Ponce Health Sciences University Scientific Journal
The Ponce Health Sciences University Scientific Journal (PHSU-SJ) is a multidisciplinary, online research journal based in Ponce, Puerto Rico. It is an open-access journal that aims to eliminate barriers and increase accessibility throughout the medical and academic community.
Authors retain copyright of their articles. All works are published under the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited.
Long-Term Outcomes of Laparoscopic Repair of Complex Ureteral Injuries: A Single-Center Experience
Ureteral injuries, often iatrogenic during gynecological or endo-urological procedures, can severely impact quality of life and renal function, potentially causing sepsis or renal failure. The distal ureter is most vulnerable, and resulting strictures require management based on their cause, location, and length. Short distal strictures are treated with ureteroureterostomy or ureteroneocystostomy, while longer ones may require a Boari flap with psoas hitch or ileal ureter replacement. This study evaluates postoperative renal function and symptoms recurrence in patients treated with these techniques for complex ureteral injuries. A retrospective review of 14 patients treated between 2007 and 2017 was conducted. Nine underwent laparoscopic Boari flap and five ileal loop interposition, with at least five years of follow-up. Intraoperative and postoperative outcomes were analyzed. Indications included endoscopic surgery strictures (3), radiation-induced strictures (2), and non-urological iatrogenic injuries (7). Two patients had primary ureteral cancer. Mean operative time was 158 minutes, and hospital stay averaged 2.1 days. Preoperative creatinine was 1.3 mg/dL, increasing to 1.4 mg/dL and 1.5 mg/dL at one and three months postoperatively. CT cystogram showed vesicoureteral reflux in all Boari flap patients. At five years, all patients were symptom-free with unobstructed ureters. Complications included one ileus and one anastomotic stricture. Boari flap and ileal ureter replacement are effective alternatives for complex ureteral strictures, preserving renal function. Larger studies are needed to validate these findings against standard open techniques.
Copyright (c) 2026 Dr. Cintrón-Cartagena, Amanda Torres-Arroyo, Emil Varas-Rodríguez, Gustavo Colón, Rodrigo Ortiz, Dr. Ruiz-Deyá (Author) https://creativecommons.org/licenses/by/4.0
Bridging the Gap: Patient Perspectives on Access to Dermatologic Care in a Student-Run Free Clinic in Puerto Rico
Underserved communities face persistent barriers to dermatologic care, yet little is known about their perceptions of barriers to access, knowledge gaps, and motivations to seek care. We conducted a two-day student-run free clinic (SRFC) in Puerto Rico, providing free dermatologic services and administering a Spanish-language questionnaire to assess patient demographics, sun protection behaviors, barriers to care, and perceived impact of the clinic. Of 350 patients, 267 (76.3%) completed the survey. The cohort was predominantly female (91.4%) and Hispanic (97.8%), with 72.7% reporting a dermatologic condition, but over half (51.3%) having never seen a dermatologist. Common barriers included difficulty obtaining appointments (42.5%) and lack of self-perceived need (38.8%). Only 6.4% felt very informed about skin cancer, and 26.6% reported never practicing sun protection. Twelve biopsies revealed both benign and malignant diagnoses, including mammary Paget’s and melanoma in situ. Patients who self-identified as informed about skin cancer reported more frequent use of sun protection and greater engagement in sun-avoidant behaviors. Most participants cited the clinic’s no-cost services as a major factor improving healthcare access. Our findings highlight the dual burden of high dermatologic disease prevalence and limited access to specialty care in Puerto Rico, exacerbated by a physician shortage and socioeconomic barriers. SRFCs can help reduce dermatologic workforce burnout by supplementing clinical capacity, allowing dermatologists to focus on complex cases while medical students assist with triage, education, and basic care delivery. Incorporating medical students in dermatologic outreach may amplify impact by expanding services capacity and promoting awareness and education in underserved populations.
Copyright (c) 2026 María Vázquez-Machado, Lara Diez-Asad, Chavely Calderón Casellas, Eric Graulau, Dr. Santiago-Soltero, Andrés Ortiz-Franco, Sofía Díaz, Deborah Colón-Lara, Dr. Blanco (Author) https://creativecommons.org/licenses/by/4.0
Artificial Intelligence–Enhanced 3D Reconstruction of Parapneumonic Effusion in a Pediatric Patient: A Novel Visualization Approach
Copyright (c) 2026 Gabriel Román-Ríos, Arnaldo Santos-López, Dr. De Jesús Rojas (Author) https://creativecommons.org/licenses/by/4.0
A Diagnostic Trifecta Case Report: Struma Ovarii with Pseudo-Meigs Syndrome and Subsequent Ovarian Remnant Syndrome
Struma ovarii is a rare ovarian teratoma composed predominantly of thyroid tissue, representing less than 1% of all ovarian tumors. The clinical presentation of struma ovarii can vary widely, from an asymptomatic palpable abdominal mass, hyperthyroidism (elevated free T4 and/or T3; low TSH), and, in rare cases, pseudo-Meigs syndrome. Diagnosis is often based on postoperative histopathological confirmation of thyroid tissue. We present a case of a 44-year-old Hispanic female with an incidental finding of an adnexal mass, pleural effusion, and ascitic fluid, but with normal tumor markers, cancer antigen 125 (CA-125), and carcinoembryonic antigen (CEA). Postoperative pathological examination confirmed struma ovarii, with pseudo-Meigs syndrome. Unexpectedly, the patient developed ovarian remnant syndrome (ORS). This case contributes to the limited literature describing struma ovarii associated with pseudo-Meigs syndrome and normal tumor markers, highlighting the diverse clinical spectrum of this tumor. It also underscores the need for a high index of suspicion for struma ovarii in atypical cases, regardless of tumor marker levels. The development of ORS further emphasizes the importance of long-term follow-up after definitive surgical management.
