Governor's Newsletter January, 2001
Governor's Message
The Puerto Rico Region has been selected to receive a Chapter Excellence Award for the activities that took place in our region during the 1999/2000 fiscal year. This was officially notified by Dr. Gregory Elliot, chair of the Chapters Subcommittee, on January 5, 2001. I will like to take this opportunity to recognize the work and dedication of our former governor Dr. Carlos Ramirez Ronda and his Council, making possible this fortunate distinction.
The year 2000 edition of the Clinical Vignette Competition was held last November 11 at the Normandie Hotel in San Juan.
It proved to be a complete success. Residents of all of our training programs presented fifteen abstracts. The activity was very well attended by residents, medical students and faculty. Winners of the event were as follows: Dr. Fernando Lopez, Associate from the University Hospital won the first prize for his paper, "Severe Community Acquired Pneumonia as an Initial Manifestation of Adult Onset Myotonic Dystrophy", while Dr. L. Montalvo and Dr. P. Magno, also Associates from the University Hospital, presentation, "Young Male with Right Hemiparesis, Aphasia, and an Intracardiac Mass" and Dr. Frances Villarini, Associate from the VA Hospital presentation "Brain Lesions in a Patient with Ataxia and Deafness" were granted both a second prize. Dr. V. Vargas and Dr. P Yapor Associates from the VA Hospital presented, "Advanced Cirrhosis in a 69 Year Old Non-Alcohol Abuser" and were awarded the third prize.
I want to take this opportunity to thank Dr. Ivonne Jimenez for the organization of the event and acknowledge the excellent work done by the panel judges: Drs. Felix Cortez, MACP, Carlos Gonzalez, FACP, Gonzalo Gonzalez, FACP, Luis Ghigliotti, Member, Melba Feliciano, FACP and Samuel Suarez, Member.
A reprint of the winning abstract is included in this newsletter for the benefit of those unable to attend the activity.
Chapter Annual Meeting
The Chapter Annual Meeting is scheduled for February 8 - 10 at the Caribe Hilton Hotel in San Juan. The theme is "Back to the Basics" and the highlights include Meet the Professor session, review session, state of the art and update lectures and the Associates' Oral Presentations. Dr. Munsey Wheby, MD, FACP, a Regent of the ACP-ASIM will attend to talk about College-related issues as well as invited faculty in the area of Hematology. Other invited faculties include Samuel Aguayo, MD, FACP, who is Associate Professor of Medicine at Emory University, Duane Gubler, ScD, Director of the Division of Vector Borne Infectious Diseases, National Center for Infectious Diseases, and Christine Wanke, who is Associate Professor of Community Health and Medicine at Tufts University School of Medicine. This an excellent opportunity for you to discuss local and national issues affecting the practice and teaching of internal medicine, in addition to earning 18 credits of continued medical education.
New Masters
The College announced that Carlos Girod MD, FACP and Carlos Ramirez-Ronda MD, FACP were elected to the category of Masters by the Board of Regents. Masters comprise a small group of highly distinguished physicians, selected from Fellows, who have achieved recognition in medicine by exhibiting pre-eminence in practice or medical research, holding positions of high honor or making significant contributions to medical science or the art of medicine.
Dr. Girod graduated Magna Cum Laude with a Bachelors degree in Science from the University of Puerto Rico (UPR) in 1957. He then went to the University of Maryland School of Medicine where he graduated Summa Cum Laude and Gold Medal Award recipient in 1961. He is certified by the NBME, and both certified and recertified by the ABIM in Internal Medicine. He is a member of the faculty of the University of Puerto Rico School of Medicine since 1966, rising through the ranks to the position of Professor of Medicine and held and continues to hold appointments of great importance to the institution including the Deanship from 1971 to 1976.
During his early professional years, Dr. Girod excelled as a clinical researcher, especially in the field of cardiology, where his works related to the electrocardiogram and vectorcardiogram in congenital heart disease were published in the American Heart Journal (1964) and in book form in 1965. He has been the recipient of numerous awards and recognition, including Alpha Omega Alpha Honor Medical Society (1960), Research Development Award of the PR Heart Association (1966-1969), Fellow of the American College of Physicians (1977), and Fellow of the American College of Cardiology (1977).
He continues to be an inspiring teacher, serving as a role model for medical students, residents, and fellows. His ability as a teacher and his contributions to medical education were recognized through the dedication of the Annual Education Forum in Health Sciences of the UPR School of Medicine in 1999.
