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.

Efecto de blanqueamientos de oficina sobre el fosfato en el esmalte dental / Effect of in-office whitening (bleaching) on phosphate concentration in dental enamel

Resumen Objetivo: Analizar los cambios en la molécula de fosfato v1 en el esmalte dental luego de la aplicación de blanqueamiento dental de oficina a diferentes concentraciones y tipo de activación. Material y métodos: 30 piezas dentales humanas recién extraídas, libres de caries y pigmentaciones fueron distribuidas aleatoriamente en tres grupos experimentales. Los blanqueamientos dentales utilizados en cada grupo experimental fueron Zoom! WhiteSpeed (grupo 1), Pola Office con fotoactivación (grupo 2) y Pola Office sin fotoactivación (grupo 3). Los agentes blanqueadores fueron aplicados de acuerdo con las instrucciones del fabricante, con dos aplicaciones en la primera sesión y una aplicación en la segunda sesión. Se midió la concentración de la molécula de fosfato v1 en el esmalte dental previo al tratamiento y después de cada sesión de blanqueamiento por medio de espectroscopia Raman. Se realizó el análisis de varianza ANOVA para mediciones repetitivas (p ≤ 0.05) y test de Bonferroni para comparaciones entre sesiones de tratamiento y semana control. Resultados: Los tres blanqueamientos de oficina utilizados causaron un incremento en la concentración de la molécula de fosfato v1 durante el proceso de blanqueamiento (p ≤ 0.05). Pola Office, con ambos tipos de activación, causó un aumento significativo en fosfato durante todo el tratamiento. Zoom! WhiteSpeed mostró un incremento significativo respecto a la semana control, pero no entre la primera y segunda sesión (p ≤ 0.05). Conclusiones: Dentro de las limitaciones de este estudio es posible concluir que los tres blanqueamientos de oficina estudiados provocaron un aumento de la molécula fosfato v1. El tipo de activación no causó una diferencia significativa.

Abstract Objective: To analyze changes in phosphate molecules in dental enamel after application of in-office dental bleach at different concentrations and type of activation. Material and methods: 30 recently extracted, human teeth free of caries and pigmentations were randomly distributed into three experimental groups. Tooth whitening materials used in each experimental group were Zoom! WhiteSpeed (group 1), Pola Office with light-activation (group 2) and Pola Office without light activation (group 3). Bleaching agents were applied according to manufacturer's instructions; two applications on the first sessions and one application in the second session. With Raman spectroscopy phosphate v1 molecule concentration was measured in tooth enamel before treatment and after each bleaching session. ANOVA variance analysis was used for repetitive measurements (p ≤ 0.05); Bonferroni post hoc test was used for comparisons between treatment sessions and control week. Results: All three in-office bleachers elicited increase in phosphate v1 molecule concentration during bleaching process (p ≤ 0.05), Pola Office, with both types of activation caused significant phosphate increase during the whole treatment. Zoom! WhiteSpeed showed significant increment with respect to control week, but did not show increase between first and second session (p ≤ 0.05). Conclusions: Within the scope of this study's limitations, it is possible to conclude that all three studied in-office bleaching agents increased phosphate v1 molecule. Activation type did not elicit significant difference.

Caffeine consumption and exacerbations of chronic obstructive pulmonary disease: retrospective study.

BACKGROUND: The modulation of adenosine receptors has been proposed as new therapeutic target for chronic obstructive pulmonary disease, but studies in humans were negative. Caffeine is widely consumed and acts by non-selective modulation of these receptors, allowing for a non-interventional evaluation of the purinergic effects on COPD. We evaluated the effects of chronic caffeine consumption on the risk for COPD exacerbations. METHODS: Retrospective study including patients with COPD. The total number of exacerbations during a three-year period and the mean daily caffeine consumption in the last twenty years were evaluated. A univariate and multiple regression analysis were performed for evaluation of the significant predictors of exacerbations. RESULTS: A total of 90 patients were included. Most were males (82.2%) and had a mean forced expiratory volume in the first second (FEV1) of 57.0±17.1% predicted. The mean daily caffeine consumption was 149.7±140.9mg. There was no correlation between the mean caffeine consumption and exacerbations (p>0.05). DISCUSSION: Our results suggest that caffeine has no significant effect on the frequency of COPD exacerbations. These conclusions are limited by the sample size and the retrospective nature of the study.

Churg-Strauss syndrome: case series.

