Boletín de la Asociación Médica de Puerto Rico
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Historical Article
History of otolaryngology in Puerto Rico: 1898-1989 (Part 1).
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Comparative Study
Attitudes toward euthanasia, assisted suicide and termination of life-sustaining treatment of Puerto Rican medical students, medical residents, and faculty.
To elicit the opinion of Puerto Rican medical students, residents and internal medicine faculty as to the appropriateness of euthanasia and physician-assisted suicide and end-of-life management. ⋯ The acceptance of euthanasia was inversely proportional to the clinical experience of the respondents: 40 per cent among students but only 20 per cent by the faculty. Withholding and withdrawing of life-sustaining treatment was most acceptable to the faculty (88 per cent) but it was also favored by most of the students and residents (68 and 67 per cent respectively). Eighty per cent of the faculty, 79 per cent of the residents, but only 50 per cent of the students considered that prescribing full doses of drugs to alleviate pain if they knew it would hasten death, was ethical. The medical profession should take notice of evolving concepts in end-of-life management.
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To determine the prevalence of hypomagnesemia in diabetic children during diabetic ketoacidosis and following restitution of acid-base balance. ⋯ In this study the prevalence of hypomagnesemia was documented to be higher than the average described elsewhere for pediatric, adult, and coronary intensive care units. As hypomagnesemia is an indication of Magnesium depletion, we speculate that the transient hypomagnesemia detected in our study group is an expression of a state of Magnesium depletion that is masked by correction of acidosis and the Magnesium shifts associated with it. Consequently serum Magnesium values ought to be considered most reliable during and not after correction of diabetic ketoacidosis. Since Magnesium was not supplemented to any of our patients, the normalization of their serum values must be the result of: a. decreased glycosuria-related urinary losses b. cessation of acidosis-related urinary losses c. Magnesium shifts from intra to extracellular space The high prevalence of hypomagnesemia and the significant lower average serum Magnesium levels in children with diabetic ketoacidosis reveals the magnitude of the problem and the potential for Magnesium depletion that occurs in diabetic children.
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Case Reports
Acute spinal cord and head injury: case report and discussion of cardiac, respiratory and endocrine abnormalities.
We report a male patient who after a fall suffered high cervical spinal cord and head (cerebral) injuries. These injuries led to spinal shock, marked sinus bradycardia and asystolic cardiac and respiratory arrests, recalcitrant central traumatic diabetes insipidus, and death within approximately seven weeks. Temporary transvenous cardiac pacing proved useful in the management of this patient.