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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.

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.

O acesso ao crédito bancário é fundamental para as empresas do setor privado, para o financiamento das suas atividades, no entanto, as condições de acesso imposta pelos bancos para a sua concessão em Moçambique constituem autênticas barreiras devido aos elevados níveis de risco de crédito. Assim, a gestão do risco de crédito é muito importante para as instituições financeiras, uma vez que representa parte integrante do processo de decisão e atribuição de crédito. O presente estudo tem como objetivo analisar o processo de gestão do risco de crédito, enumerar e descrever os principais modelos de mensuração de risco, bem como os critérios de acesso ao crédito bancário no Banco Comercial e de Investimentos (BCI, S.A). Para a concretização desta dissertação recorreu-se a uma pesquisa exploratória com recurso a uma análise descritiva dos principais indicadores de gestão de risco do BCI. Também foi aplicada uma análise econométrica na qual foi considerado o rácio entre o crédito vencido e duvidoso e o crédito total como variável dependente proxy do risco de incumprimento. As variáveis independentes consideradas são: o ROA, ROE, margem financeira sobre o crédito total, depósito total sobre o crédito total e o crédito total sobre os ativos totais ponderados sobre o risco. Os resultados da análise permitem concluir que as variáveis em estudo têm influência no nível de incumprimento de crédito. No BCI, o nível de risco de crédito aumentou apesar dos esforços. Em termos econométricos, os modelos utilizados são estatisticamente significativos e explicam o risco de incumprimento no BCI. Access to bank credit is essential for companies in the private sector to finance their activities, however, the conditions of access imposed by banks for its concession in Mozambique are real barriers due to the high levels of credit risk. Thus, credit risk management is very important for financial institutions, since it is an integral part of the credit decision and attribution process. This study aims to analyze the credit risk management process, enumerate and describe the main risk measurement models, as well as the criteria for accessing bank credit at Banco Comercial e de Investimentos (BCI, S.A). To carry out this dissertation, exploratory research was carried out using a descriptive analysis of BCI's main risk management indicators. An econometric analysis was also applied in which the ratio between overdue and doubtful loans and total credit was considered as a proxy dependent variable for default risk. The independent variables considered are ROA, ROE, financial margin on total credit, total deposit on total credit and total credit on total risk-weighted assets. The results of the analysis allow us to conclude that the variables under study have an influence on the level of credit default. At BCI, the level of credit risk has increased despite efforts. In econometric terms, the models used are statistically significant and explain the risk of default in the BCI.

Climate change is ongoing but the magnitude, extent and duration of its impacts is far from being known and, in particular, its consequence on Earth’s life is still under study. This article presents an overview about many research lines aiming to increase the resilience of chestnut in climate changes frame. In Europe, chestnut is considered a Mediterranean crop, facing nowadays significant heat and drought stresses with important consequences on species health. So, modelling its production is fundamental to project the future production and species area redistribution according to the new expected climatic conditions. These models are being developed based on specific meteorological variables and indices well related to different aspects and stages of the vegetative cycle. For example, the best range of growing degree days (GDD) for better ‘Judia’’s chestnut production was found to be within the range 2000-2200°D (between May and October). At orchard level, it is also demonstrated the benefits of preserving a good soil herbaceous vegetation cover, complemented with smart irrigation which can prevent the reduction on nut production by about 25-50%, depending on the annual precipitation, and increase the edible mushroom production. Results also clearly demonstrated the importance of bees on pollination, where a decrease of about 70% was observed when they were absent. New hybrid rootstocks are being developed (e.g., ColUTAD) aiming to face the new climatic context, namely to maximize photosynthesis rate at high air temperature (T100 = 34°C). Also in ‘Judia’, such plasticity was observed between genotypes from cold and warm localities. Calibers ranged between 58 and 107 nuts kg-1. The tolerance against blight disease (Chryphonectria parasitica) also significantly varied. Finally, additional mineral nutrition with silicon seems to lead to a lower mortality rate and phenol’s inhibition as well as to an increased tolerance of the specie to thermal and hydric stress. The addition of silicon appears to have protective effect on trees against ink (Phytophthora cinnamomi) and blight diseases as well as to prepare and adapt trees for a future climate that is expected to be warmer and drier.

