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Article ; Online: The Prevalence of Severely Increased Albuminuria in the Type 2 Diabetes Population with Chronic Kidney Disease of Low Socioeconomic Status in San Juan: A Population in Need of Improved Accessibility to Disease-Modifying Therapy.

Irizarry-Villafañe, Gabriel I / González-Bóssolo, Alex

2023 Volume 42, Issue 2, Page(s) 121–126

Abstract: Objective: The aim of this study was to determine the prevalence of severely increased albuminuria and the percentage of patients with the indication for canagliflozin in the type 2 diabetes population with chronic kidney disease (CKD) and low ... ...

Abstract	Objective: The aim of this study was to determine the prevalence of severely increased albuminuria and the percentage of patients with the indication for canagliflozin in the type 2 diabetes population with chronic kidney disease (CKD) and low socioeconomic status in the San Juan City Hospital. Methods: This cross-sectional study examined the electronic records of 129 Hispanic type 2 diabetes patients. CKD in this population was defined according to the most recent nephrology and endocrinology guidelines. Albuminuria was diagnosed with two positive urine albumin/creatinine ratio results within 3-6 months. Data was obtained from July 2017 to January 2020 and analyzed utilizing descriptive statistics and correlations. Results: The prevalence of moderately and severely increased albuminuria in patients with type 2 diabetes and CKD were 51.2% and 18.6% respectively. The number of patients with type 2 diabetes who filled the FDA indication for canagliflozin were 16.3%. The prevalence of hypertension, coronary artery disease (CAD) and heart failure (HF) was 61.2%, 15.5% and 10.1% respectively. Between albuminuria severity and decreased renal function, a tendency was observed although not statistically significant (r = -0.14, 95% CI: -0.31, 0.03; P = 0.109). While evaluating association between albuminuria groups and CAD, there was a noticeable tendency close to reaching statistical significance (P = 0.060). Conclusion: There is a scarcity of studies regarding the prevalence of severely increased albuminuria in type 2 diabetics with CKD and this study contributes to the literature. On analysis of associations, statistical significance not reached likely due to small sample size.
MeSH term(s)	Humans ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/drug therapy ; Diabetes Mellitus, Type 2/epidemiology ; Canagliflozin ; Albuminuria/epidemiology ; Albuminuria/diagnosis ; Prevalence ; Cross-Sectional Studies ; Low Socioeconomic Status ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/diagnosis
Chemical Substances	Canagliflozin (0SAC974Z85)
Language	English
Publishing date	2023-02-15
Publishing country	Puerto Rico
Document type	Journal Article
ZDB-ID	639137-0
ISSN	2373-6011 ; 0738-0658
ISSN (online)	2373-6011
ISSN	0738-0658
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Transient Hypophosphatemia: A Dangerous Event in Multiple Myeloma.

Jeffs, Paula / Mangual-García, Michelle / González-Bóssolo, Alex / Rivera-Santana, Nadyeschka

Case reports in endocrinology

2021 Volume 2021, Page(s) 3609346

Abstract: Patients with malignancies frequently experience multiple electrolyte disturbances. In multiple myeloma, hypercalcemia and hyperphosphatemia are one of the most common metabolic disturbances observed as part of pathogenesis of the disease. However, in ... ...

Abstract	Patients with malignancies frequently experience multiple electrolyte disturbances. In multiple myeloma, hypercalcemia and hyperphosphatemia are one of the most common metabolic disturbances observed as part of pathogenesis of the disease. However, in rare occasions and during the course of the disease, many patients can develop hypophosphatemia due to multiple factors that affects the phosphate absorption and excretion. We hereby present a 56 y/o woman recently diagnosed with multiple myeloma who developed severe hypophosphatemia during medical treatment. We should note that the following manuscript was presented at the 2019 American Association of Clinical Endocrinologists (AACE) 28th Annual Scientific and Clinical Congress.
Language	English
Publishing date	2021-01-16
Publishing country	United States
Document type	Case Reports
ZDB-ID	2627633-1
ISSN	2090-651X ; 2090-6501
ISSN (online)	2090-651X
ISSN	2090-6501
DOI	10.1155/2021/3609346
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Article ; Online: Quality Improvement in Thyroid Fine-Needle Aspiration Biopsy accuracy at San Juan City Hospital Endocrinology Clinics.

