Oral squamous cell carcinoma: Review of prognostic and predictive factors

Oral squamous cell carcinoma has a remarkable incidence worldwide and a fairly onerous prognosis, encouraging further research on factors that might modify disease outcome. In this review article, the authors approach the factors that may exert influence on the prognosis and eventually guide the selection of patients for more aggressive therapies. Published scientific data was collected, selected, and grouped into 3 main clusters: patient-, tumor-, and treatment-related factors. Well established aspects are discussed, but also those less common or with only supposed usefulness. Disease staging, extracapsular dissemination, resection margin free of disease, and tumor thickness are factors with high influence on the prognosis. There has been an increasing interest in the study of tumor molecular factors, and some have been strongly correlated with the outcome, showing promising pathways for the future development of more effective prognosis systems and anticancer therapies.http://www.sciencedirect.com/science/article/B6WP1-4J0WTPM-3/1/71bafa4352dd7cfb29bd0c9c32f6991

Drug-Induced Anaphylaxis: An Update on Epidemiology and Risk Factors

Drug hypersensitivity is one of the most frequent causes of anaphylaxis, particularly in adults and in hospitalized patients. Drug-induced anaphylaxis (DIA) is also associated with more severe outcomes than other anaphylaxis triggers, and drugs are responsible for the majority of deaths due to anaphylaxis. We here review the current knowledge on the incidence, prevalence, drugs involved, mortality, and mortality risk factors for DIA. The incidence of both anaphylaxis and DIA seems to be increasing worldwide. Antibiotics and analgesics are the most frequently reported triggers of DIA. However, the importance of other drug groups should be taken into account, especially in particular settings (e.g., peri-operative and oncology). The identification of risk factors, geographical variables, and drugs associated with higher risk for DIA may improve the outcomes of this entity.info:eu-repo/semantics/publishedVersio

A clinical argument or an access constraint?

Funding Information: In the preparation of this article, the authors received collaboration from the medical writer Duarte Oliveira (W4Research) financially supported by Sanofi. Sanofi had no role in the preparation of the manuscript or in the decision to submit the manuscript for publication. All authors declare collaborating and receiving fees from Sanofi and other pharmaceutical companies either through participation in advisory boards or consultancy, congress symposia, conducting clinical trials, investigator-initiated trials or grants. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.proofpublishe

Immediate Test Reactions in Hand Eczema

Introdução: O eczema das mãos é uma doença multifactorial onde, muitas vezes, coexistem dermatite atópica, dermatite de contacto irritativa, dermatite de contacto alérgica (mediada principalmente pelas células T) e ainda reacções imediatas, como ocorre na urticária de contacto e/ou dermatite de contacto por proteínas (mediada ou não por IgE). O objectivo do estudo foi a caracterização dos doentes com eczema das mãos que reportaram sintomas imediatos com o manuseamento de produtos diversos.Material e Métodos: Análise retrospectiva dos registos dos doentes do Serviço de Dermatologia com eczema das mãos que realizaram testes epicutâneos e testes cutâneos por picada. Os testes epicutâneos englobaram as séries básica europeia/portuguesa e séries complementares, seleccionadas de acordo com os antecedentes clínicos. Os testes cutâneos por picada foram realizados sempre que os doentes referiam sintomas imediatos com a exposição, e foram correlacionados com IgE específica e total.Resultados: Foram avaliados 52 doentes (49F/3M), média de idades: 33,4 ± 9,9 anos, 25 (48,1%) com antecedentes pessoais de atopia (nove com dermatite atópica). Além do eczema das mãos, considerado ocupacional em 33 doentes (63,5%), a dermatite também envolveu a face em seis doentes (11,5%). Foram observados testes epicutâneos positivos em 31 doentes (59,6%), principalmente ao níquel (14; 45,2%). Verificaram-se testes cutâneos por picada positivos em 28 doentes (53,8%), principalmente para o látex (10; 35,7%), seguido de kiwi (8; 28,6%). Não houve correlação estatisticamente significativa entre os testes cutâneos por picadapositivos e a presença de atopia ou de IgE sérica total elevada.Conclusão: Embora o estudo inclua um número limitado de doentes com eczema das mãos e apenas tenham sido realizados testes cutâneos por picada naqueles com história sugestiva, observaram-se reacções imediatas relevantes numa percentagem muito significativa de doentes (53,8%), principalmente naqueles com antecedentes pessoais de atopia. A IgE específica não foi útil para o diagnóstico, face aos testes cutâneos por picada. Reacções imediatas, não directamente dependentes de células T, podem estar significativamente envolvidos na patogénese do eczema das mãos, pelo que os testes imediatos devem ser mais frequentemente adicionados aos testes epicutâneos no estudo do eczema das mãos.Introduction: Hand eczema is a multifactorial disease that can include manifestations of atopic dermatitis, irritant contact dermatitis, allergic contact dermatitis (mediated mainly by T cells) and/or immediate reactions such as contact urticaria or protein contact dermatitis (mediated or not by IgE). The study aim was the characterization of patients with hand eczema who reported immediate symptoms with the handling of suspected triggers.Material and Methods: Retrospective analysis of medical records of patients from the Dermatology Department with hand eczema who performed patch tests (baseline and complementary series according to the clinical history) and skin prick test whenever patients presented immediate symptoms with suspected triggers. Skin prick test results were correlated with specific and total IgE.Results: A total of 52 patients were evaluated (49F/3M), mean age: 33.4 ± 9.9 years, 25 (48.1%) with a personal history of atopy (nine with atopic dermatitis). Besides hand eczema, considered occupational in 33 patients (63.5%), dermatitis also involved the face in six (11.5%). We found positive patch tests in 31 patients (59.6%), mainly to nickel (45.2%). Skin prick test were positive in 28 patients (53.8%), mainly for latex (10, 35.7%) and kiwi (8, 28.6%). There was no statistically significant correlation between positive skin prick test and the presence of atopy or high total serum IgE.Conclusion: Although the study included a limited number of patients with hand eczema and we only performed skin prick test in those with complaints, we observed immediate reactions in a very significant proportion of patients (53.8%), mainly in the atopic group. Specific IgE was not useful for the diagnosis, compared to the skin prick test. Immediate mechanisms, not directly dependent on T cells, may be significantly involved in the pathogenesis of hand eczema, so immediate tests should be added more often to patch tests in the study of hand eczema

