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Drug-induced liver injury (DILI) is an unpredictable and feared side effect of antituberculosis treatment (AT). The present study aimed to identify clinical and genetic variables associated with susceptibility to AT-associated hepatotoxicity in patients with pulmonary tuberculosis treated with a standard protocol. Of 233 patients enrolled, 90% prospectively, 103 developed liver injury: 37 with mild and 66 with severe phenotype (DILI). All patients with mild hepatitis had a RUCAM score ≥4 and all patients with DILI had a RUCAM score ≥ 6. Eight clinical variables and variants in six candidate genes were assessed. A logistic multivariate regression analysis identified four risk factors for AT-DILI: age ≥ 55 years (OR:3.67; 95% CI:1.82−7.41; p < 0.001), concomitant medication with other hepatotoxic drugs (OR:2.54; 95% CI:1.23−5.26; p = 0.012), NAT2 slow acetylator status (OR:2.46; 95% CI:1.25−4.84; p = 0.009), and carriers of p.Val444Ala variant for ABCB11 gene (OR:2.06; 95%CI:1.02−4.17; p = 0.044). The statistical model explains 24.9% of the susceptibility to AT-DILI, with an 8.9 times difference between patients in the highest and in the lowest quartiles of risk scores. This study sustains the complex architecture of AT-DILI. Prospective studies should evaluate the benefit of NAT2 and ABCB11 genotyping in AT personalization, particularly in patients over 55 years.

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Thermal and self-curing acrylic resins are frequently and versatilely used in dental medicine since they are biocompatible, have no flavor or odor, have satisfactory thermal qualities and polishing capacity, and are easy and fast. Thus, given their widespread use, their fracture resistance behavior is especially important. In this research work, we comparatively analyzed the fracture resistance capacity of thermo and self-curing acrylic resins in vitro. Materials and Methods: Five prosthesis bases were created for each of the following acrylic resins: Lucitone®, ProBase®, and Megacryl®, which were submitted to different forces through the use of the CS® Dental Testing Machine, usually mobilized in the context of fatigue tests. To this end, a point was defined in the center of the anterior edge of the aforementioned acrylic resin bases, for which the peak tended until a fracture occurred. Thermosetting resins were, on average, more resistant to fracture than self-curable resins, although the difference was not statistically significant. The thermosetting resins of the Lucitone® and Probase® brands demonstrated behavior that was more resistant to fracture than the self-curing homologues, although the difference was not statistically significant. Thermosetting resins tended to be, on average, more resistant to fracture and exhibited the maximum values for impact strength, compressive strength, tensile strength, hardness, and dimensional accuracy than self-curing resins, regardless of brand.

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Genitourinary tuberculosis is the third most common form of extrapulmonary tuberculosis, comprising 4 - 17% of extrapulmonary forms. The authors describe the case of a patient with recurrent urinary tract infections, without isolation of an infectious agent and without symptomatic resolution, despite antibiotic treatment. Imaging exams showed left ureteral stenosis with moderate hydronephrosis. The attempt of retrograde catheterization was impossible so we opted for percutaneous nephrostomy to renal relief. Microbiological urine analysis colleted by that way was positive for Mycobacterium tuberculosis complex. The patient started therapy with classical quadruple therapy and underwent nephrostomy for catheter placement. Despite therapeutic measures the patient required nephrectomy due to nonfunctioning kidney. Genitourinary tuberculosis is a diagnosis that should be considered in the presence of a persistent sterile pyuria.

A tuberculose genito-urinária é a terceira forma mais comum de tuberculose extrapulmonar compreendendo 4 - 17% dos casos extra-pulmonares. Os autores descrevem o caso de uma doente com infecções urinárias de repetição sem isolamento de agente infeccioso e sem resolução das queixas apesar da antibioterapia instituída. Os exames imagiológicos mostraram estenose ureteral com hidronefrose moderada. A tentativa de cateterismo retrógrado foi impossível pelo que se optou pela nefrostomia percutânea para descompressão renal. O exame microbiológico da urina colhido por essa via foi positivo para Micobacterium tuberculosis complex. Iniciou terapêutica antibacilar com esquema quádruplo clássico e realizou uma nefrostomia para colocação de cateter urinário. Apesar da terapêutica instituída a doente necessitou de uma nefrectomia por rim não funcionante. A tuberculose génito-urinária deve ser um diagnóstico a considerar perante a presença de uma piúria estéril persistente.