Objective: We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. Design: Baseline data from two prospective multicentre observational studies. Setting: 29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal. Participants: 395 patients (≥13 years old) with persistent asthma. Measures: Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0-50; medium 51-80; high 81-100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients' and physicians' VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. Results: High inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65-95) mm; 53% VAS>80) and by physicians (84 (68-95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p

The paper version of CARAT (pCARAT) is valid to assess asthma control over a 4-week period. For follow-up purposes, assessment through mobile apps (aCARAT) or telephone (tCARAT) may be useful alternatives. We explored the psychometric properties of the aCARAT and tCARAT. Patients with asthma were recruited at secondary care outpatient clinics. During medical visits, patients filled in the pCARAT and were invited to complete the aCARAT in the following days using the app of project Inspirers (InspirerMundi). After 1 week, tCARAT was collected. Patients completing the 3 CARAT versions within 28 days were analysed. CARAT scores (0-worst, 30-best) were calculated. The internal consistency (Cronbach’s α), convergent validity (Spearman correlation-rs) and reliability (intraclass correlation coefficient-ICC, Bland-Altman analysis) were determined. 55 patients (21 male; median 19 [interquartile range 17-37]y) were included. The aCARAT was completed by 82% of patients within 1 week of pCARAT; and by 78% within 1 week of tCARAT. The median pCARAT score was 21[17-24], the aCARAT 21[18-26], and the tCARAT 23[21-26]. Internal consistency was good for all versions (α=.73-.77). pCARAT was more strongly correlated with aCARAT than with tCARAT. Reliability was better for aCARAT than for tCARAT (table 1). App and telephonic CARAT versions are valid and reliable, exhibiting comparable psychometric properties to the paper version. These new CARAT versions are promising alternatives for assessing control in patients with asthma.

Introduction: Omalizumab is an anti-IgE monoclonal antibody used for treatment of uncontrolled severe asthma and it has shown efficacy during clinical development; however, real life data is lacking for an accurate assessment. Objective: Efficacy assessment of Omalizumab treatment. Methods: Retrospective observational study of patients with severe asthma under add-on treatment with Omalizumab, observed in a Pulmonology department of a tertiary hospital. The following criteria were analyzed: number of exacerbations, forced expiratory volume in one second, symptoms (Asthma Control Test) and inhaled treatment in baseline and in 1 year after treatment initiation (equivalent daily dose of budesonide). Seven patients were excluded from the study since they did not complete 1 year of treatment. Results: 21 patients were included in the study (mean age 48±10 years-old; 76.2% women). Eight patients (38.1%) were previously treated with specific immunotherapy. IgE total mean at baseline was 327,2±324,9 UI/ml. Conclusions: After 12 months of Omalizumab, patients had symptomatic improvement (reduction of total exacerbations and higher scores in ACT), improvement in lung function (FEV1), reductions of daily mean dose of inhaled corticosteroids and suspension of oral corticosteroids, proving its therapeutic efficacy.

© 2014 Elsevier España, S.L.U. and SEMNIM. All rights reserved., Objectives: In 2009-2010 a Portuguese consortium was created to implement the methodologies proposed by the Dose Datamed II (DDM2) project, aiming to collect data from diagnostic X-ray and nuclear medicine (NM) procedures, in order to determine the most frequently prescribed exams and the associated ionizing radiation doses for the Portuguese population. The current study is the continuation of this work, although it focuses only on NM exams for the years 2011 and 2012. Material and methods: The annual frequency of each of the 28 selected NM exams and the average administered activity per procedure was obtained by means of a nationwide survey sent to the 35 NM centres in Portugal. Results: The results show a reduction of the number of cardiac exams performed in the last two years compared with 2010, leading to a reduction of the annual average effective dose of Portuguese population due to NM exams from 0.08 mSv ± 0.017 mSv/caput to 0.059 ± 0.011 mSv/caput in 2011 and 0.054 ± 0.011 mSv/caput in 2012. Portuguese total annual average collective effective dose due to medical procedures was estimated to be 625.6 ± 110.9 manSv in 2011 and 565.1 ± 117.3 manSv in 2012, a reduction in comparison with 2010 (840.3 ± 183.8 manSv). Conclusions: The most frequent exams and the ones that contributed the most for total population dose were the cardiac and bone exams, although a decrease observed in 2011 and in 2012 was verified. The authors intend to perform this study periodically to identify trends in the annual Portuguese average effective dose and to help to raise awareness about the potential dose optimization.