Rivera-Santana, Nadyeschka / Torres-Torres, Marina / Cintrón-Colón, Héctor / García-Maldonado, Miosotis / Mangual-García, Michelle / González-Bóssolo, Alex

Puerto Rico health sciences journal

2022 Volume 41, Issue 1, Page(s) 33–36

Abstract: Objective: This study aimed to determine if there was a reduction in the amount of non-diagnostic cytopathology results of thyroid fine-needle aspiration (FNA) biopsies performed at San Juan City Hospital (SJCH) endocrinology clinics since the inclusion ...

Abstract	Objective: This study aimed to determine if there was a reduction in the amount of non-diagnostic cytopathology results of thyroid fine-needle aspiration (FNA) biopsies performed at San Juan City Hospital (SJCH) endocrinology clinics since the inclusion of a cytopathologist at the clinics. Methods: This research consisted of a retrospective analysis of thyroid nodule FNA biopsy results performed at SJCH endocrinology clinics. The biopsies analyzed were performed during academic years from July 2017-June 2018 and July 2018-June 2019, a period that reflects one academic year prior and a year after the inclusion of a cytopathologist to the clinics. The patients were classified into "pre group" and "post -group." Descriptive analysis was conducted, taking into consideration variables including sex, age, period, location, size of the nodule, and cytology results. A Chi-square test and Confidence Interval were used to assess the association and estimates between predictors and outcomes. Results: From the 145 thyroid nodules biopsied, a total of 121 nodules (83.4%) resulted in diagnostic cytologic results, while 24 nodules (16.6%) were non-diagnostic. From the "pre group," 57 nodules (78.1%) had a diagnosis, while the other 16 (21.9%) were reported as non-diagnostic. From the "post group", 64 nodules (88.9%) had a diagnosis, while the other 8 (11.1%) resulted in non-diagnostic findings (p-value: = 0.08). Even though results were statistically non-significant, a clear trend towards a decrease in non-diagnostic samples was evident. Conclusion: In our study, there was a decrease in the number of non-diagnostic thyroid nodule FNA results after on-site adequacy determination guided by a cytopathologist.
MeSH term(s)	Biopsy, Fine-Needle/methods ; Hospitals, Urban ; Humans ; Quality Improvement ; Retrospective Studies ; Thyroid Neoplasms/pathology ; Thyroid Nodule/diagnosis ; Thyroid Nodule/pathology
Language	English
Publishing date	2022-04-29
Publishing country	Puerto Rico
Document type	Journal Article
ZDB-ID	639137-0
ISSN	2373-6011 ; 0738-0658
ISSN (online)	2373-6011
ISSN	0738-0658
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Characterization of HbA1c Levels in a Subsample of Hispanic Adults Living in the San Juan Metropolitan Area.

Allende-Vigo, Myriam Z / González-Bóssolo, Alex N / Coste-Sibilia, Santiago / Suárez, Erick / Pérez, Cynthia M

Puerto Rico health sciences journal

2018 Volume 37, Issue 2, Page(s) 78–82

Abstract: Objective: To determine the mean levels of glycated hemoglobin (HbA1c) in a subsample of non-diabetic Hispanic Puerto Ricans living in the San Juan metropolitan area (SJMA) and to assess the sensitivity and specificity of HbA1c as a diagnostic test for ... ...