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INTRODUCTION: Tuberculosis (TB) remains a major global public health problem and 20% of all cases are extrapulmonar. The purpose of this study was to identify risk factors associated with extrapulmonar tuberculosis. METHODS: We carried out a transversal study which included all patients with extrapulmonary tuberculosis registered in a TB reference center in northern Portugal, between January 2008 and January 2012. We evaluated demographic data, comorbidities, BCG vaccination and previous tuberculosis treatments. Multivariable logistic regression was used to identify independent risk factors (p<0.05). RESULTS: Among the 386 patients studied, 260 (67.4%) had pulmonary tuberculosis (PTB) and 126 (32.6%) extrapulmonary TB (EPTB). Age over 40 years old (OR=2.09; 95%CI: 1.29-3.38), female gender (OR=1.63; 95%CI=1.02-2.6) and HIV infection (OR=2.72, 95%CI=1.25-5.93) were independent risk factors for EPTB. Alcoholism (OR=2.22, 95%CI: 1.00-4.95) was associated with higher risk for PTB. Previous liver disease (OR=22.30; 95%IC: 1.89-263.57) was an independent risk factor for peritoneal TB. HIV co-infection (OR=12.97; 95%IC: 1.71-48.42) and the presence of previous TB treatment (OR=7.62; 95%IC: 1.00-57.9) increase the risk of disseminated disease. CONCLUSION: We identified independent risk factors for EPTB. Recognizing risk factors associated with EPTB is essential for suspicion of disease and may help make an accurate diagnosis.

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This article has been withdrawn for editorial reasons because the journal will be published only in English. In order to avoid duplicated records, this article can be found at http://dx.doi.org/10.1016/j.rppnen.2014.06.010. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

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In recent years there has been an increase in the number of cases of intestinal tuberculosis mainly due to the HIV epidemic. Its clinical manifestations and endoscopic findings are nonspecific, making diagnosis difficult, requiring high degree of suspicion. The authors present the case of a man, 55 years old, immunocompetent, who goes to the doctor due to constitutional symptoms after two months of evolution. Given the family history of colon cancer, colonoscopy is sought, showing an ulcerated lesion at the blind. Histology showed non-caseating granulomas and for AFB was negative. The following study carried out with TC chest, sputum and bronchoscopy, has lead to the diagnosis of pulmonary tuberculosis with achievement of the digestive tract. The purpose of this case history is to emphasize the importance of differential diagnosis with other pathologies with similar clinical symptoms and endoscopic changes, and the role of bronchoscopy in diagnosis of pulmonary tuberculosis in patients with negative smear.

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INTRODUCTION: Esophageal involvement by Mycobacterium tuberculosis is rare and the diagnosis is frequently made by means of an esophageal biopsy during the evaluation of dysphagia. There are few cases reported in the literature. CASE PRESENTATION: We present two cases of esophageal tuberculosis in 85- and 65-year-old male Caucasian patients with initial complaints of dysphagia and epigastric pain. Upper gastrointestinal endoscopy resulted in the diagnosis of esophageal tuberculosis following the biopsy of lesions of irregular mucosa in one case and a sessile polyp in the other. Pulmonary tuberculosis was detected in one patient. In one patient esophageal stricture developed as a complication. Antituberculous therapy was curative in both patients. CONCLUSION: Although rare, esophageal tuberculosis has to be kept in mind in the differential diagnosis of dysphagia. Pulmonary involvement has important implications for contact screening.

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Malabsorption of oral antimycobacterial drugs is a rare cause of treatment failure in tuberculosis (TB). Several predisposing comorbidities have been recognised. HIV infection is the most important risk factor referred in the literature. There are few reports about antimycobacterial drugs malabsorption, particularly in the absence of predisposing comorbidities. The authors present a clinical case of oral treatment failure in TB due to malabsorption; however, what caused the failure remained unclear. Possible causes of malabsorption are discussed under various sections. Purpose of this case report is to point to this rare situation that can easily go unnoticed unless a very high level of suspicion is present.

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INTRODUCTION: Tuberculous psoas abscess was usually associated to complicate Pott's disease, but it can also be secondary to direct extension from other adjacent structures or haematogenous spread from an occult source. However, the occurrence of this entity as the presenting manifestation of tuberculosis, without evidence of active infection elsewhere, has been seldom reported. CASE PRESENTATION: We report a clinical case of a 64-year-old immunocompetent female that presented with left lower abdominal pain and a soft tissue mass over the left iliac fossa and inguinal regions due to a primary tuberculous psoas abscess. Early diagnosis and prompt treatment with percutaneous drainage guided by ultrasound along with antituberculous drugs, lead to a satisfactory outcome. CONCLUSION: The purpose of this case report is to point out attention to the diagnostic challenge of tuberculous psoas abscess in the absence of tuberculosis in other organs or a predisposing condition. A brief review of the literature about its epidemiology, etiology, clinical features and management is discussed over the text.

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Testicular tuberculosis is rare, occurring in approximately 3% of patients with genital tuberculosis. It is often clinically indistinguishable from lesions such as testicular tumour and infarction and may even mimic testicular torsion. Men aged 20-50 years old are most commonly affected and often present with painful or painless enlargement of the scrotum. Ultrasound (US) is currently the best technique for imaging the scrotum and its contents and for diagnosing testicular lesions. We present the case of a 58 year-old male, followed in pneumology for pulmonary tuberculosis, who complained of pain and right scrotum enlargement in the second month of anti-tuberculosis chemotherapy. First assessment, seconded by US, suggested a neoplasic lesion, and the final diagnosis revealed testicular tuberculosis.