Copyright (c) 2026 Lennis Colón-Rivera, Angelymar Vélez-Santana, Samatha M. De Filipps, Hostos Fernández-Caamaño (Author) https://creativecommons.org/licenses/by/4.0
The risk of receiving multiple spinal x-rays during treatment of scoliosis: analysis based on 2025 standards.
Scoliosis is a deformity of the spine in all three planes. The most common types emerge in otherwise healthy children during adolescent growth. Spine imaging is required for diagnosis and surveillance to determine whether the deformity is progressing. Epidemiologic studies that looked at the long-term effects of receiving multiple spine x-rays in childhood showed a concerning increase in adult malignancy. However, many of those studies were based on exposure from x-ray equipment 50 or more years ago. This paper examines the current risk of receiving necessary spinal x-rays using modern equipment and up to date exposure recommendations from the leading medical organizations. Using example treatment scenarios, children are receiving x-ray exposure that is well below the safe limits. Results show that cumulative radiation doses in adolescents with typical AIS range from 2.04 – 12.21 mSv, a safe cumulative dosage, while the most extreme cases would reach up to 28.45 mSv, a slight increase in risk.
Copyright (c) 2026 Kevin Orellana, Patrick Knott (Author) https://creativecommons.org/licenses/by/4.0
Heterozygous Frameshift Genetic Variant in TNFRSF13C Gene Associated with Specific Antibody Deficiency Memory Phenotype
Specific antibody deficiency (SAD) is a primary immunodeficiency disease (PID) in which patients present with recurrent sinopulmonary bacterial infections and decreased antibody responses to polysaccharide antigens following vaccination. SAD memory phenotype refers to an initial serologic and clinical response to the 23-valent polysaccharide vaccine followed by the loss of protective antibodies within six months. Various PID can present with diminished specific antibody responses, and it is known that patients with SAD can develop Common Variable Immunodeficiency (CVID) later in life. We present the case of a 7-year-old male with significant history of recurrent sinopulmonary infections since the age of two, who was diagnosed with SAD memory phenotype. A PID genetic panel revealed a TNFRSF13C genetic variant of unknown significance in Exon 3: c.534_543delinsAATAGCAGG (p.Ala179Ilefs*46). This variant results in a frameshift in the B cell-activating factor receptor (BAFFR) encoding gene. BAFFR is essential for the survival and maturation of transitional B cells into mature follicular and marginal zone B cells and has an important role in the development of T-independent antibody responses. BAFFR deficiency is known to be a genetic etiology for CVID and heterozygous missense polymorphisms have been implicated as risk factors for the development of CVID. The patient’s phenotype, which demonstrates inadequate T-independent antibody responses, correlates with the previously described phenotype of patients with TNFRSF13C variants. Here, we present a patient with SAD memory phenotype harboring a frameshift heterozygous variant in BAFFR. This case highlights the need to consider rare genetic causes in patients with PID.
Copyright (c) 2026 Mariana Acuña, Dr. De Jesús Rojas, Dr. Fernández Dávila (Author) https://creativecommons.org/licenses/by/4.0
Non-neoplastic cutaneous manifestations of HIV infection in patients from a community-based clinic in Puerto Rico
Abstract: Background: Although skin conditions are frequent in people living with HIV (PLWH), no prior studies have described them in Puerto Rico. This study assesses non-neoplastic cutaneous conditions in PLWH at a community clinic. Methods: We performed a cross-sectional analysis of 1,000 PLWH treated from January 2019 to December 2024. Sociodemographic, clinical, and dermatologic data were extracted from electronic records. Descriptive and bivariate analyses (Chi-square or Fisher’s exact) were conducted with p<0.05 considered significant. Results: Non-neoplastic skin conditions were identified in 19.1% of participants (241 diagnoses). The most common were herpes simplex virus (5.3%), dermatitis (2.8%), and warts (2.5%). Longer duration of HIV infection was significantly associated with skin conditions (p=0.004). No associations were found with sex, age, CD4 count, or viral load. Conclusion: Non-neoplastic dermatologic conditions remain prevalent among PLWH in Puerto Rico. These findings support incorporating routine dermatologic assessment into HIV care.
