicine Clinic. ⋯ CRPS is a challenging disease that may affect young active and athletic patients. In this population, early clinical suspicion and aggressive treatment may lead to excellent clinical results and the avoidance of invasive procedures or long-term disability. Laboratory and imaging studies should be used to discard other conditions with clinical presentations similar to CRPS.