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Cystic fibrosis (CF) is the most common autosomal recessive disease in Caucasians. Although most cases are diagnosed in childhood, diagnosis in adults is apparently increasing. Objective: Evaluate the adult population with CF, comparing patients who were diagnosed before and after 18 years of age. Methods: Retrospective analysis of patients followed in three main medical centres in Portugal in 2012. Comparison of two groups: G1 â patients diagnosed at

Introduction: The incidence of cystic fibrosis (CF) in Portugal is estimated at 1:8000 live births, although there is a lack of accurate statistics. The average life expectancy has been steadily increasing and CF is no longer an exclusively pediatric disease. Objectives: Characterize the Portuguese adult population with the diagnosis of CF. Methods: Retrospective study based on clinical data of adult CF follow-up patients in the three specialized centers in Portugal where all of CF patients are seen, during 2012. Results: In 2012, there were 89 follow-up patients, 48 (54%) female and 15 (17%) lung transplanted. The average age was 31.3 ± 9 years. The median age at diagnosis was 13 years and 34 (38%) were diagnosed in adulthood. The most frequent mutation was F508del (54.9%). Of the 89 patients, 49 patients (56%) had pancreatic insufficiency, 7 (9%) were diabetic and 42 patients (47.7%) had a body mass index (BMI)

The aims of this study were to analyze whether age, tooth type and sex are related to radiographically visible extrusion of filling material as an unintended outcome in teeth undergoing endodontic treatment with a thermoplastic obturation technique (Calamus® or GuttaCore®) and to determine whether the presence of such overfilling is associated to postoperative pain. We selected 120 teeth with diagnoses involving vital pulp and indication for endodontic treatment. Biomechanical preparation was performed using the Protaper Next® system with X2 or X3 master apical file. Teeth were randomly divided into 2 groups (n=60). Teeth in Group 1 were filled with the Guttacore® system and teeth in Group 2 were filled with single cone technique and Calamus® obturation system. Thermoplastic obturation techniques were found to cause overfilling in 53. 33% of the total cases (64 teeth) (56. 66% in Guttacore® group and 50% in the Calamus® group). Anterior teeth were found to be associated to presence of overfilling (p= 0. 024) (OR = 4. 35). Of the 120 teeth treated, 10 (8. 33%) presented postoperative pain and radiographically visible overfilling. The association between presence of extruded filling material and mild/moderate pain was statistically significant withp = 0. 002. To conclude, endodontic thermoplastic obturation with Guttacore® and Calamus® systems are significantly associated with the probability of filling material extrusion, and overfilling is associated to postoperative pain. Anterior teeth are 4 times more likely to be overfilled with the obturation techniques tested.Los objetivos de esta investigación fueron: Analizar si factores como la edad, el tipo de diente y el género están asociados con la extrusión de material obturador radiográficamente visible como desenlace imprevisto en dientes sometidos a tratamiento endodóntico con una técnica de obturación termoplástica (Calamus® o GuttaCore®) y determinar si la presencia de esta sobreobturación está asociada con dolor posoperatorio. Se seleccionaron 120 dientes con diagnósticos que implicaban pulpa vital y con indicación de tratamiento de endodoncia. La preparación biomecánica se llevó a cabo con el sistema ProtaperNext® con lima apical principal X2 o X3. Los dientes se dividieron aleatoriamente de la siguiente forma (n=60): El grupo 1 se obturó con el sistema Guttacore® y el grupo 2 se obturó con una técnica de obturación de cono único y el sistema de obturación Calamus®. Se observó quelas técnicas de obturación termoplástica generaron sobreobturación en 53. 33% del total (64 dientes), 56. 66% se presentaron en el grupo de obturación con Guttacore® y 50% en el grupo de la técnica con el sistema Calamus®. Se encontró que los dientes anteriores presentaron asociación con la presencia de sobreobturación (p= 0. 024) (OR=4. 35). De los 120 dientes tratados, 10 (8. 33 %) presentaron dolor posoperatorio y sobreobturación radiográficamente visible. La asociación entre la presencia de extrusión de material de obturación y dolor leve-moderado fue estadísticamente significativa con un valorp= 0. 002. Como conclusión las técnicas de obturación termoplástica en endodoncia Guttacore® y el sistema Calamus® están asociadas significativamente con la probabilidad de extrusión de material obturador y dicha sobreobturación está asociada con dolor posoperatorio, los dientes anteriores presentan 4 veces más riesgo de sobreobturación con las técnicas de obturación utilizadas.

