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Biomedical subjects

J Ramírez-Rivera

Publications and source records attributed to J Ramírez-Rivera.

11 recordsLinked to original sources
PubMed1992

Infected bullae: a recognizable entity.

Infected bullae are seldom diagnosed. They are frequently confused with pulmonary abscess. We present a case with a characteristic evolution. Bullae were identified previous to the infection. The illness developed gradually with scanty sputum, pleuritic pain and finally a febrile illness. Fever abated 48 hours after initiating two weeks of therapy with intravenous Clindamycin and Amikacin. As it is commonly seen, radiographic resolution was slow but it was complete in 8 weeks. Recognition of infected bullae is important to avoid inappropriate diagnostic or therapeutic interventions.

Amikacin↗
PubMed1992

The strange beginnings of diagnostic and therapeutic bronchoalveolar lavage.

Bronchoalveolar lavage was originally developed as a method for the diagnosis and treatment of pulmonary alveolar proteinosis. The first technique devised, "segmental flooding", was cumbersome but effective. Samples obtained provided information about the alveolar cellular response and alveolar protein dynamics. Most importantly, "segmental flooding" showed that living lung parenchyma was not damaged by repeated irrigation with isotonic saline as some had proposed. The therapeutic success and limitations of this first method of bronchoalveolar irrigation provided the intellectual stimulus which lead to the development of therapeutic whole-lung lavage. Serial whole-lung lavages, coupled with well-timed lung biopsies, offered the first opportunity to demonstrate in man the alveolar cellular response in a disease process, the dynamics of the production and dissipation of pulmonary lipids and the functioning of the surfactant system. The new and complex studies of the lungs' cellular reactions and metabolism may be better understood in the historical context of the first observations made possible by the development of bronchoalveolar lavage.

Biopsy↗
PubMed1991

[How one achieves the practice of medicine in Puerto Rico--1990].

We have gathered information of particular interest to students of medicine and recent graduates about the law that regulates the practice of medicine in Puerto Rico. We have also reviewed the current information about how to obtain the examination of the Puerto Rico Board of Medical Examiners, and the requirements to obtain the provisional licenses for postgraduate training (internship and residency), for the compulsory year of government service and for the regular license. We have compared 1980, 1986, and 1990 as to the number of internships in the 28 programs available. At present it is quite likely that physicians with marginal credentials will have a difficult time finding a place in fully accredited programs. Since July 1980 the unauthorized practice of practice medicine is considered a serious offense. The increasing number of malpractice suits and the recent changes in the law have made the practice of medicine in Puerto Rico increasingly risky.

Accreditation↗
PubMed1991

Career choice and professional trajectory of Fifth Pathway students.

We have studied the professional trajectory of 177 participants of the Fifth Pathway Program of the University of Puerto Rico School of Medicine between July 1973 and June 1987. Eighty six per cent of the students were Puerto Rican. Sixty seven per cent had studied in the Universidad Autónoma de Guadalajara. Ninety seven per cen of the respondents specialized and 39 per cent subspecialized; sixty nine per cent selected primary care specialties. Eighty three per cent of the fifth pathway participants are licensed to practice medicine in Puerto Rico and 37% are licensed to practice in one or more of 21 states of the Nation. Twenty one per cent held academic positions and 11.4 per cent were department chairpersons or chiefs of sections. The professional trajectory of Fifth Pathway participants is similar to that of medical graduates of the University of Puerto Rico School of Medicine.

Career Choice↗
PubMed1990

Initial evaluation of the asthmatic patient.

Bronchial asthma is a common disease that is not yet completely understood. We specify the basic evaluation that asthmatic patients should undergo and discuss some aspects of pathophysiology. Guidelines to select patients for further evaluation are suggested.

Asthma↗
PubMed1990

Spontaneous pneumomediastinum.

A 15-year-old pregnant girl developed severe substernal pain during the final effort to give birth to her first child. Shortly thereafter a growing crepitant suprasternal swelling was noted. Pneumomediastinum and subcutaneous emphysema was clearly demonstrated by a chest film showing mediastinal air dissecting towards the neck and supradiaphragmatically. The causes and physiopathology of spontaneous pneumomediastinum are reviewed. The therapeutic use of oxygen is discussed.

Adolescent↗
PubMedDate not supplied

Prevalence of hepatitis C virus infection at three hemodialysis units in the western region of Puerto Rico.

OBJECTIVE: In the United States hepatitis C virus infection (HCV) affects approximately 20 percent of hemodialysis patients but its prevalence in Puerto Rico has not been established. We have sought to determine the prevalence of HCV infection in a homogeneous sample of patients on hemodialysis in the western region of Puerto Rico and to identify its risks factors. METHODS: All patients in the hemodialysis units of Aguadilla, Mayagüez and San Germán, during December 1997 to March 1998, completed a written questionnaire in which they were asked about transfusions, multiple sexual partners, i.v. drugs use, tattooing, occupation, imprisonment, organ transplantation and years on hemodialysis. Serum samples were analysed for HCV antibodies by an enzyme-linked immunoadsorbent assay (ELISA). Sera with positive results for HCV were subjected to a confirmatory test by the polymerase chain reaction (PCR). RESULTS: Thirteen of the 376 (3%) subjects had a positive ELISA (one patient died prior the confirmatory test with PCR). Six out of the twelve patients had a positive PCR. Two had been transfused. Three were illicit i.v. drug users and one had received a renal transplant. The liver biopsies in all patients showed chronic hepatitis and in two there was cirrhosis. CONCLUSIONS: Our prevalence was two percent. As reported elsewhere blood transfusion, organ transplantation and illicit i.v. drug abuse were the major risk factors for HCV infection in our patients. Nosocomial factors were irrelevant in the results.

Hemodialysis Units, Hospital↗
PubMedDate not supplied

Chyliform (pseudochylous) pleural effusion.

A chyliform (pseudochylous) effusion is an uncommon disease entity which develops after an exudative effusion is in situ for a long time. It is commonly initiated by a tuberculous pleurisy and it is important to exclude the presence of active tuberculosis. We present a case with the characteristic features. Chylothorax was excluded by demonstrating in the pleural fluid a relatively low level of triglycerides with a cholesterol/triglyceride level of less than one and abundant cholesterol crystals.

Aged↗
PubMedDate not supplied

Euthanasia and relief of suffering: attitudes of medical students.

Medical students, from the first, second and third year classes of the University of Puerto Rico School of Medicine, answered a questionnaire which included testing knowledge and attitudes about euthanasia and the relief of suffering. More than 60% of each class participated, a total of two hundred. Ninety three percent of the students knew the definition of euthanasia but 50 percent could not tell the difference between active and passive euthanasia. Students in the first year were better oriented than their counterparts in the third year (58 percent versus 44 percent). Seventy percent of the 100 students who could differentiate between active and passive euthanasia thought that active euthanasia should not be considered murder, but 69 percent were cognizant it was so considered in Puerto Rico. Eighty-three percent of first year students but only 61 percent of third year students thought that physicians should alleviate suffering of terminally ill patients. Medical schools should provide a serious, unprejudiced and complete discussion of euthanasia and other life and death issues in their curricula. A humane orientation of medical students should be given as much emphasis as other aspects of professional training.

Attitude to Death↗