Introduction: In asthma, persistent symptoms and frequent exacerbations have a negative impact on quality of life, exercise tolerance and health status. Evidence of the benefit of pulmonary rehabilitation (PR) in asthma is less robust than in other chronic respiratory diseases such as COPD. Objectives: To evaluate the effects of PR in symptoms, exacerbations and pulmonary function. Methods: Retrospective study of all asthma patients (>18 years old) who participated in a PR program in 2013 and 2014 in our Unit of PR. The program comprised breathing and exercise training and patient education. Patients presenting other respiratory diseases and insufficient data were excluded. In patients who completed the training, dyspnoea, number of exacerbations and lung function were analysed and compared, one year before and after the program. Results: Twenty-six patients completed the program [mean age 65±12 years; 84.6% (n=22) female; 76.9% (n=20) non-smokers]. Following PR, 69.2% (n=18) of the patients showed improvement in dyspnoea (p=0.002) and 50.0% (n=13) showed a reduction of the total number of exacerbations (p=0.014). The number of emergency department admissions and the exacerbations without need of urgent healthcare use or hospitalization also decreased in, respectively, 23.1% (p=0.676) and 23.1% (p=0.059) of patients. Regarding pulmonary function there was an increase in FEV1%, PEF and FVC% after training, with statistical significance only for FVC (p=0.031). Conclusions: These results suggest a benefit of PR in patients with uncontrolled asthma. In these patients, PR improves symptoms, reduces the number of exacerbations and could improve pulmonary function.

This study aims to evaluate compliance of HIV patients to TB screening and treatment, identifying determinants for non-compliance.We reviewed clinical records of all HIV infected patients first attended in a Portuguese-Infectious-Unit from 2007 to 2010 (152 patients). Screening included: symptom inquiry, chest X-ray, TST/IGRA. In 2008 a protocol was established with a TB outpatient clinic allowing patients to choose where to perform screening (decentralization).All patients were offered screening; 69 (45.4%) accepted. Before decentralization, out of 78 patients, 20 (25%) accepted screening. After decentralization, out of 64 patients, 49 (76.6%) accepted screening. Decentralization was associated with higher levels of acceptance (p

Introduction: Data suggests that nocturnal symptoms in asthmatic patients can be caused by concomitant undiagnosed obstructive sleep apnea (OSA). However, screening all patients using polysomnography (PSG) is expensive and time-consuming. STOP-BANG questionnaire (SBQ) is a validated screening tool for identifying OSA. Aim: To evaluate the SBQ in the screening of OSA in asthmatic patients with nocturnal symptoms. Methods: Prospective study with adult asthmatic patients followed in a Pulmonology outpatient clinic. All patients were asked about nocturnal symptoms (wheezing, coughing, shortness of breath, chest tightness). If patients had nocturnal symptoms (≥ once a week) they answered the SBQ, Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI). If SBQ score was ≥3, they had an “intermediate/high probability of having OSA” and they performed a PSG to confirm it. Results: 77 patients included: 73% women, mean age 50±17years. 1 patient refused to participate. 19 patients (25%) had nocturnal symptoms: 84% women, mean age 50±13 years. 10% had mild asthma, 53% moderate and 37% severe; 74% had rhinitis. Using PSQI, 79% had a self-reported poor sleep quality. Using ESS, 63% had excessive sleepiness. 15 patients with nocturnal symptoms (79%) had a SBQ score ≥3, but OSA was only confirmed by PSG in 4 patients (27%): 3 patients mild OSA, 1 severe OSA. Conclusion: Sleep quality in asthmatic patients with nocturnal symptoms is poor and it is associated to excessive daytime sleepiness. SBQ seems to overestimate the presence of OSA in this group, probably because snoring can be caused by rhinitis and tiredness caused by poor sleep quality due to nocturnal symptoms of asthma.

