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The level of expenditure by cruise passengers in the various cities visited during their journey is a crucial variable for the key stakeholders involved in this industry. Promoting higher spending by cruise passengers in non-overnight stay ports is a challenge led by the destination manager. This study aims to shed light on the effect that different phases in the cruise passenger’s travel cycle have on their propensity to spend during their stay. Our case focuses on the city of A Coruña, a non-overnight stay port on Europe’s Atlantic arc routes, where the average spending per cruise passenger during their visit is quite low. The analysis considers the impact of passenger profiles and the cruise product consumption phases on the average spending per passenger. From a methodological perspective, we have applied logistic regression. The results indicate that the profile of the cruise passenger, variables related to the onboard journey, and the experience of the city are the factors with the greatest potential to increase cruise passenger spending during their visit to the city. This has allowed the areas of greatest impact and where actions should be focused to be identified for both the destination manager and key stakeholders.

Terra firma-forme dermatosis is a dermatological condition characterized by the presence of hyperpigmented plaques, which are easily cleared with 70% isopropyl alcohol. CASE 1: A 14-year-old boy, with no relevant past medical history, presented with a brown-colored skin lesion on his chest, which had appeared one year earlier. The lesion was cleared with 70% isopropyl alcohol, proving the diagnosis of terra firma-forme dermatosis. CASE 2: A 12-year-old girl was referred to our consultation. She was obese and had insulin-resistance. On physical examination she had significant hyperpigmentation on her neck and axillae, which was interpreted as acanthosis nigricans. Nonetheless, we performed swabbing of the lesions with 70% isopropyl alcohol, which immediately cleared the skin, confirming the diagnosis of terra firma-forme dermatosis. In conclusion, terra firma-forme dermatosis is a benign and easily solved dermatosis. Nonetheless, its unesthetic appearance is often a cause of great distress to the patient. We aim to increased awareness of this entity.

The level of expenditure by cruise passengers in the various cities visited during their journey is a crucial variable for the key stakeholders involved in this industry. Promoting higher spending by cruise passengers in non-overnight stay ports is a challenge led by the destination manager. This study aims to shed light on the effect that different phases in the cruise passenger's travel cycle have on their propensity to spend during their stay. Our case focuses on the city of A Coruña, a non-overnight stay port on Europe's Atlantic arc routes, where the average spending per cruise passenger during their visit is quite low. The analysis considers the impact of passenger profiles and the cruise product consumption phases on the average spending per passenger. From a methodological perspective, we have applied logistic regression. The results indicate that the profile of the cruise passenger, variables related to the onboard journey, and the experience of the city are the factors with the greatest potential to increase cruise passenger spending during their visit to the city. This has allowed the areas of greatest impact and where actions should be focused to be identified for both the destination manager and key stakeholders. [ABSTRACT FROM AUTHOR]

Introdução: A síndroma ARCAPA (origem anómala da artéria coronária direita a partir da artéria pulmonar) é uma cardiopatia congénita rara. Pode cursar com enfarte agudo do miocárdio ou morte súbita, embora a maioria dos doentes não apresente sintomas, sendo o diagnóstico realizado acidentalmente. O médico de família (MF) é o profissional que melhor pode compreender a perspetiva do utente face à doença, integrando-a no seu contexto biopsicossocial. Descrição: Sexo masculino, 48 anos. Antecedentes de perturbação da ansiedade generalizada. Praticante regular de exercício físico de alta intensidade. Em fevereiro/2019, por intercorrência febril e suspeita de pneumonia, realizou TC-tórax, que revelou “ectasias vasculares pericárdicas extensas”, tendo sido referenciado à consulta de cardiologia pelo MF. Realizou angioTC, que evidenciou “síndrome ARCAPA”. Encontrava-se assintomático do ponto de vista cardiovascular. Pelo risco de morte súbita foi proposta cirurgia e recomendada a suspensão do exercício físico. A descoberta acidental desta síndroma, numa fase de ausência de sintomas, gerou sentimentos de incompreensão no doente, agudizando a patologia ansiosa. Através de uma abordagem centrada na pessoa, o MF procurou compreender as expectativas, sentimentos e medos do doente, bem como envolver a família na tomada de decisão. O doente, por sua iniciativa, manteve a prática de exercício, afirmando que a suspensão iria contribuir negativamente para a sua saúde mental. Rejeitou também a proposta cirúrgica. Atualmente mantém consultas de seguimento regulares com o MF e cardiologista para vigilância de sintomas. Comentário Para além da sua raridade, o caso descrito reflete a importância da prática de uma medicina centrada na pessoa, sobretudo após o diagnóstico de uma patologia grave, com tamanho impacto na vida do doente. É fulcral que o MF tenha o conhecimento científico necessário para a gestão da doença e que a integre no contexto psicossocial e familiar do utente, aconselhando-o e apoiando-o na partilha das suas decisões.

