University of Puerto Rico, Medical Sciences Campus

About: University of Puerto Rico, Medical Sciences Campus is a education organization based out in San Juan, Puerto Rico, United States. It is known for research contribution in the topics: Population & Medicine. The organization has 1711 authors who have published 1496 publications receiving 27756 citations.

Implementation and Evaluation of Guillain-Barré Syndrome Surveillance in Puerto Rico during the 2016 Zika Virus Epidemic.

Abstract: Objective: Guillain-Barre syndrome (GBS) is an uncommon autoimmune disorder that follows infection or vaccination, and increased incidence has been reported during Zika virus (ZIKV) transmission. During the 2016 ZIKV epidemic, the Puerto Rico Department of Health (PRDH) implemented the Enhanced GBS Surveillance System (EGBSSS). Here, we describe EGBSSS implementation and evaluate completeness, validity, and timeliness. Methods: GBS cases were identified using passive surveillance and discharge diagnostic code for GBS. Completeness was evaluated by capture-recapture methods. Sensitivity and positive predictive value (PPV) for confirmed GBS cases were calculated for both case identification methods. Median time to completion of key time steps were compared by quarter (Q1–4) and hospital size. Results: A total of 122 confirmed GBS cases with onset of neurologic illness in 2016 were identified. Capture-recapture methodology estimated that four confirmed GBS cases were missed by both identification methods. Identification of cases by diagnostic code had a higher sensitivity than passive surveillance (89% vs. 80%), but a lower PPV (60% vs. 72%). There was a significant decrease from Q1 to Q3 in median time from hospital admission to case reporting (11 days vs. 2 days, p = 0.032) and from Q2 to Q3 in median time from specimen receipt to arbovirus laboratory test reporting (35 days vs. 26 days, p = 0.004). Conclusion: EGBSSS provided complete, valid, and increasingly timely surveillance data, which guided public health action and supported healthcare providers during the ZIKV epidemic. This evaluation provides programmatic lessons for GBS surveillance and emergency response surveillance.

CYP2C9*61, a rare missense variant identified in a Puerto Rican patient with low warfarin dose requirements.

Abstract: Warfarin continues to be the mainstay therapy for preventing thrombus formation. Although pharmacogenetic algorithms have shown higher predictability of the optimal warfarin dose and lower occurrence of bleeding episodes, they often do not include ethno-specific genetic variants relevant to non-Europeans. This case report describes a rare missense variant at exon 9 of CYP2C9 (rs202201137; c.1370A>G transition; p.Asn457Ser) found in a Puerto Rican patient with low warfarin dose requirements (3 mg/day). The haplotype characterized by two amino acid changes, Asn457Ser and Arg144Cys (rs1799853; c.430C>T), has been designated CYP2C9*61 by the Pharmacogene Variation Consortium. According to prediction scores assessed with the Combined Annotation Dependent Depletion tool, CYP2C9*61 (p.Asn457Ser) was classified as nondeleterious, therefore its impact on CYP2C9 enzymatic activity cannot be postulated.

Assessing the willingness of community pharmacists to test-treat-immunize during the COVID-19 pandemic in Puerto Rico

Abstract: Objective The objective of this study was to assess community pharmacists' willingness to test, treat and immunize for COVID-19 in Puerto Rico. Methods In this cross-sectional study, a 37-item survey was distributed via email and social media in May 2020 through REDCap online software. All licensed community pharmacists in Puerto Rico (N = 1200) were invited to complete the survey. Retired community pharmacists were excluded. Analysis of frequencies and chi-square tests were performed to evaluate the willingness to test, treat and immunize for COVID-19 and their associations with sociodemographic variables. Key findings The survey response rate was 26% (314/1200). Subjects' mean age was 42 (13), 86.1% were female, and most practiced in independent community or specialty pharmacy (62%). Among respondents, 44% reported willingness to test. Top concerns for testing were family (73.4%) and self (66.8%) exposure and ability to manage the workflow (53.3%). Most participants indicated their willingness to treat (88.4%) and to administer the COVID-19 vaccine (76.1%). Study participants who worked in retail pharmacies were more willing to test for COVID-19 (50.9%, P = 0.34) and to immunize (91.2%, P < 0.001). Pharmacists <= 39 years (90.3%), those who graduate in 2000 or later (88.3%), and those with a Pharm.D. degree or higher (88.6%), were more willing to immunize (P < 0.001). Conclusions Most community pharmacists were more willing to treat and immunize, than to perform COVID-19 testing. This underscores the need for training and workflow changes to facilitate the acquisition of this new role. Local pharmacists' associations should advocate for a safe and manageable work environment. These efforts are vital to empower pharmacists to adopt new roles during a public health emergency.

Long-Term Outcomes in Puerto Ricans with Rheumatoid Arthritis (RA) Receiving Early Treatment with Disease-Modifying Anti-Rheumatic Drugs using the American College of Rheumatology Definition of Early RA.

Abstract: Background Early treatment of rheumatoid arthritis (RA) results in better long-term outcomes. However, the optimal therapeutic window has not been clearly established. Objective To determine the clinical outcome of Puerto Ricans with RA receiving early treatment with conventional and/or biologic disease-modifying anti-rheumatic drugs (DMARDs) based on the American College of Rheumatology (ACR) definition of early RA. Methods A cross-sectional study was performed in a cohort of Puerto Ricans with RA. Demographic features, clinical manifestations, disease activity, functional status, and pharmacotherapy were determined. Early treatment was defined as the initiation of DMARDs (conventional and/or biologic) in less than 6 months from the onset of symptoms attributable to RA. Patients who received early (< 6months) and late (≥6 months) treatments were compared using bivariate and multivariate analyses. Results The cohort comprised 387 RA patients. The mean age at study visit was 56.0 years. The mean disease duration was 14.9 years and 337 (87.0%) patients were women. One hundred and twenty one (31.3%) patients received early treatment. In the multivariate analysis adjusted for age and sex, early treatment was associated with better functional status, lower probability of joint deformities, intra-articular injections and joint replacement surgeries, and lower scores in the physician's assessments of global health, functional impairment and physical damage of patients. Conclusion Using the ACR definition of early RA, this group of patients treated with DMARDs within 6 months of disease had better long-term outcomes with less physical damage and functional impairment.

Measurement Invariance of the Adolescent Quality of Life-Mental Health Scale (AQOL-MHS) across Gender, Age and Treatment Context.

Abstract: The Adolescent Quality of Life-Mental Health Scale (AQOL-MHS) was designed to measure quality of life in clinical samples of Latino adolescents aged 12–18 years, but has also been used in community samples. The original measure included three factors: Emotional Regulation (ER), Self-Concept (SC) and Social Context (SoC). The goals of this study are to replicate the factor structure using confirmatory factor analysis (CFA), shorten the instrument and test the degree of measurement invariance across gender, age, and type of sample. Participants for the analyses (N = 354) came from two populations in the San Juan Metropolitan Area: (1) adolescents from randomly selected households, using a multi-stage probability sampling design (n = 295), and (2) adolescents receiving treatment at mental health clinics (n = 59). We first carried out a conceptual item analysis for item reduction purposes and then assessed dimensional, configural, metric and scalar invariance for each factor using the Mplus software system. The original 3-factor structure was replicated with comparable model fit in each treatment context. Metric invariance was attained for all three scales across groups. Either full or partial scalar invariance was also observed with DIF in a total of 6 items. Invariance testing supports the use of the abridged 21 item version of the AQOL-MHS to compare diverse individuals with little bias using observed scores, but for refined estimates the ideal scoring will be from a latent variable model.