Dr. Carlos Ramirez-Ronda majored in chemistry at the University of Puerto Rico, and went on to receive a bachelor in Medicine from Northwestern University in 1967. He is certified by the NBME and the ABIM in Internal Medicine and Infectious Diseases. Dr Ramirez was elected to the Alpha Omega Alpha Honor Society in his junior year of medical school. He has been the recipient of multiple other awards including Outstanding Young Men in Medicine for Puerto Rico (1978), Federal Employee of the Year, Federal Executive Association (1978), member of the Bacteriology and Mycology Section, National Institute of Allergy and Infectious Diseases, NIH (1981-1985) and member of the advisory committee on immunization practices of the CDC in Atlanta (1990-1994).
In 1975 he was named Associate Chief of Staff for Research and Development at the VA Medical Center and became a member of the faculty of the department of Medicine of the University of Puerto Rico School of Medicine. At that time he organized the infectious disease training program as a joint venture between the San Juan VA Medical Center and the University Hospital University of Puerto Rico School of Medicine and has continued as the director up to the present time.
Dr. Ramirez-Ronda has been a very successful clinical investigator with over 256 publications, including 201 in peer-reviewed journals, nine-book chapters and some 395 abstracts. In 1989 Dr. Ramirez-Ronda assumed the position and continues to be Chief of the Department of Medicine at the San Juan VA Medical Center.
Dr. Girod and Dr. Ramirez-Ronda now join the select group of Masters in our Chapter namely: Felix Cortez, MD, MACP; Mario Garcia-Palmieri, MD, MACP; Lillian Haddock-Suarez, MD, MACP and Eli Ramirez-Rodriguez, MD, MACP.
I want to take this opportunity to invite all of you to the PR Chapter reception in honor of our new Masters on March 31, 2001 at the Madrid-Trinidad Rooms of the Marriott Marquis Hotel in Atlanta.
Severe Community Acquired Pneumonia as an Initial Manifestation of Adult Onset Myotonic Dystrophy
Fernando Lopez, MD, ACP Associate
University Hospital, UPR School of Medicine
A 42 year-old female presented to Emergency Room due to altered mental status that progressed to seizures and respiratory failure requiring mechanical ventilation ten hours after a head trauma. A CT scan revealed no vascular event, fracture, mass or edema. Past history included a prior hospitalization due to pneumonia, which required mechanical ventilation, polycystic ovary disease and depression. During the last five years she had been evaluated by a physiatrist due to muscle weakness and recurrent falls severe enough to be classified as disabled by the "Disability Determination Program". There is a family history of muscle weakness in several uncles, half sister and two nephews, all on her father side.
On admission, the patient was disoriented, with respiratory distress, obese, frontal alopecia and frontal hirsutism, left lower lobe ronchi, areflexia, weak withdrawal from all extremities and flaccid tone. There was no evidence of head trauma, nuchal rigidity, papilledema, facial asymmetry, involuntary movements, fasciculation, corticospinals or meningeal signs. A chest x-ray showed a left lower lobe infiltrate. The patient was started on parenteral antibiotics but despite treatment, was unable to be weaned off the mechanical ventilator. She had no spontaneous breathing and, in view of the muscular weakness, a neuromuscular disease was suspected. HIV testing, autoimmune panel, thyroid panel, spinal tap and VDRL were all negative. Electromyogram and Nerve Conduction study as well as DNA markers for Myotonic Dystrophy were compatible with the adult (Classical) onset of the condition.
Myotonic Dystrophy (MD) is the most common inherited muscle disorder in adults, with an incidence of 13 cases per 100,000. It is a multisystem degenerative disease caused by an unstable expansion of triplet repeats in chromosome 19 that shows anticipation (increasing disease severity and earlier onset of disease in successive generations). The most common manifestations are muscle weakness and stiffness as well as systemic manifestations such as neurobehavioral changes, cognitive impairment, cardiac conduction disease, polyneuropathy, insulin resistance, cataract and sleep apnea. The most common cause of death is respiratory failure precipitated by pulmonary infection, followed by sudden death. No treatment has been shown to slow or reverse the progressive myopathy in Myotonic Dystrophy.
What's New
Contact Information
Carlos Gonzalez-Oppenheimer, MD, FACP,
Governor, Puerto Rico Chapter
E-mail: carlos.gonzalez48@upr.edu
Lisa Gonzalez
Chapter Support Staff
Phone: 787-504-4926
Fax: 787-767-6703
E-mail: lisagonzalez1@gmail.com