Copyright (c) 2026 Itzamar Pastrana-Echevarría, Alicia Báez-Cruz, Mileidy Hernández-Nieves, Alejandro Pinilla-Baquero, Oscar Lugo-Capera, Diana Fernández-Santos, Angel Mayor-Becerra, Alexandra Conde-Toro (Author) https://creativecommons.org/licenses/by/4.0
AI-Based Digital Uroflowmetry and Symptom Tracking: Insights from MenHealth
Lower urinary tract symptoms (LUTS) and benign prostatic hyperplasia (BPH) are highly prevalent in men. Smartphone, sound based uroflowmetry enables accurate, non-invasive assessment of urinary flow. Artificial intelligence, such as MenHealth, is integrated in digital uroflowmetry to improve management of LUTS and BPH.
Copyright (c) 2025 Richard G. Soler-Banchs, Millie A López-Inostroza, Dr. Kenneth Cintrón Cartagena, Dr. Gilberto Ruiz-Deyá, Dr. William Román Torreguitart, Dr. Claudio Bernaschina-Bobadilla, Dr. Giovanni González-Albo, Dr. Adrián Santana-Parachini, Dr. Javier Castillo-Ortiz (Author) https://creativecommons.org/licenses/by/4.0
Air Compartment Analysis of nNO and FeNO in RSPH4A-Associated Primary Ciliary Dyskinesia (PCD) vs Asthma
PCD is a rare genetic disease that impairs mucociliary clearance and is known to have abnormally low nasal nitric oxide (nNO) levels. In Puerto Rico, a founder variant in RSPH4A [c.921+3_921+6delAAGT] raises the question of whether affected patients show similarly reduced nNO, in contrast to asthma, which usually has normal to elevated nNO and high FeNO from type 2 inflammation. Comparative assessment of NO provides a unique opportunity to differentiate pathophysiological signatures between genetic and inflammatory airway diseases.
Copyright (c) 2025 Natalia M. Ortiz Pérez, Gabriel Rosario Ortiz, Frances M. Quiñones Del Toro, Dr. Wilfredo De Jesús Rojas (Author) https://creativecommons.org/licenses/by/4.0
Beyond Diet: Biological and Clinical Determinants of Kidney Stones
Nephrolithiasis is a growing global health concern, affecting mostly males. Although the prevalence is rising across minority populations, less than 1% of published papers include Hispanics. Among US mainland Hispanics, Puerto Ricans have the second highest prevalence of kidney stones but there are no island-based datasets and Puerto Ricans are often excluded from mainland studies.
Copyright (c) 2025 Jeitzel Torres-Rodríguez, Dr. Jessiane Salazar, Gabriela Ramírez, Fabián Ramírez-Rivera, Jarline Encarnación-Medina, Némesis Torres-Rivera, Alondra Quintana-Girón, Millie López-Inostroza, Dr. Carmen Ortiz-Sáncez, Dr. Kenneth Cintrón-Cartagena, Docelyn Rivera-López, Dr. Gilberto Ruiz-Deyá (Author) https://creativecommons.org/licenses/by/4.0
Evaluation of Standardized POCUS-Guided regional anesthesia in the Emergency Management of Musculoskeletal Pathologies: A Retrospective Review in Southern Puerto Rico
POCUS-guided regional anesthesia (nerve block) has become a more common procedure for musculoskeletal pathologies.
Copyright (c) 2025 Zachary Morales, Claudia C. Galíndez Díaz, Dr. Miguel Agrait, Dr. Edgardo Martínez Berdecia, Dr. Alexander Torres Rey, Dr. Roberto Rosado (Author) https://creativecommons.org/licenses/by/4.0
Pure Intracranial Schwannoma of Cranial Nerve X: Case Presentation and Literature Review
Schwannomas most commonly arise from the vestibulocochlear nerve, whereas purely intracranial vagus nerve schwannomas confined to the cerebellomedullary cistern are exceptionally rare, with only a small number of cases reported. Because of its rarity, these lesions often mimic more common cerebellopontine angle tumors and lack standardized guidelines for diagnosis and surgical management.
Copyright (c) 2025 Diego López-Soto, Dr. Jeffrey Breton, Dr. Samir Sur (Author) https://creativecommons.org/licenses/by/4.0
Lactic Acidosis Induced by Prolonged Linezolid Therapy: A Case Report
Cellulitis can show up in many ways, including changes in the color and temperature of the skin, as well as swelling, but these finding are not always reliable in older patients. Because aging and chronic illnesses weaken the immune response, many elderly individuals do not develop fever or an elevated white blood cell count, which can make the condition harder to identify. Linezolid is often chosen for difficult-to-treat Gram-positive infections, but when it is used for extended periods, it may interfere with cellular energy production and eventually cause lactic acidosis.
Copyright (c) 2025 Yanizbeth Yambó-Chévere, Dr. Rafael Bermúdez-Rivera (Author) https://creativecommons.org/licenses/by/4.0
Characterizing Violence and Discrimination Patterns Across Gender and Sexual Identities in Puerto Rico's LGBTQ+ Individuals
LGBTQ+ individuals in Puerto Rico experience disproportionate violence and discrimination, driven by structural vulnerabilities such as limited legal protections, austerity, and sociocultural stigma. Understanding these patterns is essential for advancing equitable health interventions.