O progresivo envellecemento da poboación galega supón un crecemento nos custos do sistema sanitario e un desafío para a sociedade no seu conxunto para abordar os coidados e necesidades destes pacientes. Na actualidade a fragmentación do sistema sanitario en niveis e a práctica ausencia dunha coordinación entre estes e os servizos sociais fai necesario e desenvolvemento e instrumentos e canles que optimicen os recursos e melloren de forma progresiva a atención integral das persoas en situación de cronicidade. Durante os últimos anos definíronse diversos modelos de atención á cronicidade nun intento de mellorar a eficiencia da xestión dos sistemas sanitarios. Neste artigo descríbese un modelo de atención integral centrado no traballo en rede e transversal entre os diferentes actores de sistema sanitario implicados na atención á cronicidade, así como as oportunidades de mellora do modelo de atención á cronicidade. Abstract The progressive aging of the population Galician involves an increase in costs of health care and a challenge for society to address the care and needs of these patients. Actually, the fragmentation of the sanitary system and the practical absence of a coordination between the sanitary and socio-sanitary systems does necessary the development of instruments and ways that optimize the resources and improve of progressive form the integral attention of chronicity. Last years, defined diverse models of attention to the chronicity in one to improve the efficiency of the management in the sanitary system. This article describes a comprehensive care model focused on networking and cross between the different stakeholders involved in the health care for chronicity, as well as the opportunities for improvement of a model of a care chronicity.

Introdução: A hipertensão arterial (HTA) secundária corresponde a cerca de 5-10% dos casos de hipertensão. Perante uma hipertensão em adultos jovens deve-se suspeitar de causas secundárias e proceder a uma investigação clínica, laboratorial e imagiológica adequada. Em adultos jovens (19-39 anos) as causas mais frequentes de HTA secundária são as disfunções tiroideias, a displasia fibromuscular da artéria renal e as doenças do parênquima renal. Relata-se um caso clínico de uma jovem, na qual o estudo de hipertensão secundária revelou hipertiroidismo auto-imune. Descrição do Caso: Utente do sexo feminino, 19 anos de idade, que recorreu a consulta de saúde de adultos por palpitações, taquicardia (FC média: 117 bpm), e tensão arterial elevada (TA média: 154/86 mmHg), objetivadas em ambulatório desde há um mês. Constatou-se ainda ansiedade, insónia inicial, irritabilidade e polifagia. Ao exame objetivo confirmou-se HTA grau 1 e taquicardia, bem como palpação de bócio difuso, indolor e simétrico, sem nódulos aparentes, tendo sido medicada com propranolol. Do estudo efetuado confirmou-se hipertiroidismo de etiologia auto-imune, anemia microcítica e hipocrómica, aspetos sugestivos de tiroidite na ecografia, bem como bócio difuso com captação aumentada na cintingrafia tiroideia, sugestivo de Doença de Graves. A utente foi medicada com metibasol 5 mg 12/12h e referenciada para consulta de Endocrinologia. Verificou-se melhoria da sintomatologia, estabilização tensional e normalização da função tiroideia. Comentário: Este caso clínico pretende ilustrar a abordagem diagnóstica e terapêutica da HTA no adulto jovem, nos cuidados de saúde primários. Visa ainda fomentar o espírito crítico na interpretação dos exames auxiliares de diagnóstico perante uma dissociação clínico-imagiológica. O hipertiroidismo é uma causa comum de hipertensão sistólica isolada e o seu diagnóstico e tratamento atempados podem prevenir a emergência de complicações e influenciar o prognóstico. Para tal, é fundamental uma boa articulação entre os cuidados de saúde primários e secundários. Palavras-Chave: Hipertensão arterial, Hipertensão secundária, Hipertiroidismo, Doença de Graves, Jovem

ABSTRACT OBJECTIVE To culturally adapt and validate the SPICTTM to Spanish, which is a brief and simple tool to support a better identification of chronic patients who have palliative care needs. METHODS For this study, we designed a multicenter and national project between the centers of Galicia, Balearic Islands, and Andalusia. For the process of translation and cross-cultural adaptation of the SPICTTM to Spanish, we followed the steps proposed by Beaton et al. with successive translations and subsequent consensus of experts using the debriefing methodology. After the content validation was completed, the psychometric properties were validated. A prospective longitudinal study was designed with 188 patients from Galicia, the Balearic Islands, and Andalusia. The internal consistency and reliability of the test and retest was analyzed for 10 days by the same researcher. RESULTS For more than 90% of the participants of the SPICT-ESTM, it seems simple to be filled out, and they consider it written in an understandable language. The average time to apply the questionnaire without prior knowledge was 4 minutes and 45 seconds. To evaluate the internal consistency of the instrument, we used the Kuder-Richardson formula 20. Internal consistency is 0.71. The agreement index of the Kappa test is between 0.983 and 0.797 for the different items. CONCLUSIONS In this study, we demonstrate the equivalence of content with the original. In addition, the validation of the psychometric properties establishes that the SPICT-ESTM maintains adequate reliability and stability. If we add the satisfaction shown by the professionals and the ease of use, the SPICT-ESTM is an adequate tool for the identification of palliative patients with chronic diseases and palliative care needs.