Introduction: Failure of sputum smear and/or culture conversion after 2 months of tuberculosis (TB) treatment has been considered a predictor of patient infectivity and treatment failure. We aimed to identify the factors associated with delayed sputum smear and culture conversion in patients with pulmonary TB who were given anti-TB treatment. Material and methods: Retrospective cohort of 136 adult patients with sputum culture-proven pulmonary TB referred to an urban Chest Disease Centre. Socio-demographic, clinical, radiological, microbiological, and therapeutic data were evaluated. Results: The median age was 41.0 (interquartile range [IQR] 18.0) years and 75.0% of patients were male. Delayed sputum smear and culture conversion occurred in 25.4% (30/118) and 27.2% (37/136) of patients, respectively. Multivariate analysis indicated that age â¥Â 50 years (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.5â13.3), male gender (OR 10.8, 95% CI 1.3â91.1), and smear grade > 1â9 acid fast bacilli (AFB)/field (3+) (OR 11.7, 95% CI 1.4â100.6) were significantly associated with persistent smear positivity after 2 months of treatment. Bilateral radiological involvement (OR 3.7, 95% CI 1.5â9.0) and colony count > 100 (3+) (OR 5.8, 95% CI 1.2â27.4) were significantly associated with persistent culture positivity. Conclusions: Delayed sputum smear and culture conversion occurred in about one third of patients. Older age, male gender, and higher bacillary load were independently associated with delayed smear conversion. Bilateral radiological involvement and higher colony count were independently associated with delayed culture conversion. Resumo: Introdução: A ausência de conversão dos exames micobacteriológicos direto e/ou cultural de expetoração após 2 meses de tratamento para a tuberculose (TB) tem sido considerado um preditor do grau de infeciosidade do doente e de falência terapêutica. Os autores estabeleceram por objetivo a identificação dos fatores associados com a conversão tardia dos exames direto e cultural de expetoração num grupo de doentes com TB pulmonar sob tratamento antibacilar. Material e métodos: Coorte retrospetiva de 136 doentes adultos com TB pulmonar, confirmada por exame cultural de expetoração, referenciados a um Centro de Diagnóstico Pneumológico urbano. Foram analisadas variáveis sócio-demográficas, clínicas, radiológicas, microbiológicas e relacionadas com a terapêutica. Resultados: A mediana de idades foi 41,0 (intervalo interquartil [IIQ] 18,0) anos e 75,0% dos doentes eram do género masculino. A conversão tardia dos exames de expetoração direto e cultural ocorreu em 25,4% (30/118) e 27,2% (37/136) dos doentes, respetivamente. Pela análise multivariada, a idade â¥Â 50 anos (odds ratio [OR] 4,4, intervalo de confiança [IC] 95% 1,5â13,3), o género masculino (OR 10,8, IC 95% 1,3â91,1), e a carga bacilar > 1â9 bacilos álcool-ácido resistentes (BAAR)/campo (3+) (OR 11,7, IC 95% 1,4â100,6) estiveram significativamente associados com a positividade persistente do exame direto, após 2 meses de tratamento. O envolvimento radiológico bilateral (OR 3,7, IC 95% 1,5â9,0) e a contagem de colónias > 100 (3+) (OR 5,8, IC 95% 1,2â27,4) estiveram significativamente associados com a positividade persistente do exame cultural. Conclusões: A conversão tardia dos exames direto e cultural de expetoração ocorreu em cerca de um terço dos doentes. A idade mais avançada, o género masculino e a elevada carga bacilar estiveram independentemente associados com a conversão tardia do exame direto de expetoração. O envolvimento radiológico bilateral e a contagem de colónias mais elevada estiveram independentemente associados com a conversão tardia do exame cultural. Keywords: Tuberculosis, Sputum, Smear, Culture, Delayed conversion, Palavras-chave: Tuberculose, Expetoração, Exame direto, Exame cultural, Conversão tardia

Setting In 2004, the tuberculosis (TB) contact screening strategy in Vila Nova de Gaia, Portugal, was changed from targeting only close contacts identified by interviews with the index patient (reflecting national policy) to include visits to the patient?s home and workplace. Objective To find out 1) whether the new strategy increased adherence to TB screening procedures, 2) whether the strategy identified more at-risk contacts and 3) whether the strategy increased prevention of TB. Methods We compared TB contact tracing during the periods 2001-2003 and 2004-2006. The numbers of identified and screened contacts and the results of screening procedures (number of patients with active TB and latent TB infection [LTBI] detected per index case) were analysed. The number of instances of active TB prevented and the numbers of contacts that had to be screened to prevent one such instance were calculated and compared for both screening strategies. Results Home and workplace visits helped to identify more at-risk contacts (8.4 per index patient) than interview (2.5 per index patient), and improved adherence (87.3% of identified contacts were screened compared to 67.6% previously). More patients with active TB and LTBI were detected (1.4 per index patient compared with 0.75 per index patient previously), and more TB cases were prevented. Conclusion The newly implemented contact screening programme, featuring home and workplace evaluation of TB patient contacts, improved adherence to screening procedures, identified more at-risk contacts and should prevent more TB cases in the future.