Background: The opioid system modulates prolactin release during late pregnancy. Its role and the participation of ovarian hormones in this modulation are explored in ether stress-induced prolactin release. Methods/Results: Estrous, 3-day and 19-day pregnant rats were used. We administered the antagonist mifepristone (Mp) and tamoxifen to evaluate progesterone and estradiol action in naloxone (NAL, opioid antagonist) or saline treated rats. Ether stress had no effect on serum prolactin levels in controls but increased prolactin release in NAL-treated rats. Prolactin response to stress in NAL-treated rats was blocked by L-DOPA administration. Mp treatment on day 18 of pregnancy increased prolactin levels after stress without alterations by NAL. Tamoxifen on days 14 and 15 of pregnancy completely blocked Mp and NAL effects on prolactin release at late pregnancy. In contrast, stress significantly increased prolactin levels in estrous rats and pretreatment with NAL prevented this. On day 3 of pregnancy, at 6.00 p.m., stress and NAL treatment inhibited prolactin levels in saline-treated rat. No effect of stress or NAL administration was detected on day 3 of pregnancy at 9.00 a.m. icv administration of specific opioids antagonist, B-Funaltrexamine but not Nor-Binaltorphimine or Naltrindole, caused a significant increase in stress-induced prolactin release. Conclusions: Opioid system suppression of prolactin stress response during late pregnancy was observed only after progesterone withdrawal, involving a different opioid mechanism from its well-established stimulatory role. This mechanism acts through a mu opioid receptor and requires estrogen participation. The opioid system and progesterone may modulate stress-induced prolactin release, probably involving a putative prolactin-releasing factor. Fil: Valdez, Susana Ruth. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; Argentina. Universidad Nacional de Cuyo; Argentina Fil: Pennacchio, Gisela Erika. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; Argentina Fil: Gamboa, Dante F.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; Argentina Fil: de Di Nasso, Elina G.. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; Argentina Fil: Bregonzio Diaz, Claudia. Universidad Nacional de Córdoba. Facultad de Ciencias Químicas. Departamento de Farmacología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Soaje, Marta. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; Argentina. Universidad Nacional de Cuyo. Facultad de Ciencias Médicas; Argentina

Deciduoid Mesothelioma is a rare variant of epithelioid mesothelioma; it was initially thought that it only occurred in the peritoneum of young women and had nothing to do with asbestos exposure. However, since these early findings it has also been observed in the pleura and the pericardium, with possible association to asbestos. In general the prognosis is poor compared to epithelioid mesothelioma. 45 cases have been reported in the literature up to now, 22 of these were located in the pleural cavity. The authors describe a case of deciduoid pleural mesothelioma in a 40-year-old-woman who presented with right pleuritic chest pain, with no history of asbestos exposure, treated with chemotherapy followed by surgery and who died postoperatively.

Patients with cystic fibrosis (CF) have an increasing life span and osteoporosis has become a more recognised problem in these patients. The pathogenesis of low bone mineral density (BMD) in CF seems to be multifactorial and the aim of this study was to assess the prevalence of low BMD in a group of CF outpatients and to relate the findings with the variables studied.The study included 22 patients aged between 14 and 45 years (mean age 26.3). Two of the subjects were lung transplant patients. BMD was assessed by dualenergy X-ray absorptiometry (DEXA) at the lumbar spine (LS) and femoral neck (FN). This data was correlated with serum 25-hydroxy vitamin D (25-OHD) levels, BMI and the forced expiratory volume in one second (FEV1).BMD (Z-score and T-score) ranged from 0.6 to -6 and from 0.5 to -6.7 at LS; at FN the scores ranged from 0.6 to -3.9 and from 0.6 to -4.1. The mean serum 25-OHD concentration (12,57 ng/ml) was at the low end of the normal range (10-60 ng/ml). On average patients did not present with malnutrition, however BMI ranged from 15.2 to 33.7 kg/m2. Lung function status was assessed by FEV1; 64% of patients had FEV1 below 80% and within this group four patients had a FEV1 under 40%.There was a positive correlation between low BMD and 25-OHD concentrations and also between BMD and FEV1. There was no linear correlation between BMD and BMI. Resumo: A esperança de vida dos doentes com fibrose quística (FQ) tem vindo a aumentar, sendo mais frequente a identificação de osteoporose. A patogénese de uma baixa densidade mineral óssea (DMO) na FQ parece ser multifactorial e o objectivo deste trabalho foi avaliar a prevalência de baixa DMO num grupo de doentes com FQ e a sua correlação com outros parâmetros avaliados.O estudo incluiu 22 doentes com FQ com idades compreendidas entre os 14 e os 45 anos (média 26,3), dois dos quais transplantados pulmonares. A DMO foi avaliada por densitometria óssea ao nível da coluna lombar e do colo do fémur. Estes dados foram correlacionados com os valores séricos de 25-hydroxivitamina D, o IMC e o volume expiratório máximo forçado no primeiro segundo (VEM).Os valores da DMO (Z-score e T-score) variaram entre 0,6 e -6 e entre 0,5 e -6,7, respectivamente, a nível da coluna lombar e entre 0,6 e -3,9 e 0,6 e -4,1 a nível do colo do fémur. A média das concentrações séricas de 25-(OH)D (12,57 ng/ml) encontrava-se no limite inferior da normalidade (10-60 ng/ml). Em média os doentes não apresentavam malnutrição mas os valores de IMC variam entre 15,2 e 33,7 kg/m2. Relativamente à função pulmonar, 64% dos doentes apresentavam VEM inferior a 80% e, destes, quatro tinham valores inferiores a 40%. Foi encontrada uma correlação positiva entre valores baixos de DMO e VEM, assim como entre valores de DMO e 25-OHD. Não houve correlação linear entre IMC e DMO. Key-words: Cystic fibrosis, bone mineral density, vitamin D, Palavras-chave: Fibrose quística, densidade mineral óssea, vitamina D

