Early detection of interstitial lung disease in rheumatic diseases: A joint statement from the Portuguese Pulmonology Society, the Portuguese Rheumatology Society, and the Portuguese Radiology and Nuclear Medicine Society.

INTRODUCTION: Interstitial lung disease (ILD) contributes significantly to morbidity and mortality in connective tissue disease (CTD). Early detection and accurate diagnosis are essential for informing treatment decisions and prognosis in this setting. Clear guidance on CTD-ILD screening, however, is lacking. OBJECTIVE: To establish recommendations for CTD-ILD screening based on the current evidence. METHOD: Following an extensive literature research and evaluation of articles selected for their recency and relevance to the characterization, screening, and management of CTD-ILD, an expert panel formed by six pulmonologists from the Portuguese Society of Pulmonology, six rheumatologists from the Portuguese Society of Rheumatology, and six radiologists from the Portuguese Society of Radiology and Nuclear Medicine participated in a multidisciplinary discussion to produce a joint statement on screening recommendations for ILD in CTD. RESULTS: The expert panel achieved consensus on when and how to screen for ILD in patients with systemic sclerosis, rheumatoid arthritis, mixed connective tissue disease, Sjögren syndrome, idiopathic inflammatory myopathies and systemic lupus erythematous. CONCLUSIONS: Despite the lack of data on screening for CTD-ILD, an expert panel of pulmonologists, rheumatologists and radiologists agreed on a series of screening recommendations to support decision-making and enable early diagnosis of ILD to ultimately improve outcomes and prognosis in patients with CTD.

Multimodality imaging in connective tissue disease-related interstitial lung disease.

Interstitial lung disease is a well-recognised manifestation and a major cause of morbidity and mortality in patients with connective tissue diseases. Interstitial lung disease may arise in the context of an established connective tissue disease or be the initial manifestation of an otherwise occult autoimmune disorder. Early detection and characterisation are paramount for adequate patient management and require a multidisciplinary approach, in which imaging plays a vital role. Computed tomography is currently the imaging method of choice; however, other imaging techniques have recently been investigated, namely ultrasound, magnetic resonance imaging, and positron-emission tomography, with promising results. The aim of this review is to describe the imaging findings of connective tissue disease-related interstitial lung disease and explain the role of each imaging technique in diagnosis and disease characterisation.

Analysis of the management of antipsychotics in a group of prisons.

Objective: To assess the use of prescribed antipsychotic treatments in the Spanish prison population in order to determine whether there are differences in efficacy and cost between the different long-acting antipsychotic injectables (LAIs). Material and method: An observational, retrospective study was carried out in twelve prisons and in two prison psychiatric hospitals. To assess efficacy, all the clinical histories of patients with some kind of LAI were reviewed and only those who were in a situation of therapeutic stability were selected, defined as those treatments that had not undergone any change in the three last months, both in doses and in the association of another antipsychotic. Results: Of the 11,953 inmates included in the study, 1,851 (15.5%) received prescriptions for an antipsychotic, 415 in penitentiary psychiatric hospitals (87%) and 1,436 in prisons (12%), which is a much higher prevalence than that found in the population. Regarding the prescription pattern of LAIs, paliperidone is the most widely prescribed in prison psychiatric hospitals and prisons, followed by aripiprazole, zuclopenthixol and risperidone. Finally flufenazine, olanzapine and paliperidone quarterly, which are scarcely represented. Of the 292 patients with LAI, 41% (121 patients) are with monotherapy and 59% (171 patients) are with polytherapy, which is similar to the data found in the bibliography. Discussion: The use of prescribed LAIs amongst inmates is widespread. Polytherapy is also a common phenomenon, although there is a downward trend due to the use of more recently marketed drugs. Since the use of LAI is long-term, with numerous side effects and a wide range of prices, it is essential to consider the patient's risk factors and the cost of treatment alongside the therapeutic efficacy.

Raman microspectroscopy for probing the impact of a dietary antioxidant on human breast cancer cells.