Copyright (c) 2025 Jan M. Ruiz Núñez, Vanessa Pagán Rodríguez, Dr. Caleb Esteban (Author) https://creativecommons.org/licenses/by/4.0
Optimization of Patient Allocation in the Emergency Department: An Evaluation of Bed Admissions and Fast-Track Implementation
ED boarding and overcrowding are associated with adverse patient outcomes and place significant strain on physicians, healthcare staff, and hospital systems. At Centro Médico Episcopal San Lucas (CMESL), all patients arriving by EMS are assigned to high-acuity beds regardless of complaint severity, a practice that may exacerbate overcrowding and delay care for truly high-acuity patients. Identifying the factors contributing to ED overcrowding is essential for guiding quality improvement initiatives aimed at optimizing patient flow, resource allocation, and overall emergency care delivery.
Copyright (c) 2025 Ana Carolina Rivera-Martínez, Juan Mercado-Muñoz, Dr. Kevin Laureano, Dr. Eddie Romero, Leslie N. Padilla Vásquez, Dr. Carlos García Gubern (Author) https://creativecommons.org/licenses/by/4.0
Exploring the Inflammatory and Intracellular Role of Exogenous Plasminogen Activator Inhibitor 1 (PAI-1) in Endothelial Cells
Preeclampsia - New onset hypertension in pregnant people - Maternal endothelial cell dysfunction - High maternal and fetal mortality - PAI-1 is a biomarker Does PAI-1 induce inflammation through eNOS mediated NFKB activation?
Copyright (c) 2025 Arianna C. López Pérez, Gjina Ahmetaj, Dr. McAdow (Author) https://creativecommons.org/licenses/by/4.0
The Role of Anxiety and Clinical Factors in Predicting Clinically Significant Perceived Stress Among Young Women with Breast Cancer
Women with breast cancer often experience significant psychological distress, including anxiety and perceived stress, which can affect their overall well-being and treatment outcomes.
Copyright (c) 2025 Sanel Figueroa-Vargas, Dayaneira Rivera-Alers, Yamilet Torres-Cruz, Manuel Rivera-Vélez, Dr. Zindie Rodríguez-Castro, Cinthia Cortes-Castro, Dr. Cristina Peña-Vargas, Dr. Guillermo Armaiz-Pena, Dr. Eida M. Castro-Figueroa (Author) https://creativecommons.org/licenses/by/4.0
Racial Differences in Inpatient Mortality Rates by Goals of Care Documentation Status
Previous studies suggest goals of care (GOC) conversations may be associated with racial differences in patient outcomes. This study examines whether goals of care documentation are associated with racial disparities in inpatient mortality among seriously ill hospitalized adults.
Copyright (c) 2025 Andrea N. Navarro-Zambrana, Dr. Gina Piscitello (Author) https://creativecommons.org/licenses/by/4.0
Consecutive Case Series of Surgically Treated Adolescent Idiopathic Scoliosis (AIS) Patients in Puerto Rico
AIS is the most common pediatric spine deformity requiring surgery. Puerto Rican AIS data are limited. Study describes baseline characteristics and surgical outcomes.
Copyright (c) 2025 Alexandra Vela Williams, Dr. Jael Camacho Matos, Dr. Humberto Guzmán (Author) https://creativecommons.org/licenses/by/4.0
Age-Specific Trends and the Impact of Hypertension in SEDSS Participants from 2012 through 2025
Arboviral infections, such as dengue, Zika, and chikungunya, remain a major public health concern in Puerto Rico. Despite this, the evolving burden of chronic conditions within these infections has not been well characterized. This study aims to address this gap by examining how hypertension prevalence has changed across epidemic periods and infection types by using SEDSS data ranging from 2012 to 2025.
Copyright (c) 2025 Cristina A. Román Soto, Angélica De Jesús Mieres, Víctor Burgos Ruiz, Verónica Frasqueri-Quintana, Rachel M. Rodríguez-Santiago, Vanessa Rivera-Amill Dr. Rivera-Amill (Author) https://creativecommons.org/licenses/by/4.0
Circulating T Follicular Helper Cells in Dengue Virus immunity: Protection and Pathogenesis
Dengue virus (DENV) infects ~400 million people annually and causes illness ranging from mild fever to life-threatening disease. Effective immunity requires coordinated B-cell and T-cell activation. Circulating T follicular helper cells (cTFH) support B-cell maturation, plasmablast expansion, and production of neutralizing antibodies (nAbs). However, heightened cTFH activity may also contribute to antibody-dependent enhancement (ADE) and severe dengue.
