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The capacity of particulate matter (PM) to enhance and stimulate the expression of pro-inflammatory mediators has been previously demonstrated in non-antigen-presenting cells (human bronchial epithelia). Nonetheless, many proposed mechanisms for this are extrapolated from known canonical molecular pathways. This work evaluates a possible mechanism for inflammatory exacerbation after exposure to PM2.5 (from Puerto Rico) and CuSO4, using human bronchial epithelial cells (BEAS-2B) as a model. The induction of CIITA, MHCII genes, and various pro-inflammatory mediators was investigated. Among these, the phosphorylation of STAT1 Y701 was significantly induced after 4 h of PM2.5 exposure, concurrent with a slight increase in CIITA and HLA-DRα mRNA levels. INFγ mRNA levels remained low amidst exposure time, while IL-6 levels significantly increased at earlier times. IL-8 remained low, as expected from attenuation by IL-6 in the known INFγ-independent inflammation pathway. The effects of CuSO4 showed an increase in HLA-DRα expression after 8 h, an increase in STAT1 at 1 h, and RF1 at 8 h We hypothesize and show evidence that an inflammatory response due to PM2.5 extract exposure in human bronchial epithelia can be induced early via an alternate non-canonical pathway in the absence of INFγ.

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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.

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The exposure to airborne particulate matter (PM) and its constituents is an important factor to be considered when evaluating their potential health risk. Transition metals found in PM are known to contribute significantly to the exacerbation of respiratory ailments. Exposure to these constituents results in the induction of oxidative stress in the bronchial epithelium, thus promoting the secretion of inflammatory mediators. Therefore, it is important to know the contributions of PM2.5 constituents to further investigate their relationship with toxic responses and associated health risks. PM2.5 samples from three rural (Humacao, Guayama, and Guayanilla) and two urban (more populated) sites (Bayamón and Ponce) from Puerto Rico were analyzed for various inorganic constituents. A total of 59 trace elements were analyzed, of which eight were considered with the greatest toxic potential. The highest annual average concentration of PM2.5 was reported at the urban site of Ponce (5.82 ± 1.40 µg m-3), while Bayamón's average concentration was not as high (4.69 ± 1.30 µg m-3) compared to concentrations at the rural sites Humacao, Guayama, and Guayanilla (4.33 ± 1.20 µg m-3, 4.93 ± 1.50 µg m-3, and 4.88 ± 1.20 µg m-3 respectively. The concentration at the Ponce site exhibited the highest summer value (7.57 µg m-3) compared to that of all the rural sites (~ 6.40 µg m-3). The lowest summer PM2.5 values were obtained at the Humacao site with an average of 5.76 µg m-3. Average Cu and Zn concentrations were 3- and 2-fold higher at the urban sites (0.68 ng m-3 and 6.74 ng m-3 respectively) compared to the rural sites (0.17 ng m-3 and 4.11 ng m-3). Relative toxicity of inorganic PM extract indicates Bayamón (urban) and Guayama with similar low LC50 followed by Humacao, Guayanilla, and finally Ponce (urban) with the highest LC50. Of the eight potential toxic metals considered, only Fe was found to be higher at the rural sites. To our understanding, there are different sources of emission for these metals which potentially indicate main anthropogenic sources, together with the trade winds adding periodically volcanic and African Dust Storm particulates that affect Puerto Rico. These results are the first of their kind to be reported in Puerto Rico.

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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.

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Mercury (Hg) has been identified as one of the most toxic nonradioactive materials known to man. Although mercury is a naturally occurring element, anthropogenic mercury is now a major worldwide concern and is an international priority toxic pollutant. It also comprises one of the primary constituents of dental amalgam fillings. Even though dental mercury amalgams have been used for almost two centuries, its safety has never been tested or proven in the United States by any regulatory agency. There has been an ongoing debate regarding the safety of its use since 1845, and many studies conclude that its use exposes patients to troublesome toxicity. In this review, we present in an objective way the danger of dental amalgam to human health based on current knowledge. This dilemma is addressed in terms of an integrated toxicological approach by focusing on four mayor issues to show how these interrelate to create the whole picture: (1) the irrefutable constant release of mercury vapor from dental amalgams which is responsible for individual chronic exposure, (2) the evidence of organic mercury formation from dental amalgam in the oral cavity, (3) the effect of mercury exposure on gene regulation in human cells which supports the intrinsic genetic susceptibility to toxicant and, finally, (4) the availability of recent epidemiological data supporting the link of dental amalgams to diseases such as Alzheimer's and Parkinson.