Breast cancer is the second most common type of cancer worldwide and the most frequent among women, being the fifth cause of death from neoplastic disease. Since this is an oxidative-stress related neoplasia, it is largely preventable. A dietary isoflavone abundant in soybean - daidzein - is currently being investigated owing to its chemopreventive and/or chemotherapeutic properties towards the human MDA-MB-231 (metastatic, estrogen-unresponsive) and MCF-7 (estrogen-responsive) breast cancer cell lines. Biological assays for evaluation of antitumour and anti-invasive activities were combined with state-of-the-art vibrational microspectroscopy techniques. At 50 and 100 µM concentrations and 48 h incubation time, daidzein was found to induce a marked decrease in cell viability (ca. 50%) for MDA-MB-231 and MCF-7 cells (respectively ca. 50% and 42%) and 40% inhibition of cell migration. MicroRaman analysis of fixed cells upon exposure to this isoflavone unveiled its metabolic impact on both cell lines. Multivariate data analysis (unsupervised PCA) led to a clear discrimination between the control and DAID-exposed cells, with distinctive effects on their biochemical profile, particularly regarding DNA, lipids and protein components, in a cell-dependent way. This is the first reported study on the impact of dietary antioxidants on cancer cells by microRaman techniques.

Effect of Zinc Intake on Growth in Infants: A Meta-analysis.

A systematic review and meta-analysis of available randomized controlled trials (RCTs) was conducted to evaluate the effect of zinc (Zn) intake on growth in infants. Out of 5500 studies identified through electronic searches and reference lists, 19 RCTs were selected after applying the exclusion/inclusion criteria. The influence of Zn intake on growth was considered in the overall meta-analysis. Other variables were also taken into account as possible effect modifiers: doses of Zn intake, intervention duration, nutritional status, and risk of bias. From each select growth study, final measures of weight, length, mid upper arm circumference (MUAC), head circumference, weight for age z-score (WAZ), length for age z-score (LAZ), and weight for length z-score (WLZ) were assessed. Pooled ß and 95% confidence interval (CI) were calculated. Additionally, we carried out a sensitivity analysis. Zn intake was not associated with weight, length, MUAC, head circumference, and LAZ in the pooled analyses. However, Zn intake had a positive and statistically effect on WAZ (ß = 0.06; 95%CI 0.02 to 0.10) and WLZ (ß = 0.05; 95%CI 0.01 to 0.08). The dose-response relationship between Zn intake and these parameters indicated that a doubling of Zn intake increased WAZ and WLZ by approximately 4%. Substantial heterogeneity was present only in length analyses (I(2) = 45%; p = 0.03). Zn intake was positively associated with length values at short time (four to 20 weeks) (ß = 0.01; CI 95% 0 to 0.02) and at medium doses of Zn (4.1 to 8 mg/day) (ß = 0.003; CI 95% 0 to 0.01). Nevertheless, the effect magnitude was small. Our results indicate that Zn intake increases growth parameters of infants. Nonetheless, interpretation of these results should be carefully considered.

Perfil de uso y rango de dosis de analgésicos en un hospital de cuarto nivel en Bogotá / Profile of use and dose range of painkillers on a fourth-level hospital in Bogotá

Introducción: El dolor es uno de los síntomas más frecuentes e importantesen el paciente hospitalizado, con una frecuencia hasta de 76.9 porciento. El adecuado control del mismo es uno de los objetivos terapéuticos más buscados. Para lograr este objetivo, frecuentemente suelen usarse dosis inadecuadas de analgésicos, lo cual ocasiona reacciones adversas en los pacientes. El objetivo de este trabajo fue identificar los analgésicos de mayor uso en el paciente adulto hospitalizado y el rango de dosis de los mismos en un hospital de cuarto nivel de la ciudad de Bogotá. Métodos: Estudio observacional descriptivo de corte transversal en pacientes hospitalizados mayores de 18 años, con prescripción de analgésicos; seleccionados por muestreo aleatorio estratificado según servicio, entre julio a diciembre de 2013. Se evaluaron los analgésicos y las dosis prescritas, comparándolas con las dosis diarias máximas descritas para cada uno. El análisis de las variables sociodemográficas y farmacológicos serealizó con STATA 12. Resultados: Se evaluaron 355 historias clínicas depacientes, encontrando 555 prescripciones de analgésicos. Los más usados fueron acetaminofén en 186 casos (33,5 porciento) y tramadol en 167 (30,1 porciento). El uso de tramadol y acetaminofén se encontró en un rango de dosis adecuado en el 99,4 porciento y 90,9 porciento respectivamente. Los otros opiáceos utilizdos diferentes a tramadol, se encontraron en el rango de dósis según indica la literatura.Conclusiones: Los analgésicos más utilizados en el paciente hospitalizado pertenecen al escalón I y II de la escala del manejodel dolor de la OMS, siendo los más frecuentes acetaminofén y tramadol. Eluso de antiinflamatorios no esteroideos fue escaso, siendo el más relevanteentre estos, diclofenaco. Las dosis utilizadas de analgésicos en general fueron adecuadas, pero para dipirona se observó sobredosificación muy frecuente.Elanalgésico para el cual hay un mayor porcentaje de casos de subdosificación fue butilbromuro de hioscina.