Copyright (c) 2025 José A. Collazo-Llera, Paola N. Flores-Pérez, Fabiola A. Rodríguez-Alvarado, Dr. Rivera-Amill (Author) https://creativecommons.org/licenses/by/4.0
Evaluating Sexual Disparities in the Management of Acute Coronary Syndrome in the Southern region of Puerto Rico
Cardiovascular disease (CVD) is the leading cause of death in women in the US and Puerto Rico (PR). Acute coronary syndrome (ACS), including unstable angina (UA), ST=elevation myocardial infarction (STEMI), and non-ST elevation myocardial infarction (NSTEMI), represents a major contributor. National and international data consistently show sex-based disparities: women with ACS frequently experience diagnostic delay, underrepresentation in clinical trials, and higher prevalence of non-traditional risk factors (e.g. Psychiatric disorders, autoimmune disease). However, data specific to the Puerto Rican population remains limited, highlighting the need to determine if similar disparities exist locally.
Copyright (c) 2025 Yadira López-Rivera, Dr. Andrea San Antonio Sierra (Author) https://creativecommons.org/licenses/by/4.0
Burnout, Well-being, and Distress Among Orthopaedic Surgeons in Puerto Rico
Physician burnout is a global concern, yet its prevalence among Puerto Rico’s surgeons remains underexplored. This study assesses burnout among orthopaedic surgeons working within the island’s strained healthcare system, marked by economic disparities, privatization, and physician exodus. A cross-sectional survey was conducted among 67 orthopaedic surgeons (over 60% of the island's workforce) and 27 romantic partners. The survey included the Maslach Burnout Inventory-Human Services Survey, General Health Questionnaire 12, and the Revised Dyadic Adjustment Scale. Burnout was identified in 28.4% of surgeons, with 58.2% reporting high emotional exhaustion and 37.3% high depersonalization. No respondents exhibited low personal accomplishment. The most frequently cited stressor was Puerto Rico's healthcare system, particularly health insurance restrictions (66.7%). Additionally, 25.4% of surgeons showed signs of mental health concerns, and 22.0% experienced relationship distress. While emotional exhaustion and depersonalization present as alarmingly high, resilience in personal accomplishment was notable. Interventions are needed to address systemic stressors while leveraging cultural factors that protect against burnout.
Copyright (c) 2025 Gabriel González-Díaz, Emil Varas-Rodríguez, Joshua Vivas, Francis Cedeño, Gerardo E. Rodríguez-Matias, Jerry Cruz, Hans Hess, Oscar Duyos (Author) https://creativecommons.org/licenses/by/4.0
Generative AI as a Tool for Enhancing ESL Students’ Understanding
Wilfredo De Jesus-Rojas, MD Ponce Health Sciences University Scientific Journal August 14, 2024 Dear Editor-in-Chief, As former ESL (English as a Second Language) students who have pursued science, technology, engineering and mathematics (STEM) fields and current researchers and instructors, we intimately understand the challenges faced by students adapting not just to a new language, but to the complex context in which that language is used in academic settings. Our experiences have given us unique insights into the difficulties ESL students encounter in higher education, particularly in STEM disciplines. <span data-ccp-props="{"201341983":0,"335559685":270,"335559737":2466,"335559738":240,"335559739":60,"335559740":228,"335572071":0,"335572072":0,"335572073":0,"335572075":0,"335572076":0,"335572077":0,"335572079":0,"335572080":0,"335572081":0,"335572083":0,"335572084":0,"335572085":0,"335572087":0,"335572088":0,"335572089":0,"469789798":"nil","469789802":"nil","469789806":"nil","469789810":"nil","469789814":"nil"}"> Research aligns with our personal observations. ESL students often struggle with academic language proficiency, which can severely impact their ability to understand complex materials and engage in academic discourse [1]. These students are also more likely to face higher attrition rates [2], with studies indicating that they are more likely to experience academic probation or drop out compared to their native English-speaking peers [3]. ESL students often encounter significant obstacles in accessing and understanding academic resources that are primarily available in English, which can impede their ability to fully engage with the material.<span data-ccp-props="{"201341983":0,"335559685":270,"335559737":2466,"335559738":240,"335559739":60,"335559740":228,"335572071":0,"335572072":0,"335572073":0,"335572075":0,"335572076":0,"335572077":0,"335572079":0,"335572080":0,"335572081":0,"335572083":0,"335572084":0,"335572085":0,"335572087":0,"335572088":0,"335572089":0,"469789798":"nil","469789802":"nil","469789806":"nil","469789810":"nil","469789814":"nil"}"> To illustrate the challenges and potential solutions, we would like to share an experience from Nelson's academic journey that led us to appreciate the potential of generative AI in ESL students' education. During his graduate studies, Nelson was enrolled in a rigorous Real Analysis course. Despite his best efforts, he found himself struggling to grasp the material. In a meeting with his then mentor, Prof. Doug Moupasiri, Nelson confessed his difficulties. Prof. Moupasiri asked a simple yet profound question: “What other books on the subject have you read?'' When Nelson admitted that he had only been using the assigned textbook, Prof. Moupasiri encouraged him to explore other authors' works. This advice—to seek out different perspectives—was a turning point in Nelson's academic career. By finding an author whose style resonated with him, he was able to understand concepts that had previously eluded him. This experience made us realize that sometimes, the issue is not with the subject itself but with how it is presented.