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Background: The island of Vieques (a municipality of Puerto Rico) was used as a military practice range by the US Navy for more than 60 years. Many studies have reported the presence of toxic metals in soil samples taken from Vieques. The bombing range is only 18 km upwind from the Vieques residential area and inhalable resuspended particles resulting from bombing are known to reach the populated area. The current study reports for the first time, the presence of toxic metals' depuration profiles obtained from Vieques and Main Island Puerto Rico human subjects. Objectives: This study was designed to evaluate the distribution of toxic metals in a random population exposed to contaminants originating from military activities and comparing it to a non-exposed random population from Main Island Puerto Rico. Methods: A total of 83 subjects studied; 32 were from Vieques and 51 were from Main Island Puerto Rico. A physician administrated chelation therapy to all subjects and collected urine samples during a 24-h period. A total of 20 trace elements associated with military activities were measured in urine by induced coupled plasma mass spectrometry (ICP-MS). The results were compared between both population samples. Results: Significant differences in the levels of eight trace elements associated with military practices were found between Vieques and Main Island Puerto Rico. Lead (Pb), aluminum (Al), uranium (U) (p < 0.001), arsenic (As), cadmium (Cd) (p = 0.02), and gadolinium (Gd) (p = 0.03) were significantly higher in Vieques while niobium (Nb) and platinum (Pt) levels (p < 0.006) were lower in the Vieques samples. Discussion: Higher concentrations of Pb, Al, As, Cd, Gd, and U were found in Vieques residents' urine samples compared to Main Island. Nonetheless, Pt and Ga were present in Main Island at higher concentrations than in Vieques. Although limited by its sample size, this report should set a basis for the importance of health assessment in these subjects exposed to military activities remnants throughout the years and further evaluation of their effects on the overall health of the population.

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OBJECTIVE: Studies of human papillomavirus (HPV) awareness in Puerto Rico (PR) are limited and are of interest given low HPV vaccine uptake in this population. This cross-sectional study aimed to determine factors associated to HPV and HPV vaccine awareness among persons aged 15-74 years living in Puerto Rico. METHODS: We analysed data from a sub-sample of 1,476 men and women who participated in a 2008 population-based island-wide household survey and who completed an HPV module. Multivariate logistic regression models were used to examine factors associated with HPV and HPV vaccine awareness. RESULTS: Overall, 37.2% of participants had heard about HPV and 33.4% had heard of the vaccine. Multivariate logistic regression showed that women were more likely to have heard of HPV (OR adjusted: 4.54; 95% CI=3.45, 5.98) or of the HPV vaccine (OR adjusted: 6.15; 95% CI=4.50, 8.40) as compared to men. HPV awareness was also lower among older adults, persons with lower income and with lower educational attainment, those without children and smokers (p < 0.05). CONCLUSION: In 2008, two years after the introduction of the first HPV vaccine in PR and the US, public awareness about HPV infection and the HPV vaccine was lower in Hispanics in PR as compared to other populations. Identified high-risk populations should be targeted in preventive care strategies. Future efforts should increase HPV knowledge and vaccine use in this population in order to maximize the impact of vaccination programs.

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OBJECTIVE: The objective of this study was to determine the association between binge drinking and violence in a representative sample of secondary-school students in Puerto Rico. METHODS: Consulta Juvenil VII (a biennial survey of school-aged youths in Puerto Rico) has a representative sample of adolescent students in Puerto Rico. A multi-stage stratified cluster sampling design was used. The sampling frame of Consulta Juvenil VII includes all the public and private schools registered with the Department of Education and the Council of General Education in Puerto Rico. The study utilizes a self-administered questionnaire that was translated and adapted from the "Student Survey of Risk and Protective Factors and Prevalence of Alcohol, Tobacco, and Other Drug Use". "Binge drinking" was defined as having 5 or more alcoholic drinks in a row during the 30 days preceding the survey. RESULTS: Almost 20% of the sample members reported that at least 1 instance of binge drinking had taken place during the 2 weeks prior to the survey (17.7%). After controlling for gender, age, school level, the type of system, and the parents' educational levels, the odds of a given binge drinker reporting violent behaviors were 5 times greater than the odds among non-binge drinkers (OR: 5.6; 95% CI: 4.7-6.7). CONCLUSION: The study shows an association between binge drinking and violence in Puerto Rican adolescents, indicating that Hispanic youths who abuse alcohol may be at increased risk of violence. These findings suggest that violence prevention programs should be integrated with substance use prevention programs. [PR Health

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BACKGROUND: In order to prevent the spread of the hepatitis C virus (HCV) amongst Hispanic injection drug users (IDUs), we developed, validated, and implemented a multimedia educational intervention program. METHODS: A pre-post intervention study design was used to evaluate long-lasting knowledge and behavior changes in a group of 88 low-income Hispanic HIV-infected IDUs. Pre-intervention data was compared with data measured six months after the intervention. RESULTS: A significant increase in the awareness regarding HCV clinical manifestations, HCV risky behaviors, HCV prevention practices, and HIV/HCV co-infection synergisms was observed in the group six months post-intervention. CONCLUSION: Our study confirms the long-lasting benefits of multimedia based intervention programs for disseminating HCV prevention strategies in IDUs. Preventive educational approaches that use images, figures, and animations tools can be recommended to target and tailor interventions for vulnerable populations.

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