Introduction: Pain is one of the most common and important symptomsinpatients, with a frequency of up to 76.9%. Proper control of the same is oneof the most sought therapeutic targets. To achieve this goal, often inadequatedoses of analgesics used, which causes adverse reactions in patients. The aim ofthis study was to identify the most widely used analgesics adult inpatient and thedose range of them at a hospital in fourth level of Bogota. Methods: Descriptiveobservational cross-sectional study inpatients over 18 years with prescriptionpainkillers, selected by stratified random sampling according to service, fromJuly to December 2013. Painkillers and prescribed doses were evaluated andcompared with the maximum daily doses described for each one. The analysisof the sociodemographic and pharmacological variables was performed usingSTATA 12, Results: Medical records of 355 patients were evaluated, finding555 prescription painkillers. The most used were acetaminophen in 186 cases(33.5%) and tramadol 167 (30.1%). The use of tramadol and acetaminophenwas found an appropriate range of doses in 99.4% and 90.9% respectively. Twocases with 4 prescription painkillers and a case with 5 concurrent analgesicswere found. Conclusions: The most commonly used in hospitalized patientsanalgesics belonging to stage I and II of the scale of pain management WHO,being the two main acetaminophen and tramadol. The use of NSAIDs wasrare, the most important among these, diclofenac. Analgesic doses used weregenerally adequate, but dipyrone overdosing very frequently observed. Theanalgesic for which there is a higher percentage of cases of underdosing washyoscine butylbromide.

Adherence to the Mediterranean diet and quality of life in the SUN Project.

BACKGROUND/OBJECTIVES: Mediterranean diet has been related with reduced morbidity and better well-being. The aim of this study was to assess whether the adherence to the Mediterranean diet were associated with mental and physical health related to quality of life. SUBJECTS/METHODS: This analysis included 11 015 participants with 4 years of follow-up in the SUN Project (a multipurpose cohort study based on university graduates from Spain). A validated 136-item food frequency questionnaire was used to assess the adherence to the Mediterranean diet at baseline, according to a nine-point score, presented in four categories (low, low-moderate, moderate-high and high). Health-related quality of life (HRQL) was measured after 4 years of follow-up with the Spanish version of the SF-36 Health Survey. Generalized Linear Models were fitted to assess adjusted mean scores, the regression coefficients (ß) and their 95% confidence intervals (95% CIs) for the SF-36 domains according to categories of adherence to Mediterranean diet. RESULTS: Multivariate-adjusted models revealed a significant direct association between adherence to Mediterranean diet and all the physical and most mental health domains (vitality, social functioning and role emotional). Vitality (ß=0.50, 95% CI=0.32-0.68) and general health (ß=0.45, 95% CI=0.26-0.62) showed the highest coefficients. Mean values for physical functioning, role physical, bodily pain, general health and vitality domains were significantly better with increasing adherence to the Mediterranean diet. Those having improved their initial high diet scores have better scores in physical functioning, general health and vitality. CONCLUSIONS: Adherence to the Mediterranean diet seems to be a factor importantly associated with a better HRQL.

Chromone-3-carboxylic acid as a potential electron scavenger: a surface-enhanced Raman scattering study.

A SERS study of chromone 3-carboxylic acid adsorbed on silver colloids was undertaken, in order to assess the ability of this compound to accept electrons in charge transfer (CT) processes. Theoretical SERS intensities under photoinduced CT resonant conditions have been carried out for both the neutral and the deprotonated species allowing to conclude, by comparison with the experimental data, that the recorded SER corresponds to the anionic form of the acid linked to the metal. It was shown that the SERS-CT mechanism predominates for this particular compound, thus explaining the strong enhancement of the band at ca. 1600 cm(-1) assigned to the 8a ring stretching mode. The identification of CT processes is of the utmost importance for understanding the mechanism through which these benzopyranes may act as antioxidants.

[Women in climacteric. Results of the implementation of a health program]. / La mujer en edad de climaterio. Resultados de la aplicación de un programa de salud.