Abstract	Objective: To determine the mean levels of glycated hemoglobin (HbA1c) in a subsample of non-diabetic Hispanic Puerto Ricans living in the San Juan metropolitan area (SJMA) and to assess the sensitivity and specificity of HbA1c as a diagnostic test for prediabetes. Research design and methods: This was a secondary data analysis of the parent study, Burden of Diabetes and Hypertension in the Adult Population of the San Juan Metropolitan Area of Puerto Rico. Based on their HbA1c and fasting plasma glucose (FPG) values, 370 adults (147 males; 223 females) were classified as non-diabetics. An additional analysis of sensitivity, specificity, and predictive values for this subsample examined the association between FPG and HbA1c. Results: The mean HbA1c among the non-diabetic population was 5.38% (±0.23). Sensitivity, specificity, and the area under the receiving operating characteristic curve were 56.8%, 74.2%, and 84.3%, respectively, for the diagnosis of prediabetes, using HbA1c as the sole diagnostic test (P<0.001). Conclusion: This study demonstrated that HbA1c levels among the non-diabetic Hispanic population residing in the SJMA were very similar to those of non-Hispanic whites living in the US. Our results are consistent with those of other studies that have shown that the sensitivity of the HbA1c test is too low to be used in the diagnosis of prediabetes.
MeSH term(s)	Adolescent ; Adult ; Aged ; Blood Glucose/analysis ; Female ; Glycated Hemoglobin A/analysis ; Hispanic Americans/statistics & numerical data ; Humans ; Male ; Middle Aged ; Prediabetic State/diagnosis ; Prediabetic State/epidemiology ; Predictive Value of Tests ; Puerto Rico/epidemiology ; ROC Curve ; Sensitivity and Specificity ; Young Adult
Chemical Substances	Blood Glucose ; Glycated Hemoglobin A ; hemoglobin A1c protein, human
Language	English
Publishing date	2018-08-23
Publishing country	Puerto Rico
Document type	Journal Article
ZDB-ID	639137-0
ISSN	0738-0658
ISSN	0738-0658
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: A Rare Case of Uterine Leiomyosarcoma with Metastasis to the Thyroid Gland.

Irizarry-Villafañe, Gabriel / Rivera-Santana, Nadyeschka / Mangual-García, Michelle / González-Bóssolo, Alex / Trinidad-Hernández, Rafael / García-Maldonado, Miosotis / Carlo-Chévere, Víctor

Case reports in endocrinology

2020 Volume 2020, Page(s) 8889843

Abstract: Uterine leiomyosarcomas are aggressive tumors associated with a poor prognosis. These neoplasms have high metastatic potential, more frequently affecting the lungs, liver, and peritoneum. There are very few cases of metastasis to the thyroid described in ...

Abstract	Uterine leiomyosarcomas are aggressive tumors associated with a poor prognosis. These neoplasms have high metastatic potential, more frequently affecting the lungs, liver, and peritoneum. There are very few cases of metastasis to the thyroid described in the literature. We present the case of a 47-year-old female diagnosed with uterine leiomyosarcoma metastatic to the thyroid gland. In this case report, we want to emphasize the utility of ancillary studies to help differentiate a leiomyosarcoma from anaplastic thyroid carcinoma since cytologic evaluation alone can be challenging.
Language	English
Publishing date	2020-06-29
Publishing country	United States
Document type	Case Reports
ZDB-ID	2627633-1
ISSN	2090-651X ; 2090-6501
ISSN (online)	2090-651X
ISSN	2090-6501
DOI	10.1155/2020/8889843
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Article: Lingual thyroid gland: it's time for awareness.

Cruz-Dardíz, Nicolás / Rivera-Santana, Nadyeschka / Torres-Torres, Marina / Cintrón-Colón, Héctor / Lajud, Shayanne / Solá-Sánchez, Ernesto / Mangual-García, Michelle / González-Bóssolo, Alex

Endocrinology, diabetes & metabolism case reports

2020 Volume 2020

Abstract: Summary: Lingual thyroid (LT) gland is the most common type of ectopic thyroid tissue, but it is an extremely rare presentation. We present a case of a 41-year-old Hispanic female patient complaining of dysphonia and dysphagia. As part of the evaluation, ...

Abstract	Summary: Lingual thyroid (LT) gland is the most common type of ectopic thyroid tissue, but it is an extremely rare presentation. We present a case of a 41-year-old Hispanic female patient complaining of dysphonia and dysphagia. As part of the evaluation, fiber optic flexible indirect laryngoscopy (FIL) was performed which revealed a mass at the base of the tongue. The morphological examination was highly suspicious for ectopic thyroid tissue and the diagnosis was confirmed with neck ultrasound and thyroid scintigraphy. Although the patient presented subclinical hypothyroidism, levothyroxine therapy was initiated with a favorable response which included resolution of symptoms and mass size reduction. Our case portrays how thyroid hormone replacement therapy (THRT) may lead to a reduction in the size of the ectopic tissue and improvement of symptoms, thus avoiding the need for surgical intervention which could result in profound hypothyroidism severely affecting the patients' quality of life. Learning points: Benign LT and malignant LT are indistinguishable clinically and radiographically for which histopathology is recommended. THRT, radioactive iodine 131 (RAI) therapy, and surgical excision are potential management options for LT. THRT may lead to size reduction of the ectopic tissue and resolution of symptoms avoiding surgical intervention.
Language	English
Publishing date	2020-05-29
Publishing country	England
Document type	Journal Article
ZDB-ID	2785530-2
ISSN	2052-0573
ISSN	2052-0573
DOI	10.1530/EDM-20-0026
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Article: Cerebrovascular Accident due to Thyroid Storm: Should We Anticoagulate?