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INTRODUCTION: Tuberculosis remains an infectious disease with a high prevalence worldwide and represents a major public health issue. Although venous thromboembolism is a rare complication of this disease, it may be a potentially life-threatening event. CASE SERIES PRESENTATION: We report two cases of severe pulmonary tuberculosis associated with venous thromboembolism. A 38 year-old caucasian male that had a thromboembolic event as an unsual presentation form of tuberculosis and a 51 year-old caucasian male that developed deep venous thrombosis later in the course of the disease. CONCLUSION: An association between inflamation induced by tuberculosis and a hypercoagulable state has been described. Therefore, the occurence of deep venous thrombosis or pulmonary embolic episods, should be considered in patients with tuberculosis particulary during the first weeks of treatment. The physician's awarness of these phenomena is important to an early diagnostic suspicion and prompt treatment in order to prevent fatal outcomes.

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We report on a patient diagnosed with disseminated (hepatic and pulmonary) tuberculosis in the context of immunosuppression following liver transplant. During the administration of anti-tuberculosis drugs an abrupt elevation of liver enzymes was detected leading us to suspect drug toxicity rather than graft rejection. Nevertheless, careful surveillance and adjustment of serum levels of immunosuppressant drugs permitted continuance of tuberculosis treatment with no further side effects.

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SETTING: The smoking rate in Portugal is 19.2% and 33% in Europe. There is no precise data on the smoking rate of the asthmatic population. AIM: To determine the smoking rate and its repercussions on an asthmatic population sample. DESIGN: One hundred and ten asthmatic patients observed in asthma consultations were classified as non-smokers, former-smokers or smokers. Subsequently, based on functional and clinical criteria, they were classified as having Severe Persistent (SPA), Moderate Persistent (MoPA), Mild Persistent (MiPA) and Intermittent (IA) Asthma. RESULTS: 8% of 110 patients (65% female) aged 18 to 78 years were smokers, 9% former-smokers, 83% non-smokers. Among the asthmatics: - smokers: 0% SPA, 56% MoPA, 33% MiPA, 11% IA; - former smokers: 10% SPA, 30%MoPA, 50% MiPA, 10% IA; - non-smokers: 7% SPA, 27% MoPA, 36% MiPA, 30% IA. Patients with exposure to smoking had worse functional evaluation than those without exposure. CONCLUSION: In this population sample the rate of current smoking habits (8% of current smokers) was considerably low than in Portugal (19.2%). Analysis and comparison of asthma severity and functional evaluation detected worse results in both current and former smokers. These reinforce the role of tobacco exposure in asthma aggravation and worsening of its prognosis. Further studies may be important to prove and alert the asthmatic population, in particular, to the well-known risks of smoking.

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Actinomycosis is a chronic suppurative bacterial infection characterized by multiple abscesses, fistulous pathways, and fibrosis involving the face, neck, chest, and abdomen. It is caused by an anaerobic Gram-positive saprophytic bacterium (Actinomyces). Primary actinomycosis of the lung is a rare disease that probably results from aspiration of oropharyngeal secretions. It can present as a chronic respiratory disease. The treatment of choice is antibiotic therapy with penicillin. The authors report the case of a 55-year-old female diagnosed with pulmonary actinomycosis and successfully treated with levofloxacin.

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A actinomicose é uma infecção bacteriana supurativa crônica caracterizada por múltiplos abcessos, trajetos fistulosos e fibrose envolvendo a face, o pescoço, o tórax e o abdômen. É causada por uma bactéria anaeróbia, Gram-positiva e saprófita (Actinomyces). A actinomicose pulmonar primária é uma doença rara que resulta provavelmente da aspiração de secreções da orofaringe. Pode apresentar-se como uma doença respiratória crônica. O tratamento de escolha é a antibioticoterapia com penicilina. Os autores apresentam o caso clínico de uma mulher de 55 anos com diagnóstico de actinomicose pulmonar tratada com sucesso com levofloxacina.

Actinomycosis is a chronic suppurative bacterial infection characterized by multiple abscesses, fistulous pathways, and fibrosis involving the face, neck, chest, and abdomen. It is caused by an anaerobic Gram-positive saprophytic bacterium (Actinomyces). Primary actinomycosis of the lung is a rare disease that probably results from aspiration of oropharyngeal secretions. It can present as a chronic respiratory disease. The treatment of choice is antibiotic therapy with penicillin. The authors report the case of a 55-year-old female diagnosed with pulmonary actinomycosis and successfully treated with levofloxacin.

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