Patients with chronic conditions are often readmitted to hospital. A study was designed to improve health care to these patients.Patients attended at the Internal Medicine Department of a hospital area who were admitted to hospital at least three times in a year were included in the study. Within a prospective study, patients were attended by means of specific consultation with care upon request and telephone care, with the possibility of programmed admission.Patients were followed for 32 months, with a 45% decrease in the admission rate, 50% in visits to the Emergency Department, and 26% in hospital stay days.The proposed care model decrease the attending needs for these patients.

Decrease in mortality due to cardiovascular diseases during last years seems to be a widespread phenomenon in industrialized countries. This study analyses the evolution of mortality due to cardiovascular diseases in Andalucía, Spain, from 1975 to 1992. The analysis has been carried out for ischemic heart diseases, cerebrovascular diseases and cardiovascular diseases as a whole.Data of mortality have been obtained from the Natural Movement of the Population. From these data, both the annual standardized rates for age and sex through the direct method and percentage differences between 1975 and 1992, have been estimated.Decrease in mortality due to cardiovascular diseases for men was of 33.5% between 1975 and 1992, with 13.8% in the ischemic cardiopathy and 46.0% for cerebrovascular diseases. For women, reduction was of 33.8, 29.3 and 42.4% respectively.In Andalucía and for the period analyzed, mortality due to cardiovascular diseases is clearly decreasing. Such a reduction has been produced mainly for the cerebrovascular diseases, and it is remarkable the low percentage of the average decrease due to ischemic heart disease for men during the last years.

To measure interleukin-1 beta (IL-1 beta) levels in pleural effusions of different etiologies and their relationship with several pleural inflammatory parameters, and to verify whether IL-1 beta can be used as diagnostic marker in the differential diagnosis of pleural diseases.One hundred two pleural effusions were analyzed using a monoclonal antibody enzyme-linked immunosorbent assay. Pleural fluids were classified as follows: transudates (n = 28), empyema (n = 14), parapneumonic (n = 13), tuberculous (n = 19), neoplastic (n = 17), and miscellaneous effusions (n = 11).IL-1 beta was above 200 pg/mL in all the patients with empyema but only in three patients with other etiologies. Two of those three had parapneumonic effusions and the remaining one had a tuberculous pleurisy with a previous bacterial empyema. No significant relationships were found between pleural effusion IL-1 beta levels and the different inflammatory parameters analyzed. As a diagnostic criterion for empyema, pleural IL-1 beta concentration greater than 200 pg/mL had a sensitivity of 100%, a specificity of 96%, and a positive and negative predictive value of 0.82 and 1, respectively.Our data suggest that IL-1 beta has a significant role in pyogenic infections of the pleural space but not in effusions of other etiologies. It could be used as a diagnostic marker of empyema.

Dementia is an infrequent and little known manifestation of giant cell arteritis or temporal arteritis (GCA-TA). The cases of 2 women with histologically proven GCA-TA are presented in which, together with the most classical symptoms, they presented a brusque mental deterioration on initiation of the disease. One patient developed a severe irreversible dementia which coincided with a rapid reduction in the doses of corticoids; while the other patient demonstrated improvement in cognitive function with steroid treatment and control of the disease. Magnetic resonance studies revealed multiple areas of infarction in both hemispheres in the two patients. The importance of treating multi-infarct dementia is underlined in the context of GCA-TA with high doses of corticoids. It is also emphasized that GCA-TA should be considered in the evaluation of older patients with mental alterations.

Shigella, toxigenic Escherichia coli (stable toxin) and rotaviruses were frequently found among 50 children hospitalized with diarrhea studied during one year. These agents were less common among 45 controls without diarrhea, of comparable age and from the same wards as the cases reported. There was a greater frequency of respiratory symptoms in the diarrhea associated with rotaviruses. These were characterized by frequent bowel movements and vomiting and often fever. The bacterial diarrheas showed, in general, a more severe clinical picture than the viral ones. The rotaviruses had a low endemic level during April-October, but their prevalence increased in December and January; in such months these viruses were found in more than 50 per cent of the diarrheal cases.