Gonzalez-Bossolo, Alex / Gonzalez-Rivera, Alexis / Coste-Sibilia, Santiago

Case reports in endocrinology

2016 Volume 2016, Page(s) 5218985

Abstract: Thyroid storm is a life-threatening condition that occurs secondary to an uncontrolled hyperthyroid state. Atrial fibrillation is a cardiovascular complication occurring in up to 15% of patients experiencing thyroid storm, and if left untreated this ... ...

Abstract	Thyroid storm is a life-threatening condition that occurs secondary to an uncontrolled hyperthyroid state. Atrial fibrillation is a cardiovascular complication occurring in up to 15% of patients experiencing thyroid storm, and if left untreated this condition could have up to a 25% mortality rate. Thyroid storm with stroke is a rare presentation. This case report details a left middle cerebral artery (MCA) stroke with global aphasia and thyroid storm in a 53-year-old Hispanic male patient. Although uncommon, this combination has been reported in multiple case series. Although it is well documented that dysfunctional thyroid levels promote a hypercoagulable state, available guidelines from multiple entities are unclear on whether anticoagulation therapy is appropriate in this situation.
Language	English
Publishing date	2016-08-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2627633-1
ISSN	2090-651X ; 2090-6501
ISSN (online)	2090-651X
ISSN	2090-6501
DOI	10.1155/2016/5218985
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Article: Prevalence of Vitamin D Insufficiency and Deficiency among Young Physicians at University District Hospital in San Juan, Puerto Rico.

Ramírez-Vick, Margarita / Hernández-Dávila, Leticia / Rodríguez-Rivera, Nixzaliz / López-Valentín, Mariel / Haddock, Lillian / Rodríguez-Martínez, Renil / González-Bossolo, Alex

Puerto Rico health sciences journal

2015 Volume 34, Issue 2, Page(s) 83–88

Abstract: Vitamin D has been attracting increased attention because of higher prevalences of vitamin D insufficiency and deficiency than expected in areas with sufficient sun exposure. Even though sunlight exposure and diet are the main determinants of vitamin D ... ...

Abstract	Vitamin D has been attracting increased attention because of higher prevalences of vitamin D insufficiency and deficiency than expected in areas with sufficient sun exposure. Even though sunlight exposure and diet are the main determinants of vitamin D status, other factors, such as age, race, the use (or not) of sunscreen, medications, and malabsorptive conditions, also affect vitamin D levels. Recent studies have found high prevalences of vitamin D deficiency and insufficiency in different populations. However, there are limited data regarding the prevalence of vitamin D deficiency and insufficiency in Puerto Rico. To shed more light on the subject, we evaluated a sample of 51 internal medicine residents and research fellows, aged from 25 to 39 years at the University District Hospital in San Juan, Puerto Rico, doing so by means of a questionnaire that explored basic socio demographic and lifestyle characteristics and collected anthropometric data; in addition, we obtained blood samples in order to determine 25-hydroxyvitamin D levels. The median 25-hydroxyvitamin D level was 21 ng/mL (range, 7-38 ng/mL). Forty-five participants (88.2%) had 25-hydroxyvitamin D concentrations of lower than 30 ng/mL. We found vitamin D deficiencies in 43.1% of the population and insufficiencies in 45.1%. Contributory factors to our findings include limited exposure to sunlight during periods of high sun intensity, increased body mass index, and a limited area of the body being exposed to sunlight. A relationship between reduced physical activity levels and hypovitaminosis D was also found. Both calcium intake and vitamin D intake, which were markedly below recommended daily allowances, were positively correlated with 25-hydroxy vitamin D levels, but with a weak association.
MeSH term(s)	Adult ; Female ; Hospitals, District ; Hospitals, University ; Humans ; Male ; Physicians ; Prevalence ; Puerto Rico ; Vitamin D Deficiency/epidemiology
Language	English
Publishing date	2015-06
Publishing country	Puerto Rico
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	639137-0
ISSN	0738-0658
ISSN	0738-0658
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Papillary Thyroid Carcinoma: Ectopic Malignancy versus Metastatic Disease.