<span data-ccp-props="{"201341983":0,"335559685":270,"335559737":2466,"335559738":240,"335559739":60,"335559740":228,"335572071":0,"335572072":0,"335572073":0,"335572075":0,"335572076":0,"335572077":0,"335572079":0,"335572080":0,"335572081":0,"335572083":0,"335572084":0,"335572085":0,"335572087":0,"335572088":0,"335572089":0,"469789798":"nil","469789802":"nil","469789806":"nil","469789810":"nil","469789814":"nil"}"> This is where we see a tremendous opportunity for generative Al tools to support students, particularly ESL students, in their learning journey. ESL students often benefit from different learning approaches, and findings show that they have positive perceptions of AI-based learning tools, appreciating their personalized learning paths and time-saving advantages [4]. As evidenced in recent studies [5], AI technologies are already being successfully used in medical education to provide real-time feedback on quizzes, assist in anatomy learning, and support the recognition and diagnosis of medical images. Additionally, a study performed in a medical school in Puerto Rico showed that integrating a course aimed to bridge the gaps in AI knowledge among participants resulted in more positive perceptions of AI. However, it also revealed a lack of practical experience with AI applications, emphasizing the need for better integration of AI into educational programs [6].<span data-ccp-props="{"201341983":0,"335559685":270,"335559737":2466,"335559738":240,"335559739":60,"335559740":228,"335572071":0,"335572072":0,"335572073":0,"335572075":0,"335572076":0,"335572077":0,"335572079":0,"335572080":0,"335572081":0,"335572083":0,"335572084":0,"335572085":0,"335572087":0,"335572088":0,"335572089":0,"469789798":"nil","469789802":"nil","469789806":"nil","469789810":"nil","469789814":"nil"}"> Initiatives aimed specifically at Hispanic students are demonstrating the value of incorporating AI literacy into their education, helping them critically evaluate and effectively use AI technologies across different contexts [7]. By equipping students with essential AI competencies, these programs foster not only academic success but also readiness for AI-rich environments at home and in the workplace. We believe extending such support to ESL students can enhance equitable access to education by providing adaptive and personalized learning paths that cater to specific language needs. Just as different authors can present the same subject in varying ways, generative AI can offer students alternative explanations, analogies, and examples that align more closely with their individual learning styles. This ability to reshape content makes generative AI particularly powerful for students at institutions in Puerto Rico and elsewhere, allowing them to bridge gaps in understanding through tailored explanations in their native language or more accessible rephrasing, ultimately making challenging subjects more comprehensible.<span data-ccp-props="{"201341983":0,"335559685":270,"335559737":2466,"335559738":240,"335559739":60,"335559740":228,"335572071":0,"335572072":0,"335572073":0,"335572075":0,"335572076":0,"335572077":0,"335572079":0,"335572080":0,"335572081":0,"335572083":0,"335572084":0,"335572085":0,"335572087":0,"335572088":0,"335572089":0,"469789798":"nil","469789802":"nil","469789806":"nil","469789810":"nil","469789814":"nil"}"> Generative AI is not just a tool for information retrieval but a companion in the learning process, helping students navigate complex subjects with a personalized approach that traditional methods may not always provide. The greatest value of generative AI as a tutor lies in its ability to customize learning experiences, tailoring them to fit the context and background of each student. As we continue to integrate AI into the educational landscape, it is our hope that we can leverage these tools to not only enhance learning but also to empower students to overcome the challenges that come with language barriers and different learning styles. Just as Nelson's mentor's advice reshaped his educational path, we believe encouraging the correct use of generative AI can play a similar role for many students, directly impacting academic outcomes.<span data-ccp-props="{"201341983":0,"335559685":270,"335559737":2466,"335559738":240,"335559739":60,"335559740":228,"335572071":0,"335572072":0,"335572073":0,"335572075":0,"335572076":0,"335572077":0,"335572079":0,"335572080":0,"335572081":0,"335572083":0,"335572084":0,"335572085":0,"335572087":0,"335572088":0,"335572089":0,"469789798":"nil","469789802":"nil","469789806":"nil","469789810":"nil","469789814":"nil"}"> We urge educators and administrators to consider the potential of generative AI as a powerful tool for addressing the unique challenges faced by ESL students and those from diverse backgrounds. By embracing this technology, we can create a more inclusive and effective learning environment that supports all students in reaching their full potential.<span data-ccp-props="{"201341983":0,"335559685":270,"335559737":2466,"335559738":240,"335559739":60,"335559740":228,"335572071":0,"335572072":0,"335572073":0,"335572075":0,"335572076":0,"335572077":0,"335572079":0,"335572080":0,"335572081":0,"335572083":0,"335572084":0,"335572085":0,"335572087":0,"335572088":0,"335572089":0,"469789798":"nil","469789802":"nil","469789806":"nil","469789810":"nil","469789814":"nil"}"> Sincerely, Nelson Colón Vargas, PhD and Marcos J. Ramos-Benitez, PhD<span data-ccp-props="{"201341983":0,"335551550":1,"335551620":1,"335559685":270,"335559737":2466,"335559740":228,"335572071":0,"335572072":0,"335572073":0,"335572075":0,"335572076":0,"335572077":0,"335572079":0,"335572080":0,"335572081":0,"335572083":0,"335572084":0,"335572085":0,"335572087":0,"335572088":0,"335572089":0,"469789798":"nil","469789802":"nil","469789806":"nil","469789810":"nil","469789814":"nil"}">
Copyright (c) 2025 Nelson Colón-Vargas, PhD, Marcos J. Ramos Benítez, PhD (Author) https://creativecommons.org/licenses/by/4.0
Sevelamer-induced Stercoral Ulceration in a Patient with End Stage Renal Disease
This is a case describing the sequence of stercoral ulceration leading to fecal impaction and subsequent feculent peritonitis in a patient with end-stage renal disease (ESRD). Analyzing the patient’s operative course and hospitalization illustrates the complex nature of ESRD and the associated circumstances leading to this patient’s death. Utilizing the patient’s imaging and pathology results concludes that medication resins such as sevelamer caused mucosal ulceration in her colon. These results emphasize current literature which describes the potential for gastrointestinal complications with use of sevelamer.
