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.

Introduction. Malnutrition is underdiagnosed in chronic obstructive pulmonary disease. Objectives. This study aimed to evaluate the nutritional status of COPD patients and the link between dyspnea and nutritional status. Methods. This longitudinal observational study included patients hospitalized with exacerbated COPD. Nutritional status was assessed using Nutrition Risk Screening 2002, anthropometric, and biochemical assessments, in the first 48 hours of hospitalization. Results. Thirty patients were evaluated. According to the Nutrition Risk Screening 2002, half of the patients were at increased risk of malnutrition. 36.7% were classified as malnourished if we only considered the body mass index. From the evaluation of the tricipital skin fold, 69.0% were classified as malnourished, with 48.3% having severe malnutrition. According to the serum albumin level, 29.6% had malnutrition criteria. A significant association between dyspnea and increasing age ( ) was found. There was a strong association between the fold classification and the degrees of severity of dyspnea (Fisher exact test: 13.60, , V Cramer = 0.826). Most patients were malnourished and had higher grades of dyspnea. Tricipital skinfold reflects subcutaneous adipose tissue; this anthropometric measurement seems to be a good method to classify the nutritional status of COPD patients. It classified the biggest portion of patients as malnourished. Conclusion. The number of patients classified as malnourished changed with the method under analysis. The tricipital skin fold parameter was strongly associated with the dyspnea score. Most patients had adipose tissue and muscular mass depletion.

Introduction: Early diagnosis of tuberculosis (TB) is essential to achieve cure and to reduce disease transmission. Total diagnostic delay (TDD) can be divided in patient delay (PD - from symptoms onset to seeking a health care facility) and health system delay (HSD - from first contact to confirmation of TB diagnosis). In Portugal, the median TDD is 80 days. This study aimed to identify risk factors associated with PD and HSD in a portuguese center. Methods: Cross-sectional study of patients diagnosed with pulmonary TB between 2011 and 2021. Demographic, clinical, microbiological and radiological data at time of diagnosis were analyzed. Results: Of the 130 patients included, 102 (78.5%) were male and 33 (25.4%) had >60 years (mean age of 49.4 years). History of previous TB infection was present in 7 (5.4%) patients and 15 (11.5%) had known contact with a TB patient. The mean and median TDD were respectively 68.0/48 days, with 18.3/8 days due to PD and 49.7/25.6 days due to HSD. TDD was ≤30 days in 38 (29.2%) patients. Health system delay was more frequent in patients with >60 years (p=0.043) and chronic diseases (p=0.043). Other factors associated with higher HSD were negative acid-fast bacilli smear (p>0.001), localized pulmonary disease (p>0.001) and absence of cavitation (p=0.014). Patient delay was higher if patients reported constitutional symptoms without respiratory complaints (p>0.001). Patients with history of prior treatment or TB contact did not seek medical attention earlier. Conclusion: Delay in diagnosis is still a major challenge of TB control. This study highlights the need to maintain a high level of suspicion in all patients who seek health care and to educate the population in regard to TB symptoms and transmission.

The cancer ratio (CR), defined as serum lactate dehydrogenase to pleural fluid adenosine deaminase ratio (sLDH/pADA), has emerged as a diagnostic marker for malignant pleural effusion (MPE). However, previous studies have primarily compared MPE with exudative effusions, excluding transudates. The aim of this study was to determine the diagnostic accuracy of CR in differentiating MPE from benign pleural effusions (BPE), including both exudates and transudates. An observational analysis was conducted on patients with pleural effusion (PE) evaluated in a Portuguese center between January 2017 and August 2025. Diagnostic accuracy was assessed using receiver operating characteristic curves and area under the curve (AUC) analysis. Of the 423 PE evaluated, 154 (36.4%) were MPE and 269 (63.6%) were BPE, including 82 transudates, 159 true benign exudates (TBEPE) and 28 PE misclassified as exudates. Significantly higher CR levels were observed in MPE than in BPE (p < 0.001). When comparing MPE with TBEPE, a CR threshold of 20 yielded an AUC of 0.90, with 76.0% sensitivity and 93.1% specificity. The inclusion of misclassified exudative BPE and transudates reduced diagnostic accuracy (AUC 0.86/0.73, respectively). In conclusion, a CR > 20 is highly predictive of malignancy etiology. Accurate pre-classification according to the Light’s criteria is essential to preserve the diagnostic validity of this biomarker.