Agosto-Vargas, Yanery's / Gutiérrez, Madeleine / Martínez, José Hernán / Mangual-Garcia, Michelle / Palermo, Coromoto / Vélez-Maymi, Sharon / Hernández-Vázquez, Luis / Miranda-Rodríguez, Samayra / González-Bossolo, Alex / Solá-Sánchez, Ernesto / Hernández-Negrón, Marianne

Case reports in endocrinology

2017 Volume 2017, Page(s) 9707031

Abstract: Papillary thyroid carcinoma frequently metastasizes to regional lymph nodes. However, cervical lymph node metastasis as a sole manifestation of occult papillary thyroid carcinoma is rarely observed. Ectopic thyroid is an uncommon condition defined as the ...

Abstract	Papillary thyroid carcinoma frequently metastasizes to regional lymph nodes. However, cervical lymph node metastasis as a sole manifestation of occult papillary thyroid carcinoma is rarely observed. Ectopic thyroid is an uncommon condition defined as the presence of thyroid tissue at a site other than pretracheal area. Approximately 1-3% of all ectopic thyroid tissue is located in the lateral neck. This entity may represent the only functional thyroid tissue in the body. Malignant transformation of ectopic thyroid is uncommon; but even rarer is the development of papillary carcinoma on it. We present a case of a 33-year-old man with an incidental lateral neck mass diagnosed after a motor vehicle accident. Total thyroidectomy and lymph node resection were completed without evidence of papillary thyroid carcinoma. Malignant transformation of heterotopic thyroid tissue was the final diagnosis. The possibility of an ectopic thyroid cancer should be considered in the differential diagnosis of a pathological mass in the neck. The uniqueness of this case strives in the rarity that the thyroid gland was free of malignancy, despite ectopic tissue being positive for thyroid carcinoma. Management strategies, including performance of total thyroidectomy, neck dissection, and treatment with radioiodine, should be based on individualized risk assessment.
Language	English
Publishing date	2017-06-18
Publishing country	United States
Document type	Case Reports
ZDB-ID	2627633-1
ISSN	2090-651X ; 2090-6501
ISSN (online)	2090-651X
ISSN	2090-6501
DOI	10.1155/2017/9707031
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Article: A Rare Localized Pituitary Stalk Germinoma Presenting in the Third Decade.

González Bóssolo, Alex / Mangual Garcia, Michelle / Davila, Kyrmarie / Brau, Ricardo / Sanchez Ortiz, Javier / Hernan Martinez, Jose

Case reports in endocrinology

2018 Volume 2018, Page(s) 1746917

Abstract: We report the case of a 34-year-old male Hispanic patient who presented with an 8-month history of polyuria and decreased libido. An evaluation revealed hypopituitarism, central diabetes insipidus, and a pituitary stalk lesion. No evidence of a neoplasm ... ...

Abstract	We report the case of a 34-year-old male Hispanic patient who presented with an 8-month history of polyuria and decreased libido. An evaluation revealed hypopituitarism, central diabetes insipidus, and a pituitary stalk lesion. No evidence of a neoplasm or an inflammatory/infiltrative disease was found. We treated the patient conservatively with steroid therapy. However, as a result of disease progression, transsphenoidal surgery was performed to obtain tissue for a pathological analysis. Histopathology revealed an intrasellar germinoma, confirmed by immunochemistry. Due to localized disease, radiotherapy was initiated and clinical improvement was noted. This case emphasizes the importance of histopathological analysis; for many physicians, the presentation of a pituitary stalk lesion in a young male adult creates a clinical conundrum. Although the most common etiologies are an inflammatory or secondary neoplasm, the possible presence of an intrasellar neoplasm should not be ruled out. In many cases, imaging characteristics and tumor markers may aid in the diagnosis without the need of an aggressive diagnostic approach. However, in this case, histopathological analysis was the only way to make a correct diagnosis and provide adequate treatment for the patient.
Language	English
Publishing date	2018-12-17
Publishing country	United States
Document type	Case Reports
ZDB-ID	2627633-1
ISSN	2090-651X ; 2090-6501
ISSN (online)	2090-651X
ISSN	2090-6501
DOI	10.1155/2018/1746917
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