Copyright (c) 2025 Shruti Rai, Loren Bach (Author) https://creativecommons.org/licenses/by/4.0
Semaglutide and Tirzepatide: Revolutionary Therapies for Obesity and Type 2 Diabetes Mellitus Management
Obesity and Type 2 Diabetes Mellitus (T2DM) represent significant global health challenges, contributing to high morbidity and mortality due to a combination of lifestyle, dietary, and genetic factors. Traditional management strategies, including lifestyle modifications, pharmacotherapy, and bariatric surgery, often fail to achieve sustained weight loss and glycemic control or are overly invasive. This review explores the potential of semaglutide (a glucagon-like peptide-1 [GLP-1] receptor agonist) and tirzepatide (a dual GLP-1/glucose-dependent insulinotropic polypeptide [GIP] receptor agonist) as transformative therapies for obesity and T2DM management. These agents act by stimulating glucose-dependent insulin secretion, suppressing glucagon release, delaying gastric emptying, and reducing appetite, resulting in significant weight reduction and improved glycemic control. Tirzepatide further enhances these benefits through dual receptor activation, promoting fat oxidation and additional metabolic benefits. Clinical trials, such as the STEP and SURPASS programs, demonstrate that semaglutide and tirzepatide achieve weight loss of up to 20.9% of initial body weight, comparable to bariatric surgery, and HbA1c reductions exceeding 2%, surpassing the 0.5% to 2% reductions typically observed with other T2DM therapies. These agents also improve cardiometabolic health and quality of life. Both drugs are generally well-tolerated, with gastrointestinal issues being the most common side effects. These therapies redefine obesity and diabetes as treatable chronic conditions, transforming metabolic health management. This review examines their mechanisms of action, efficacy, and safety, underscoring their potential to revolutionize the approach to these conditions.
Copyright (c) 2025 James P. Torres-Pirela (Author) https://creativecommons.org/licenses/by/4.0
Robotically Assisted Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS-TLIF) Outcomes in the Aging Hispanic Population: A Retrospective Cohort Study
Minimally invasive techniques for lumbar spinal fusions have evolved significantly to treat lumbar spinal stenosis, degenerative spondylolisthesis, and many other complex conditions. This study evaluates the clinical outcomes of patients aged 65 and older who underwent minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) with robotic assistance. In this single-surgeon single-institution retrospective cohort study, 72 patients aged 65 and older who underwent MIS-TLIF from 2018 to 2021 were analyzed. Patients had diagnoses of lumbar spinal stenosis, with or without degenerative spondylolisthesis. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for back and lower extremities at baseline, and 6, 9, or 12 months postoperatively. The data was analyzed, and outcomes were compared using paired t-tests. Significant improvements in disability were observed postoperatively, with mean ODI scores decreasing from 46.4% to 9.3% (95% CI: -41.2, -33.1). In terms of pain intensity, mean VAS scores for back pain decreased from 8.0 to 3.5 (95% CI: -5.1, -3.9) and leg pain scores also decreased from 8.2 to 2.9 (95% CI: -5.9, -4.6). These changes indicate substantial clinical improvements (p < 0.001). This study substantiates the efficacy of MIS-TLIF in significantly improving pain relief and functional mobility among seniors with lumbar conditions. The substantial reductions in ODI and VAS scores highlight its clinical benefits potential to set a new standard of care. By offering a robotically assisted, minimally invasive alternative, this approach aligns with contemporary healthcare objectives of enhancing patient recovery while minimizing procedural risks and costs.