Menopause is a very important period in the life of a woman due to the physiological and psychological changes which happen during this period. The authors apply an educational program providing integrated attention to women during this phase of their lives to evaluate possible improvements in the conflictive aspects which menopause generates. The authors carried out a longitudinal study with interventions before and after their study. The sample was a group of 28 women between the ages of 45 and 64. The educational intervention consisted of the application of a program providing integrated attention to women by the Generalitat Valenciana, the autonomous government in the Valencia Autonomous Region. This program had a positive influence on the knowledge and aptitudes of these women regarding this period of their lives. Their physical and psychological health improved, with a decrease in the most common symptoms caused by menopause and there were very significant differences found on the Kupperman test. The application of this program succeeded in relating the material taught to these women with a positive repercussion in their physical, psychological and social states during their climacteric years.

Infecciones nosocomiales y marcadores epidemiológicos / Nosocomiales infections and marking epidemiologists

Las infecciones nosocomiales o intrahospitalarias continúan siendo en la actualidad un grave problema de salud pública principalmente por falta de monitoreo y control permanentes. En los últimos años, el análisis epidemiológico de las infecciones nosocomiales ha evolucionado y ha experimentado importantes cambios, desde la caracterización fenotípica hasta el desarrollo de técnicas de biología molecular y la utilización del genoma de los microbios e investigaciones basadas en la utilización de chips de ADN. En el presente trabajo hacemos una revisión de algunas publicaciones sobre este tema y analizamos las ventajas y desventajkas de varios métodos de tipificación y su utilidad epidemiológica.

Infecciones nosocomiales y marcadores epidemiológicos / Nosocomiales infections and marking epidemiologists

Las infecciones nosocomiales o intrahospitalarias continúan siendo en la actualidad un grave problema de salud pública principalmente por falta de monitoreo y control permanentes. En los últimos años, el análisis epidemiológico de las infecciones nosocomiales ha evolucionado y ha experimentado importantes cambios, desde la caracterización fenotípica hasta el desarrollo de técnicas de biología molecular y la utilización del genoma de los microbios e investigaciones basadas en la utilización de chips de ADN. En el presente trabajo hacemos una revisión de algunas publicaciones sobre este tema y analizamos las ventajas y desventajas de varios métodos de tipificación y su utilidad epidemiológica.

Calcium supplementation and the risk of preeclampsia in Ecuadorian pregnant teenagers.

OBJECTIVE: To determine whether increased calcium intake (2 g/day) in pregnancy is effective in reducing the risk of preeclampsia in pregnant teenagers. METHODS: The present study was a prospective, randomized, double-blind, controlled clinical trial. Two hundred sixty teenaged pregnant girls attending the Hospital Gíneco-Obstétrico Isidro Ayora in Quito, Ecuador, were included. Selection criteria were age less than 17.5 years, nulliparity, first prenatal visit before 20 weeks' gestation, and residency in Quito (2800-m altitude). We used a table of random numbers to assign 125 girls to receive 2000 mg of elemental calcium daily, beginning at 20 weeks of gestation and continuing until delivery; 135 women in the control group received a placebo. Blood pressure (BP) was measured twice every 4 weeks until delivery and at 48 hours after delivery. The diagnosis of preeclampsia was defined as BP greater than 140/90 mmHg on at least two occasions more than 6 hours apart and proteinuria greater than 30 mg/dL (over one cross by dipstick on two occasions 4-24 hours apart). RESULTS: The average daily calcium intake in this population was approximately 51% of the Recommended Dietary Allowance. Calcium supplementation was associated with a significantly decreased risk of preeclampsia (risk reduction 12.35%; P < .001), with 3.2% (n = 4) developing preeclampsia in the treatment group versus 15.5% (n = 21) in the placebo group. Moreover, calcium supplementation led to a reduction in systolic BP of 9.1 mmHg and in diastolic BP of 6.0 mmHg. CONCLUSION: These results suggest that calcium supplementation during pregnancy in populations with low calcium intake is a safe, effective, and inexpensive preventive measure that significantly reduces the risk of preeclampsia.

Cyclic guanosine 3',5' monophosphate concentrations in pre-eclampsia: effects of hydralazine.