Acetylcholine is a neurotransmitter that has a major role in the function of the insulin-secreting pancreatic beta cell (1,2). Parasympathetic innervation of the endocrine pancreas, the islets of Langerhans, has been shown to provide cholinergic input to the beta cell in several species (1,3,4), but the role of autonomic innervation in human beta cell function is at present unclear. Here we show that, in contrast to the case in mouse islets, cholinergic innervation of human islets is sparse. Instead, we find that the alpha cells of human islets provide paracrine cholinergic input to surrounding endocrine cells. Human alpha cells express the vesicular acetylcholine transporter and release acetylcholine when stimulated with kainate or a lowering in glucose concentration. Acetylcholine secretion by alpha cells in turn sensitizes the beta cell response to increases in glucose concentration. Our results demonstrate that in human islets acetylcholine is a paracrine signal that primes the beta cell to respond optimally to subsequent increases in glucose concentration. Cholinergic signaling within islets represents a potential therapeutic target in diabetes (5), highlighting the relevance of this advance to future drug development., Acetylcholine is crucial for pancreatic beta cell function. It stimulates insulin secretion by increasing the cytoplasmic free [Ca.sup.2+] concentration, [[[Ca.sup.2+]].sub.i], via inositol phosphate production and enhancing the effects of [Ca.sup.2+] [...]

Extracellular ATP has been proposed as a paracrine signal in rodent islets, but it is unclear what role ATP plays in human islets. We now show the presence of an ATP signaling pathway that enhances the human [beta] cell's sensitivity and responsiveness to glucose fluctuations. By using in situ hybridization, RT-PCR, immunohistochemistry, and Western blotting as well as recordings of cytoplasmic-free [Ca.sup.2+] concentration, [[[Ca.sup.2+]].sub.i], and hormone release in vitro, we show that human [beta] cells express ionotropic ATP receptors of the [P2X.sub.3] type and that activation of these receptors by ATP coreleased with insulin amplifies glucose-induced insulin secretion. Released ATP activates [P2X.sub.3] receptors in the [beta]-cell plasma membrane, resulting in increased [[[Ca.sup.2+]].sub.i] and enhanced insulin secretion. Therefore, in human islets, released ATP forms a positive autocrine feedback loop that sensitizes the [beta] cell's secretory machinery. This may explain how the human pancreatic [beta] cell can respond so effectively to relatively modest changes in glucose concentration under physiological conditions in vivo. extracellular ATP | human pancreatic [beta] cell | insulin secretion | P2X receptor | positive autocrine feedback doi/10.1073/pnas.0908935107

Background. Genital ulcers are an unusual complaint in pediatrics. Most are caused by sexually transmitted infections (stIs), although there are non-venereal etiologies that should also be considered. lipschütz ulcers are a rare and frequently underdiag- nosed cause of non-infectious genital ulcers, which are usually preceded by a viral trigger and have a self-limiting course. Case report. a 17-year-old female patient presented with an acute vulvar lesion, accompanied by complaints of malaise, fever and odynophagia. she was sexually active. on examination, she had bilateral tonsillar exudates, hepatomegaly and a painful, well-limited vulvar ulcer. Complementary exams ruled out most common stIs, and the Paul-Bunnel test was positive. treatment was supportive. Based on the clinical presentation and laboratory results, the diagnosis of a lipschütz ulcer, in the context of acute mononucleosis, was made. three weeks after the initial presentation, the lesion was fully healed. the case was entirely managed in ambulatory care. Conclusions. this case represents a rare but important differential diagnosis of genital ulceration. the prompt suspicion of a lipschütz ulcer spared the patient from unnecessary exams and therapies. It should be noted that this disease mainly affects young adolescents, for whom the disclosure of its symptoms might be challenging. a trusting doctor–patient relationship is fundamental to ensure proper management and follow-up. [ABSTRACT FROM AUTHOR]

