Immune thrombocytopenic purpura induced by intestinal tuberculosis in a liver transplant recipient

A variety of clinical manifestations are associated directly or indirectly with tuberculosis. Among them, haematological abnormalities can be found in both the pulmonary and extrapulmonary forms of the disease. We report a case of immune thrombocytopenic purpura (ITP) associated with intestinal tuberculosis in a liver transplant recipient. The initial management of thrombocytopenia, with steroids and intravenous immunoglobulin, was not successful, and the lack of tuberculosis symptoms hampered a proper diagnostic evaluation. After the diagnosis of intestinal tuberculosis and the initiation of specific treatment, a progressive increase in the platelet count was observed. The mechanism of ITP associated with tuberculosis has not yet been well elucidated, but this condition should be considered in cases of ITP that are unresponsive to steroids and intravenous immunoglobulin, especially in immunocompromised patients and those from endemic areas.     

Monte Carlo validation of the irradiator parameters of the Portuguese gamma irradiation facility after its replenishment

In December 2003 the irradiator of the Portuguese ⁶⁰Co irradiation facility, UTR, was replenished. Monte Carlo simulation studies were used to characterize the facility. Comparison of simulation results with experimental measurements were useful in estimating where the source elements were positioned and what the total activity was. For this purpose the MCNPX code was used. From the experimental point of view ionization chambers and PMMA dosemeters were used.The results indicate that the geometry of the irradiator used for simulation studies shows a shift on the vertical dimension relative to the actual geometry of approximately 8 cm, but with reduced influence on the irradiation process. Considering the uncertainties of the experimental and simulated approaches the activity of the irradiator stated by supplier has been confirmed.     

Additional cardiac investigation prior to the introduction of the CAD-RADS classification in coronary computed tomography angiography reports

Introduction

The CAD-RADS^TM classification was recently introduced in an attempt to standardize coronary computed tomography angiography (CCTA) reports and to provide recommendations for further management. The aim of this study was to assess how additional cardiac investigations were being ordered before the introduction of the CAD-RADS classification in a tertiary hospital's CCTA reports.

The relationship between uric acid and brain health from observational studies

Metabolic Brain Disease - This study conducts a systematic literature review and meta-analysis regarding the potential influence of serum uric acid levels on cerebral small vessel diseases and the...     

Metabolic syndrome and colorectal neoplasms:An ominous association

AIM:To evaluate the association of metabolic syndrome(MS) and colorectal cancer and adenomas in a Western country,where the incidence of MS is over 27%.METHODS:This was a prospective study between March 2013 and March 2014.MS was diagnosed according to the National Cholesterol Education ProgramATP III.Demographic characteristics,anthropometric measurements,metabolic risk factors,and colonoscopic pathologic findings were assessed in patients with MS(group 1) who underwent routine colonoscopy at our department.This data was compared with consecutive patients without metabolic syndrome(group 2),with no differences regarding sex and age.Patients with incomplete colonoscopy,family history,or past history of colorectal neoplasm were excluded.Informed consent was obtained and the ethics committee approved this study.Statistical analysis was performed using Student's t-test and χ2 test,with a P value ≤ 0.05 being considered statistically significant.RESULTS:Of 258 patients,129 had MS;51% males;mean-age 67.1 years(50-87).Among the MS group,94% had high blood pressure,91% had increased waist circumference,60% had diabetes,55% had low high-density lipoprotein cholesterol level,50% had increased triglyceride level,and 54% were obese [body mass index(BMI) 30 kg/m2].51% presented 4 criteria of MS.MS was associated with increased prevalence of adenomas(43% vs 25%,P = 0.004) and colorectal cancer(13% vs 5%,P = 0.027),compared with patients without MS.MS was also positively associated with multiple(≥ 3) adenomas(35% vs 9%,P = 0.024) and sessile adenomas(69% vs 53%,P = 0.05).No difference existed between location(P = 0.086),grade of dysplasia(P = 0.196),or size(P= 0.841) of adenomas.In addition,no difference was found between BMI(P = 0.078),smoking(P = 0.146),alcohol consumption(P = 0.231),and the presence of adenomas.CONCLUSION:MS is positively associated with adenomas and colorectal cancer.However,there is not enough information in western European countries to justify screening in patients with MS.To our knowledge,no previous study has evaluated this association in Portuguese patients.