Churg-Strauss syndrome (CSS) is a systemic necrotizing vasculitis of the small and medium vessels, associated with extravascular eosinophilic granulomas, peripheral eosinophilia and asthma. This is a rare syndrome of unknown etiology, affecting both genders and all age groups. CSS patients usually respond well to steroid treatment, although relapses are common after it ends. Timely diagnosis and treatment generally lead to a good prognosis with a 90% survival rate at one year. A brief review of CSS is presented, with particular attention to diagnosis, therapy and recent developments in this area. The authors then report and discuss the clinical, laboratory and imaging characteristics of four patients admitted to an Internal Medicine Department with this diagnosis. The treatment, response and follow-up of the cases are also described.

Organizing pneumonia due to actinomycosis: an undescribed association.

Organizing pneumonia is a pathologic entity characterized by intra-alveolar buds of granulation tissue that can extend to the bronchiolar lumen. It is a non-specific finding reflecting a pattern of pulmonary response to aggression that can be cryptogenic or associated with several causes. Pulmonary actinomycosis is a rare infectious disease, of bacterial aetiology, and of difficult diagnosis. This disease usually causes non-specific respiratory symptoms and radiological findings, and the treatment is based on the use of antibiotics. The authors describe a clinical case of a 53-year-old male smoker (50 pack years), initially seen for complaints of right-sided chest pain and sub-febrile temperature. Imaging studies revealed a mass in the inferior right lobe and enlarged mediastinal lymph nodes. Empirical treatment with antibiotics caused partial and temporary improvement. Transthoracic biopsy revealed a pattern of organizing pneumonia with giant multinucleated cell granulomas. Repeat imaging studies revealed an enlargement of the pulmonary mass and therefore a right inferior lobectomy was performed. The pathologic study revealed a histological pattern of organizing pneumonia surrounding inflammatory bronchiectasis with a large number of Actinomyces colonies. To our knowledge there is presently no report in the literature of organizing pneumonia associated with Actinomyces infection.

Most-probable-number rapid viability PCR method to detect viable spores of Bacillus anthracis in swab samples.

A comparison of Most-Probable-Number Rapid Viability (MPN RV) PCR and traditional culture methods for the quantification of Bacillus anthracis Sterne spores in macrofoam swabs from a multi-center validation study was performed. The purpose of the study was to compare environmental swab processing methods for recovery, detection, and quantification of viable B. anthracis spores from surfaces. Results show that spore numbers provided by the MPN RV-PCR method were typically within 1-log of the values from a plate count method for all three levels of spores tested (3.1x10(4), 400, and 40 spores sampled from surfaces with swabs) even in the presence of debris. The MPN method tended to overestimate the expected result, especially at lower spore levels. Blind negative samples were correctly identified using both methods showing a lack of cross contamination. In addition to detecting low levels of spores in environmental conditions, the MPN RV-PCR method is specific, and compatible with automated high-throughput sample processing and analysis protocols, enhancing its utility for characterization and clearance following a biothreat agent release.

Rapid, high-throughput, culture-based PCR methods to analyze samples for viable spores of Bacillus anthracis and its surrogates.

To rapidly remediate facilities after a biothreat agent release, improved turnaround times are needed for sample analysis. Current methods to confirm the presence of a viable biothreat agent are limited by low sample throughput. We have developed a rapid-viability-polymerase chain reaction (RV-PCR) method to determine the presence of viable spores. The method combines high-throughput sample processing with 96-well PCR analysis, which measures a change in real-time, quantitative PCR response arising from increased target-cell populations during culturing. The method accurately detects 1 to 10 live spores in a high-dead spore background (10(6)). Field tests using approximately 1000 biological indicators, each containing 10(6) spores of the B. anthracis surrogate, Bacillus atrophaeus, exposed to seven lethal and sub-lethal chlorine dioxide levels showed no significant difference (p>0.05) between RV-PCR and standard culturing methods for detecting the percent survival of spores. RV-PCR results were obtained in <17 h compared to 7 days for the standard culturing method. High-throughput sample processing and RV-PCR protocols were also developed and tested for synthetic wipe samples containing reference dirt material. RV-PCR protocols allowed processing and accurate analysis of approximately100 dirty wipe samples (2''x2'' synthetic) containing approximately10 viable B. atrophaeus spores in <24 h. Quantitative RV-PCR protocols based on a Most-Probable-Number (MPN) statistical approach developed for B. anthracis Sterne resulted in more rapid turnaround times than those for traditional culturing and no significant difference in log colony-forming units compared to traditional viability analysis. Integration of RV-PCR assays with high-throughput protocols will allow the processing of 200 wipe samples per day per robot using commercially available automation.