Toxoplasmic encephalitis (TE) is a mayor cause of central nervous system infection in patients with acquired immunodeficiency syndrome (AIDS). Toxoplasma antibodies were detected in 56 of 79 patients with AIDS (71%), in the present study. Fourteen out of 57 seropositive patients developed TF (25%) and had Toxoplasma gondii antigen detected in their urine. For this, most of them received an effective therapy, with the subsequent disappearance of the symptoms and discontinuity of excretion of the T. gondii antigens. Our results suggest that the monitoring of T. gondii antigen in the urine of AIDS patients may be useful to decide on the proper time for therapy, as well as to avoid the beginning of neurologic signs in these patients.La Encefalitis Toxoplásmica (ET) es la más importante complicación infecciosa del Sistema Nervioso Central en pacientes de SIDA. Anticuerpos anti-Toxoplasma gondii fueron detectados en 57 de 79 pacientes de SIDA (71%). De estos seropositivos, desarrollaron la enfermedad (ET) 14 (25%), en los que coincidentemente se detectó la presencia de antígeno del parásito en orina y por tanto fueron objeto de una terapia efectiva, con la subsecuente desaparición de los sintomas y de los antígenos excretados. Por los resultados del presente trabajo, consideramos lo útil de monitorear en estos pacientes la presencia de antígenos de T. gondii con el objetivo de aplicar oportunamente métodos quimoprofilácticos que eviten el surgimiento de manifestaciones neurológicas en estos pacientes.

The aim of this study was the assesment of psychometric properties of the Portuguese version of the instrument "Medical Outcomes Study - Social Support Survey (MOSSSS)". This questionnaire has been translated and adapted in a Portuguese sample of 101 patients with chronic illness of a rural health centre in Portugal. The average age of patients was 63.4 years, 56.4% female. 29% were illiterate and 2% had completed high school. 78% had arterial hypertension and the 56.4% had diabetes mellitus type 2. The internal consistency was evaluated using Cronbach's alpha. Exploratory and Confirmatory factor analysis were performed in order to confirm reliability and validity of the scale and its multidimensional characteristics. The 2-week test-retest reliability was estimated using weighted kappa for the ordinals variables and intraclass coefficient correlation for the quantitative variables. Cronbach's alphas for the subscales ranged from 0.873 to 0.967 at test, and 0.862 to 0.972 at retest. Exploratory factor analysis revealed the existence of four factors (emotional, tangible, positive interaction and affection support) that explain the 72.71% of the variance. Confirmatory factor analysis supported the existence of four factors that allowed the application of the scale with original items. The goodness-of-fit measures corroborate the initial structure, with chi2/ df=2.01, GFI=0.998, CFI=0.999, AGFI=0.998, TLI=0.999, NFI=0.998, SRMR=0.332, RMSEA=0.76. The 2-weeks test-retest reliability of the Portuguese MOS-SSS as measured by the intraclass correlation coefficient was ranged from 0.941 to 0.966 for the four dimensions and the overall support index. The weighted kappa was ranged from 0.67 to 0.87 for all the items. The MOS-SSS Portuguese version demonstrates good psychometric properties and seems to be useful to measure multidimensional aspects of social support in the Portuguese population.

A simple and rapid staphylococcal coagglutination test for the detection of Toxoplasma gondii antigens in mice urine is described. A suspension of protein-A containing Staphylococcus aureus coated with rabbit hyperimmune serum was used as reagent. The sensitivity of the antigen assay was found to be at least 118 ng of the antigen protein per ml. No coagglutination was observed when the reagent was challenged against antigenic solutions of other parasites. The suitability of the method for detecting antigens of T. gondii in urine samples was studied by experimental toxoplasma infection in mice. Before the staphylococcal test, the urine samples were double serially diluted in 0.1 M PBS. From the second day on all samples from infected mice were positive at 1/16 dilution. At this dilution, all samples from non infected mice were negative or did not produce coagglutination. This method might be used in the rapid etiological diagnosis also in human cases of acute toxoplasmosis.

An important challenge in pancreatic islet transplantation in association with type 1 diabetes is to define automatic high-throughput assays for evaluation of human islet function. The physiological techniques presently used are amenable to small-scale experimental samples and produce descriptive results. The postgenomic era provides an opportunity to analyze biological processes on a larger scale, but the transition to high-throughput technologies is still a challenge. As a first step to implement high-throughput assays for the study of human islet function, we have developed two methodologies: multiple automated perifusion to determine islet hormone secretion and high-throughput kinetic imaging to examine islet cellular responses. Both technologies use fully automated devices that allow performing simultaneous experiments on multiple islet preparations. Our results illustrate that these technologies can be applied to study the functional status and explore the pharmacological profiles of islet cells. These methodologies will enable functional characterization of human islet preparations before transplantation and thereby provide the basis for the establishment of predictive tests for β-cell potency.