Resumo: O diagnóstico e tratamento da infecção latente por Mycobacterium tuberculosis reduz significativamente o risco de desenvolvimento de tuberculose activa e a transmissão da doença na comunidade. O rastreio da tuberculose infecção latente deve passar pela exclusão de doença activa (inquérito de sintomas e radiografia pulmonar) e avaliação da resposta imunológica ao M. tuberculosis através dos testes actualmente ao dispor, como o teste tuberculínico e os testes IGRA (interferon-gamma release assay). A escolha do esquema de tratamento deve ter em linha de conta a eficácia, a adesão e os efeitos colaterais associados ao mesmo Este documento actualiza as recomendações sobre tratamento da tuberculose infecção latente. São apresentadas indicações sobre quem deve ser rastreado e revistos os esquemas de tratamento.Rev Port Pneumol 2010; XVI (5): 809-814 Abstract: Diagnosis and treatment of latent infection with Mycobacterium tuberculosis (LTBI), significantly reduces the risk of developing active tuberculosis and the transmission of the disease in the community. LTBI screening must pass by the exclusion of active disease (symptoms enquiry and chest radiography) and assessment of immune response to Mycobacterium tuberculosis testing with the tests currently available â tuberculin skin test and interferon-gamma release assay (IGRA). The choice of treatment must take into account the efficacy and side effects associated with the same. This document provides updated recommendations on latent tuberculosis infection treatment. Topics covered include whom to test for TB and reviewed LTBI treatment regimens.Rev Port Pneumol 2010; XVI (5): 809-814 Palavras-chave: Tuberculose, tuberculose infecção latente, tratamento, preventivo, Key words: Tuberculosis, latent tuberculosis infection, treatment, preventive

Resumo: A tuberculose é uma doença bem conhecida e para a qual há fármacos de reconhecida eficácia. Em Portugal, a incidência da tuberculose tem vindo a diminuir de forma consistente nos últimos anos, mantendo contudo valores acima da média europeia. Uma nova dificuldade surge, associada à resistência aos antibacilares reconhecidamente relacionada com a não adesão ao tratamento e/ou a uma incorrecta escolha do regime terapêutico. Assim, é importante focar a atenção na abordagem inicial do caso de tuberculose, sendo esse o objectivo desta revisão.Rev Port Pneumol 2010; XVI (4): 559-572 Abstract: Tuberculosis is a well-known illness for which there is treatment of recognized effectiveness. In Portugal, tuberculosis incidence has been diminishing although keeping values higher than the rest of the Western Europe. A new challenge is associated with resistance to drugs, admittedly related to treatment noncompliance or incorrect treatment choice. The purpose of this review to focus our attention on the importante of the first approach to the tuberculosis case.Rev Port Pneumol 2010; XVI (4): 559-572 Palavras-chave: Tuberculose, tratamento, efeitos colaterais, Key-words: Tuberculosis, treatment, side effects

Background and Aims: Fatty liver is very frequent in the general population. Although many studies evaluated the prevalence of nonalcoholic fatty liver disease there is scarce information regarding alcoholic fatty liver. We aimed to estimate the prevalence of alcoholic hepatic steatosis, and to what extent it depended on obesity and its interaction. info:eu-repo/semantics/publishedVersion