OBJECTIVE: To elucidate the role of the L-arginine:nitric oxide pathway in pregnancy and pre-eclampsia. PARTICIPANTS: Pregnant women (nulliparous, age <25 years). Normotensive pregnancy (n=22) was defined when blood pressure remained at levels of <120/80 mmHg and there was no proteinuria. Women with pre-eclampsia (n=22) had blood pressure measurements of >140/90 mmHg and proteinuria of >300 mg/l. Nonpregnant normotensive women (n=22) were studied as controls. STUDY DESIGN: Blood samples were taken for measurements of ionised calcium, atrial natriuretic factor, cyclic guanosine 3'5' monophosphate (GMP),arginine and asymmetric dimethylarginine. Urine samples were collected for determination of cyclic GMP excretion. Cyclic GMP concentrations were also determined in 12 women with severe pre-eclampsia before and after treatment with hydralazine. RESULTS: L-arginine, asymmetric dimethylarginine and atrial natriuretic factor were not different in any group. Cyclic GMP concentrations in plasma [0.94 (SD 0.23) nM] as well as in urine [50.1 (SD 15.7) microM] were increased significantly (P<0.05) in normal pregnancy compared to nonpregnant controls [plasma mean 0.46 (SD 0.12) nM and urine mean 18.4 (SD 10.3) microM], but not in the pre-eclampsia group [plasma mean 0.48 (SD 0.10) nM and urine mean 24.1 (SD 14.5) microM]. Concentrations of cyclic GMP in plasma and urine increased significantly (P<0.05) in women treated with hydralazine. CONCLUSIONS: The differences in cyclic GMP concentrations may reflect differences in nitric oxide production. Hydralazine increases cyclic GMP concentrations in severely pre-eclamptic women. This action could explain the antihypertensive effect of hydralazine.

[Dengue: an disease imported from the Indian subcontinent]. / Dengue: enfermedad importada del subcontinente indio.

BACKGROUND: The febrile syndrome is one of the most frequent diseases in travellers with transient clinical pictures, not being reported on many ocassions. In Spain no cases of dengue fever has been published so far. METHODS: A prospective clinical study was carried out in travellers from endemic zones with serologic diagnosis for dengue viruses being performed: IgM/IgG by hemagglutination inhibition and ELISA enhancement. RESULTS: Six cases of dengue are described in Spanish travellers (4 tourists and 2 workers) from the Indian subcontinent (1989-1992). Serologic diagnosis: IgM/IgG by hemagglutination inhibition and ELISA enhancement was carried out. Five cases presented with classical dengue fever picture and 1 with hemorrhagic dengue. In all cases, fever and thrombopenia were reported. The clinical picture was self-limited in 2 patients, complicated with post-dengue syndrome in 3 cases and with fatal outcome in 1. CONCLUSIONS: Dengue fever should be included in the differential diagnosis of febrile syndrome in travellers coming from endemic zones. The authors present the first cases of imported dengue in Spain.

[Intubation with propofol without neuromuscular blockade. Effect of premedication on fentanyl and lidocaine]. / Intubación con propofol sin bloqueo neuromuscular. Efecto de la premedicación con fentanilo y lidocaína.

AIMS: Laryngotracheal reflexes, and possibilities of intubations following anaesthetic induction with propofol, with or without premedication and without neuromuscular blockade were evaluated. Hemodynamic parameters were also measured. METHODS: Sixty ASA I-II patients were randomly allocated into 3 groups according to anaesthetic premedication. Group P: (placebo), 2 and 4 ml of saline 0.9%; group F, 4 micrograms/kg of fentanyl and 2 ml of saline 0.9%; group L, 4 micrograms/kg of fentanyl and 1.5 mg/kg of lidocaine 5%. Two point five mg/kg of propofol were administered and 45 seconds later intubation was attempted. Mandibular relaxation, visualization of the glottis, opening of the vocal chords, reflex reactions to laryngoscopy and intubation, time used, blood pressure and heart rate were evaluated. RESULTS: Mandibular relaxation and visualization of the glottis were acceptable in all the patients. The aperture of the vocal chords was enough so as to carry out intubation in 65% (P), 100% (F) (p < 0.05) and 95% (L) (p < 0.05). Laryngeal reactivity significantly decreased (p < 0.001) from 40% (P) to 15% (F) and 10% (L). Tracheal reflexes decreased from 84.6% (P) to 55% (F) (p < 0.01) and 37% (L) (p < 0.001). Blood pressure and heart rate rose with intubation over the basal levels in group P and significantly decreased in groups F and L. CONCLUSIONS: The use of propofol without neuromuscular blockade is inadequate for intubation since laryngotracheal reflexes are not suppressed. Besides, propofol does not prevent hemodynamic reactions. Premedication with fentanyl and/or lidocaine improves the responses not sufficiently to safely perform intubation.