Copyright (c) 2025 Emil Varas-Rodríguez, Gabriel González-Díaz, Alexander Matos, Miguel Cartagena, Oscar Duyos (Author) https://creativecommons.org/licenses/by/4.0
Unraveling Leptin's Influence: Sleep Abnormalities in Obesity-Related Neurogenetics
The role of early-onset obesity-related genetic predisposition and leptin receptor variants have been previously studied. However, studies involving sleep-related disorders linked to a genetic predisposition, leading to obesity, and how leptin could play a role in sleep-related disorders have been limited. In this study, we explore a case of how leptin receptor variants could play a role in the relationship between obesity and sleep-related disorders. We present a case of a morbidly obese (BMI of 62.87 kg/m2) Puerto Rican teenage female with a past medical history of type 2 diabetes mellitus, hypothyroidism, essential primary hypertension, and obstructive sleep apnea (OSA), who was evaluated due to complications regarding sleeping difficulties, despite being on Continuous Positive Airway Pressure (CPAP) treatment. Genetic studies performed to assess the causes of obesity revealed BBS9 heterozygous gene for a sequence variant defined as c.396GC and heterozygous LEPR gene for a sequence variant defined as c.658GA, which has been associated with an increased predisposition to obesity. This case report emphasizes the value of genetic research in figuring out the root causes of obesity and its comorbidities, especially in cases of early-onset obesity and co-occurring disorders such as OSA. The discovery of genetic variations in LEPR and BBS9 genes offers crucial information on potential mechanisms underlying the clinical phenotype of the patient.
Copyright (c) 2025 José Colón-Soto, Bryan Vega-Sanabria, Roberto A. Cardona-Quiñones, Alexandra Balsalobre Vélez, Simón Carlo-Torres, MD, Jesús Meléndez-Montañez, MD, Wilfredo De Jesús-Rojas, MD, FAAP, MSc, ATSF (Author) https://creativecommons.org/licenses/by/4.0
Hermansky-Pudlak Syndrome: A Bilingual Assessment of Quality and Readability of Online Health Information
Hermansky-Pudlak Syndrome (HPS), characterized by oculocutaneous albinism and a bleeding diathesis, is an autosomal recessive disorder particularly found in Puerto Ricans. The highest prevalence is noted in the northwest of Puerto Rico, where one in 1,800 individuals are affected. Due to its complex presentation and treatment regimen, health information must ideally be accessible, understandable, and of high quality. We selected three keyword phrases in English and three in Spanish that describe the disease in layman’s terms and entered them as prompts in a Google search to simulate patient-initiated searches. The first 20 websites for each of the six terms were analyzed for quality and readability utilizing a DISCERN instrument questionnaire and an online readability test tool, respectively. The results for the English terms yielded a mean general reliability of 72.8%, with the quality and reliability of treatment information at a mean of 37.4%. The average grade level (AGL) recommended for the English sites was 14, with academic and private/commercial sites scoring 15 and 13, respectively. For the Spanish keywords, the general mean reliability was 65.8%, and the treatment information mean score was 27.4%. The recommended AGL for Spanish websites was 16. Although information on HPS is readily available, our analysis suggests that the complexity of the content may be high, with extreme variations in quality. This phenomenon was observed in both languages. Our results highlight the need to provide understandable, simple, and reliable quality information in both languages for educational purposes.
Copyright (c) 2025 Laura I. Ortiz-López, MD, Karla M. Santiago-Soltero, MD, Sofia Milosavljevic, BA, Krithika Nayudu, BA, Mihir K. Patil, BA, Goranit Sakunchotpanit, BS, Rhea Malik, TJ Hazen, BA, Stephanie Sánchez-Meléndez, MD, Vinod E. Nambudiri, MD, MBA (Author) https://creativecommons.org/licenses/by/4.0
Regional Disparities in COVID-19 Mortality Rates: An Analysis of the 2021 National Inpatient Sample
Amid the 2019 coronavirus (COVID-19) pandemic, regional disparities in outcomes were identified as crucial for an effective public health response. Regional variations in COVID-19 outcomes in the United States of America (USA) were studied in this retrospective cross-sectional analysis, with a focus on in-hospital mortality rates among COVID-19 patients with pneumonia or respiratory failure, using the 2021 National Inpatient Sample dataset. Patients aged ≥18 years with confirmed diagnoses of COVID-19 associated pneumonia or respiratory failure were included in the study. The association between hospital census regions and in-hospital mortality rates was examined using multivariate logistic regression, adjusting for demographic, clinical, and hospital characteristics. Significant disparities in regional COVID-19 outcomes in the USA were revealed by the results. Mortality rates in the COVID-19 study cohort ranged from 14% in the Midwest to 18% in the West. Adjusted significant differences were shown by regression analysis, with the West exhibiting up to 28% higher odds of death (odds ratio: 1.28, 95% confidence interval: 1.218–1.354, p<0.001) than the Midwest, the region with the lowest mortality. The importance of accounting for demographic, clinical, and contextual factors in understanding these disparities and addressing regional disparities to promote health equity during the ongoing pandemic was underscored by these substantial regional variations in COVID-19 mortality rates in the USA.
Copyright (c) 2025 José A. Acosta, MD, MBA, MPH (Author) https://creativecommons.org/licenses/by/4.0