Resumo: Introdução â A prevalência de hábitos tabágicos em Portugal e na Europa ronda os 19,2 e 33%, respectivamente. Não existem, porém, dados precisos quanto à prevalência de hábitos tabágicos na popoulação asmática. Objectivos â Determinar a prevalência de hábitos tabágicos e sua repercussão numa amostra populacional asmática. Material e métodos â Cento e dez doentes asmáticos observados em consultas consecutivas de asma foram classificados como não fumadores, ex-fumadores ou fumadores, de acordo com os seus hábitos tabágicos. Subsequentemente, baseados numa avaliação clínica e funcional, foram incluídos num de quatro grupos: asma persistente severa (APS), persistente moderada (APM), persistente ligeira (APL) e intermitente (AI). Resultados â Entre os 110 doentes (65% do sexo feminino), com idades compreendidas entre os 18 e 78, 8% eram fumadores, 9% ex-fumadores e 83% não fumadores. Distribuição entre os asmáticos: â Fumadores â 0% APS, 56% APM, 33% APL, 11%AI; â Ex-fumadores â 10% APS, 30% APM, 50% APL, 10%AI; â Não fumadores â 7%APS, 27%APM, 36%APL, 30%AI;A avaliação funcional foi globalmente pior em doentes com exposição (actual ou prévia) a tabaco. Conclusão â A prevalência de hábitos tabágicos nesta amostra populacional foi de 8%, consideravelmente inferior à sua prevalência na população portuguesa (19,2%). A análise e comparação do grau de severidade de asma e da sua avaliação funcional revelou resultados piores na população de fumadores e ex-fumadores. Estes reforçam o papel da exposição ao tabaco como factor de agravamento da asma e, consequentemente, do seu prognóstico. Estudos posteriores podem revelar-se importantes na comprovação dos bem conhecidos riscos dos hábitos tabágicos, contribuindo para alertar a população asmática neste sentido. Rev Port Pneumol 2008; XIV (5): 617-624 Abstract: Setting â 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 â To determine the smoking rate and its repercussions on an asthmatic population sample. Design â 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 â 8% of 110 patients (65% female) aged 18 to 78 years were smokers, 9% former-smokers, 83% non-smokers. Among the asthmatics:â smokers: 0% SPA, 56% MoPA, 33% MiPA, 11% IA;â former smokers: 10% SPA, 30%MoPA, 50% MiPA, 10% IA;â non-smokers: 7% SPA, 27% MoPA, 36% MiPA, 30% IA. Patients with exposure to smoking had worse functional evaluation than those without exposure. Conclusion â 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. Rev Port Pneumol 2008; XIV (5): 617-624 Palavras-chave: Asma, tabaco, GINA, VEMS, Key-words: Asthma, smoking, GINA, FEV1

It is estimated that in developed countries between 1% and 2% of total healthcare expenditure goes on asthma treatment. The natural progression and causes of severe asthma are still not well defined. Severe persistent asthma is a less common situation, accounting for 5% of total asthma patients. Despite representing a small percentage of total patients, this group is largely responsible for the high health costs of asthma. Consequently, the improvement of risk factors can lead to both socioeconomic and health gains. The aim of this study was to examine risk factors for exacerbations in a group of patients with severe persistent asthma. It was a retrospective study, based on patient case histories that included subjects with severe persistent asthma with follow-up in an allergy unit between 1984 and 2005. A total 27 patients were included (mean age=50.64±12.7 years), 81.5% female. Main risk factors for exacerbations analysed were atopy, respiratory infections, premenstrual asthma, nasal symptoms, gastroesophageal reflux disease (GERD), psychological factors and obesity. Correction of these risk factors improved asthma control. The most significant impact was achieved with polypectomy and oral contraceptives in a teenager. In conclusion, correct identification of all risk factors for exacerbation in asthma, selection of those that can be controlled and their correction can improve asthma control. Resumo: Nos países desenvolvidos, 1 a 2% do total dos custos em cuidados de saúde são gastos no controlo da asma. A história natural e as causas da asma grave não estão ainda bem definidas. A asma persistente grave é uma situação menos comum, representando 5% do total de doentes asmáticos. Apesar de constituir um pequeno número de doentes, este grupo é responsável por elevados custos na asma. Como consequência, o controlo dos factores de risco pode levar a ganhos socioeconómicos e também na saúde. O objectivo deste trabalho foi analisar os factores de risco de exacerbações na asma persistente grave num grupo de doentes asmáticos. Consistiu num estudo retrospectivo de doentes com asma persistente grave em vigilância em consulta hospitalar de asma entre 1984 e 2005, baseando-se na revisão de processos clínicos. Foram incluídos 27 doentes, idade média=50,64±12,7 anos, 81,5% do sexo feminino. Analisaram-se os principais factores de risco de exacerbações: atopia, infecções respiratórias, asma pré-menstrual, sintomas nasais, refluxo gastroesofágico, psicológicos e obesidade. A correcção destes factores permitiu um melhor controlo da doença. O impacto mais significativo foi conseguido através da polipectomia e contracepção oral numa adolescente Em conclusão, a correcta identificação de todos os factores de risco de exacerbação da asma, a selecção dos factores que podem ser controlados e a sua correcção podem melhorar o controlo da doença. Key-words: Severe persistent asthma, risk factors, control, Palavras-chave: Asma persistente grave, factores de risco, controlo