Assessing the risk of infection and rejection in Hispanic renal transplant recipients by means of an adenosine triphosphate release assay.

INTRODUCTION: Because of the necessary immunosuppression, transplant recipients have a high risk of infection. Conversely, underimmunosuppression carries with it the risk of rejection. It would be quite useful to have a test that could differentiate between infection and rejection in renal transplant patients and better still, to predict which patients are at risk of complications. A new assay, which measures adenosine triphosphate (ATP) synthesis by CD4+ T cells in response to stimulation by phytohemagglutinine (Immuknow assay, Cylex, Inc) is undergoing clinical evaluations. Preliminary investigations suggest that this test could be useful to assess and predict the immune status of patients with other conditions. METHODS: We examined the records of all patients who received a kidney transplant in our program between August 2004 and January 2005. Of 64 patients, 58 had pretransplant and posttransplant ATP level determinations. We searched for associations between ATP levels and immunosuppression type, doses, and levels; creatinine levels; white blood cell count; tissue typing; preformed antibodies; as well as ATP levels on infection and rejection, and changes in ATP levels with time. Chi-square, Fisher, t test, analysis of variance (ANOVA), and relative risks were used for analysis of data. RESULTS: There was no relation between ATP levels and immunosuppression type, doses, or levels; creatinine levels; white blood cell counts; HLA; and panel-reactive antibody (P > 0.05). However, patients with moderate or high pretransplant ATP levels had more rejection episodes (8/10) while patients with ATP levels in the low immune response had more infections (6/11) (P < .001; relative risk [RR] for rejection = 1.2; RR for infection = 4.4). The mean ATP levels for rejection was 423.3 ng/mL versus 268.45 ng/mL for infection and 277.15 ng/mL for no events (ANOVA, P = .0145). Although acute rejections occurred mostly above 300, this was not significant (P = .059; RR = 0.9). Infections were more frequent with ATP under 300 (RR = 7.3) and severe infection (endocarditis, meningitis, peritoneal abscesses, pneumonia, etc) were more frequent under 200 (P < .001). Comparing pretransplant with posttransplant values at the second week an increase correlated with rejection (P < .001, RR = 15.3), while a decrease did not correlate with the infection (P = .845, RR = 1.4). Patients who received antirejection treatment had a decrease in their ATP levels at 5 days (P = .002). CONCLUSION: This ATP release assays helpful in determining the risk of developing infection or rejection, as well as follow-up in the response to therapy.

[Nutritional and microbiological profile of soybean sausages available in Costa Rica]. / Perfil nutricional y microbiológico de los embutidos de soya disponibles en Costa Rica.

The nutritional and microbiological quality of 80 soybean sausage samples (50% frankfurter and 50% sausage mortadela) was studied. On average, the protein content was 17.5 g/100 g in sausage mortadela and 20 g/100 g in frankfurter. The mean total fat content was 5.5 g/100 g for both products. However when products of different manufacture industries were compared, a highly significant difference (p = 0.0000) in the fatty acids speciation between both groups and between samples of the same product were found. Bigger differences were found in the content of palmitic acid (C16:0), oleic acid (C18:1) and linoleic acid (C18:2). Cholesterol was not detected in samples analyzed. On average the atherogenicity index was 0.55 for sausage mortadela and 0.59 for frankfurter. A consumption of 25 grams of of soybean protein from these sausages can bring an intake of saturated fatty acids between 20-90% of the daily recommendation. Likewise, they can supply between 12-70% of the recommended daily polyunsaturated fatty acids. These variations are owing to the big difference in fatty acids speciation in each sausage brand. Around 20% of soybean sausages studied showed total coliform levels above 10(4)/g, being more frequent in sausage mortadela. Also 60% of this product and 10% of frankfurters showed psychrotroph levels of 10(6)/g. Clostridium perfringens, in levels above 10(2)/g was evidenciated in 5% of samples, Escherichia coli was not isolated from them. The findings of this study suggest the urgent need for implementing a quality control system for soybean sausages, before national health authorities consider to support nutritional campainings that promote their consumption.

Squamous cell carcinoma of the penis arising on lichen sclerosus et atrophicus.

Squamous cell carcinoma of the penis arising on lichen sclerosus et atrophicus is rarely reported. A case is described in a 63-year-old man who had been diagnosed of lichen sclerosus et atrophicus 3 years before. The previously reported cases, the association of these diseases in women and men, and the possible pathogenesis are discussed.

