BackgroundBenign prostatic hyperplasia (BPH) is the most common canine prostatic disorder. Although most or even all intact male dogs may develop BPH by 5–8 years of age, many show no clinical signs. Taking into account the non-specific character of clinical and ultrasonographic findings, a new diagnostic approach has recently been proposed based on the augmentation of blood canine prostate-specific arginine esterase (CPSE) in hyperplasic dogs. The aim of the present study was to verify CPSE levels in negative controls and hyperplasic dogs, considering cytological findings as the reference method and taking into account the fact that controls were middle-aged intact dogs (median of 5.0 years), contrarily to previous studies carried out with very young control dogs.ResultsSignificant differences of median CPSE levels were found between controls and hyperplasic dogs (29.1 versus 160.7 ng/mL, respectively); and significant positive correlations were found between median CPSE levels and age or prostatic volume (r = 0.549 and 0.448, respectively; p < 0.001). Sensitivity, specificity, positive and negative likelihood ratios put into evidence the good performance of the test. The agreement between methods was found to be very high, notably between CPSE levels and cytological results (Cohen’s kappa coefficients above 0.8).ConclusionsConsidering the results all together, measurement of CPSE is confirmed as a useful and accurate method and should be considered as an alternative or complementary tool to conventional methods for the diagnosis of BPH in middle-aged dogs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12917-017-0996-5) contains supplementary material, which is available to authorized users.

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Acute-on-chronic liver failure (ACLF) is a syndrome characterized by an acute deterioration of a patient with cirrhosis, frequently associated with multi-organ failure and a high short-term mortality rate. We present a retrospective study that aims to characterize the presentation, evolution, and outcome of patients diagnosed with ACLF at our center over the last 3 years, with a comparative analysis between the group of patients that had ACLF precipitated by infectious insults of bacterial origin and the group of those with ACLF triggered by a nonbacterial infectious insult; the incidence of acute kidney injury and its impact on the prognosis of ACLF was also analyzed. Twenty-nine patients were enrolled, the majority of them being male (89.6%), and the mean age was 53 years. Fourteen patients (48.3%) developed ACLF due to a bacterial infectious event, and 9 of them died (64.2%, overall mortality rate 31%); however, no statistical significance was found (p < 0.7). Of the remaining 15 patients (51.7%) with noninfectious triggers, 11 died (73.3%, overall mortality rate 37.9%); again there was no statistical significance (p < 0.7). Twenty-four patients (83%) developed acute kidney injury (overall mortality rate 65.5%; p < 0.022) at the 28-day and 90-day follow-up. Twelve patients had acute kidney injury requiring renal replacement therapy (41.37%; overall mortality rate 37.9%; p < 0.043). Hepatic transplant was performed in 3 patients, with a 100% survival at the 28-day and 90-day follow-up (p < 0.023). Higher grades of ACLF were associated with increased mortality (p < 0.02; overall mortality 69%). Conclusions: ACLF is a heterogeneous syndrome with a variety of precipitant factors and different grades of extrahepatic involvement. Most cases will have some degree of renal dysfunction, with an increased risk of mortality. Hepatic transplant is an efficient form of therapy for this syndrome.

RESUMOIntrodução: A incidência de tuberculose em Portugal entre 2010 -2014 foi de 20 a 22 casos por 100 000 habitantes. A incidência de tuberculose em transplantados hepáticos não é conhecida, estimando-se que seja mais elevada do que a da população em geral. O manejo da tuberculose em transplantados hepáticos constitui um desafio, não só pela apresentação clínica frequentemente atípica, mas também pelos efeitos secundários da terapêutica antibacilar e suas interações farmacológicas com a medicação imunossupressora, necessária no período pós-transplante. Material e Métodos: Os autores fizeram uma revisão retrospetiva dos casos de doentes transplantados hepáticos com tuberculose pós-transplante diagnosticada durante o período entre janeiro 2010 e dezembro 2014 num centro de transplantação hepática em Lisboa, Portugal. Foram analisados os dados demográficos, características clínicas, a par do regime antibacilar, toxicidade e evolução. Resultados: Num total de 1005 transplantados foi diagnosticada tuberculose ativa em oito doentes entre janeiro de 2010 e dezembro de 2014 (frequência de 0,8%). O desenvolvimento de tuberculose tardia foi mais frequente do que a doença precoce. Foi isolado Mycobacterium tuberculosis complex no exame cultural de sete doentes (87,5%). Foram frequentes a presença de envolvimento extrapulmonar, assim como doença tuberculosa disseminada. Dois doentes desenvolveram rejeição aguda, sem perda de enxerto. A taxa de mortalidade global foi de 37,5%, com duas mortes directamente atribuíveis à tuberculose. Discussão: Apesar da incerteza quanto à duração do tratamento da tuberculose em transplantados hepáticos, deverão ser tidos em conta a gravidade da doença, assim como o número de fármacos com actividade antibacilar. Nesta série, os doentes que desenvolveram rejeição aguda necessitaram da utilização de um regime sem rifampicina, e ajuste da terapêutica imunossupressora. Conclusão: Apesar do baixo número de casos de tuberculose, a sua frequência pós-transplante é significativa e a mortalidade associada não é negligenciável. Os casos de hepatotoxicidade e rejeição de enxerto demonstram os desafios no diagnóstico da tuberculose em transplantados hepáticos e a dificuldade do manejo das interações entre imunossupressores e a rifampicina. Este estudo reforça a recomendação de rastreio e tratamento de tuberculose latente em transplantados ou candidatos a transplante hepático.