To the Editors: The main objective of a tuberculosis (TB) control programme is to break the chain of transmission in the community [1, 2]. Early identification and effective treatment of infectious cases is key. It is assumed that active TB may develop in ∼10% of infected patients, usually within 2 yrs of infection [3]. In our centre (Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal), reflecting the Portuguese policy, the focus of TB contact investigations used to be only on the persons named by the index case. In 2004, we decided to include a routine evaluation of every patient’s home and work environment with the co-operation of public health teams [4]. According to Portuguese guidelines, a close contact is defined as a subject exposed to the index case for >8 h daily or >40 h of cumulative exposure time. All these identified contacts are requested to undergo a screening programme, which includes a symptoms questionnaire, clinical examination, a tuberculin skin test (TST) with 2 TU of purified protein derivative RT 23, an interferon-γ release assay (IGRA) and chest radiography. TST reactions >10 mm in diameter are confirmed with IGRAs. 6 months of chemotherapy with isoniazid …

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.

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.

To the Editors: Anti-tumour necrosis factor (TNF) therapy is increasingly used in chronic inflammatory diseases. These agents are related to an increased risk of tuberculosis (TB) depending on the clinical setting and the anti-TNF agent used, so screening is mandatory before its start [1]. Inhibition of TNF-α and TNF-regulated chemokine networks is the presumed biological basis [2]. Though patients with chronic inflammatory diseases and suspected latent TB infection (LTBI) who are candidates for anti-TNF therapy are at higher risk of TB reactivation, they are prone to false-negative tuberculin skin test (TST) and interferon-γ release assay (IGRA) results due to T-cell hyporesponsiveness, either because of illness or immunosuppressive medications [3]. The reliability of these tests in this population is therefore of interest, but currently unclear. The negative predictive value (NPV) of TST and IGRA is still not defined in this group of patients. National guidelines for diagnosis and treatment of LTBI require screening of any candidate on anti-TNF therapy, prior to starting it, through assessment of …

respiratory infection.In March of 2013, a 72-year-old male presented with hematuria. The patient also had hypertension, dyslipidemia, cerebrovascular disease (previous stroke), chronic renal failure, and depression. He was being treated with perindopril, indapamide, atorvastatin, acetylsalicylic acid, furosemide, and escitalopram. He had no known drug allergies. Ultrasound revealed a 2.5-cm polyp in the bladder. The patient underwent transurethral resection of the bladder tumor. Histological examination revealed urothelial cell carcinoma (grade 2), without vascular or muscle invasion. Chemotherapy and immunotherapy with intravesical instillation of BCG were started and continued until December of 2013. In February of 2014, the patient presented to the emergency department with a one-week history of dyspnea and productive cough (mucopurulent sputum). He reported no fever, chest pain, hemoptysis, sweating, or other symptoms. On physical examination, he was afebrile, with an increased respiratory rate, hemodynamic stability, and an SpO

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.

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.

Tuberculosis (TB) transmission in a non-household setting is difficult to detect, because contact with the source case is often not obvious. Here, we report on a case of a four-year-old child who got infected through sporadic non-household exposure at a coffee shop. The source case was a woman who had suffered from weight loss, productive cough and fatigue for two months before being diagnosed with TB. Screening the child’s contacts revealed two active TB cases within its family. Overall 148 contacts were screened for both cases and 18 cases of latent TB infection detected. The connection between the child and the source case, who were not aware of their contact, was confirmed by molecular fingerprinting. Our case report illustrates the difficulty in detecting non-household transmission between individuals that do not have significant contact, and draws attention to the need to look for the infected adult whenever a child falls ill with TB. This report is a reminder of the importance to consider possibly neglected ways of TB transmission and highlights once again the need of early diagnosis of TB.