Inaplicabilidad de los patrones internacionales de capacidad vital en poblaciones adultas residentes permanentes de altura en Chuquicamata / Unapplicability of international standards of vital capacity in an adult population living at high altitude in Chuquicamata

Se trata de un estudio longitudinal prospectivo efectuado en Chuquicamata (Chile) en una población de 276 hombres normales; 327 mujeres normales y 132 mineros activos, todos residentes permanentes de ese nivel de altura (2.800 mt. s.n.m.). Se muestra los valores de capacidad vital (CV) obtenidos para cada grupo y subgrupos etarios. El valor promedio fue de 5065; 3610 y 4707 ml BTPS, respectivamente, signficativamente superiores a nivel de p < 0.0001, en los tres grupos cuando sde compararon con los valores ideales según los estándares internacionales del Kory (117.6%;121.7% y 111.8%, respectivamente) y Knudson (117.1%;116.5% y 111.3, respectivamente). No se demostró D.E.S. entre el uso de una u otra ecuación de regresión de referencia, a excepción de la población femenina, en la cual la ecuación de Knudson resultó menos alejada de los valores obtenidos. Sin embargo ambos estándares internacionales son igualmente inaplicables. Pese a que las capacidades vitales obtenidas en la población minera activa son significativamente superiores a las normas internacionales, ellas fueron significativamente inferiores a las obtenidas en los hombres normales estudiados (p < 0.0001) de igual edad. Esta diferencia puede explicarse por el deterioro que la faena minera causa en la función pulmonar, hecho que por primera vez se demuestra en nuestro medio, respecto de una población comparable

Cáncer de la vesícula biliar: estudio anatomoclínico de 100 casos / Gallblader cancer: anatomoclinical study of 100 cases

Se estudian retrospectivamente 100 casos de cáncer vesicular operados en el Hospital Clínico de la Pontificia Universidad Católica de Chile entre 1970 y 1984. Se registra un aparente aumento de su incidencia en los últimos años. Es mas frecuente en el sexo femenino, sobre los 50 años y se asocia a colelitiasis en el 87% de los casos. Más del 85% son adenocarcinomas. Su diagnóstico con frecuencia se hace por laparotomía y corresponde a etapas irresecables, en las que sólo caben medidas paliativas. Su pronóstico, generalmente es muy malo con sobrevida a 5 años menor al 5%. Los pocos casos con mejor sobrevida corresponden a pacientes con "cáncer oculto", de tipo papilar y en los que el tumor no sobrepasa la serosa. Se propone como única medida práctica actual para mejorar su pronóstico, la detección y tratamiento intraoperatorio del "cáncer oculto". Se recomienda la colecistectomía profiláctica en pacientes de mayor riesgo

Capacidad vital en trabajadores residentes en altura: ¿son las normas actualmente en uso confiables? / Vital capacity of workers living in high altitude: are the standards reliably

Se analizan diversos parámetros antropométicos, físicos y la C.V. de 131 trabajadores varones residentes en altura (2.400-2.800 m.s.n.m.),encontrándose una C.V. significativamente mayor que la de grupos comparables obtenidas por investigadores extranjeros y la de un estudio nacional realizado en trabajadores que residen en Santiago (450 m.s.n.m.) se infiere que las normas actualmente en uso no son confiables para la evaluación de la normalidad o anormalidad de la función pulmonar de la población trabajadora chilena. Mediante análisis computacional se determinó la ecuación de regresión múltiple para la C.V., en relación con las variables independientes edad y estatura, para población masculina, trabajadora, sana y que reside a una altitud calificada como moderada. Esta fórmula es: C.V.(1)=0,0848 por talla (cm)- 0,016 por edad (años)- 8,51; que es diferente a la encontrada por Kory y cols. que es la norma de referencia en la evaluación médico-legal de las enfermedades respiratorias ocupacionales. La aplicación de esta norma puede originar considerables errores, especialmente en sujetos residentes de altura. Se postula que dentro de los factores que pueden incidir en el valor de la C.V. de trabajadores, debe considerarse la altura a la cual residen y su correspondiente presión barométrica. Esto se desprende de cuatro estudios nacionales realizados a diferentes altitudes y en los cuales la C.V. de los sujetos aumenta a medida que la presión barométrica disminuye. La C.V.F. fue mayor en los sujetos que realizaban actividad física habitual, al igual que lo que ocurre a nivel del mar, donde los deportistas tienen valores significativamente superiores a grupos comparables de la población general