“Vencer a asma 2017” campaign: A community-based screening

A asma é uma das doenças crónicas não transmissíveis mais frequentes afetando cerca de 700 000 portugueses atualmente. Os rastreios constituem uma oportunidade de prestar esclarecimentos sobre a doença à população, alertar a população para a importância do controlo da asma e reconhecimento dos seus sintomas. Objetivos, material e métodos: Caracterização sociodemográfica e descritiva dos resultados da campanha “Vencer a Asma 2017”. Estudo transversal em 8 cidades de Portugal continental numa iniciativa pública, gratuita e de inclusão voluntária da população a propósito do Dia Mundial da Asma. Aplicação de questões adaptadas do questionário GA2LEN e realização de espirometria simples. Resultados: 1086 participantes (idade 52,5±19,7 anos; 62,4 % do género feminino; 20,5 % fumadores e 62,6 % observados na região Norte). Dos participantes, 299 (28,0 %; IC95 % 25,3-30,7) declararam ter asma atual ou no passado (autorreportada) e, entre estes, 80 (26,8 %; IC95 % 21,7-31,8) reportaram pelo menos uma hospitalização por asma, 181 (60,5 %; IC95 % 55,0-66,1) afirmaram estar medicados para a asma; 498 (46,6 %; IC95 % 43,6-49,6) mencionaram ter tido um episódio de sibilância nos últimos 12 meses. Durante o rastreio, 549 participantes (50,6%; IC95 % 47,6-53,5) realizaram espirometria simples e, destes, 186 (34,1 %; IC95 % 30,1-38,1) apresentaram alte-rações dos parâmetros espirométricos avaliados. A análise de subgrupos revelou uma prevalência de “asma atual” de 19,9 % (IC95 %; 17,5-22,2). Conclusões: O rastreio permitiu, apesar das suas limitações, identificar um grande número de indivíduos na comunidade num curto espaço de tempo. No futuro, será útil que estas iniciativas incluam questionários de resultados reportados pelo doente, testes cutâneos por picada, prova de broncodilatação ou fração exalada de óxido nítrico, que permitam uma melhor caracterização da população estudada bem como a perceção de necessidade de avaliação clínica posterior nos casos em que não haja um adequado acompanhamento médico.GlaxoSmithKline™; LPM Consultadoria, MEDIDA, Lda,info:eu-repo/semantics/publishedVersio

Sustained suppression by Foxp3+ regulatory T cells is vital for infectious transplantation tolerance

A new genetic mouse model demonstrates the necessity of Foxp3+ T reg cells for infectious tolerance

Academic productivity of young people with allergic rhinitis:A MASK-air® study

Peer reviewe

Validity, reliability, and responsiveness of daily monitoring visual analog scales in MASK‐air®

Background: MASK-air® is an app that supports allergic rhinitis patients in disease control. Users register daily allergy symptoms and their impact on activities using visual analog scales (VASs). We aimed to assess the concurrent validity, reliability, and responsiveness of these daily VASs. Methods: Daily monitoring VAS data were assessed in MASK-air® users with allergic rhinitis. Concurrent validity was assessed by correlating daily VAS values with those of the EuroQol-5 Dimensions (EQ-5D) VAS, the Control of Allergic Rhinitis and Asthma Test (CARAT) score, and the Work Productivity and Activity Impairment Allergic Specific (WPAI-AS) Questionnaire (work and activity impairment scores). Intra-rater reliability was assessed in users providing multiple daily VASs within the same day. Test–retest reliability was tested in clinically stable users, as defined by the EQ-5D VAS, CARAT, or “VAS Work” (i.e., VAS assessing the impact of allergy on work). Responsiveness was determined in users with two consecutive measurements of EQ-5D-VAS or “VAS Work” indicating clinical change. Results: A total of 17,780 MASK-air® users, with 317,176 VAS days, were assessed. Concurrent validity was moderate–high (Spearman correlation coefficient range: 0.437–0.716). Intra-rater reliability intraclass correlation coefficients (ICCs) ranged between 0.870 (VAS assessing global allergy symptoms) and 0.937 (VAS assessing allergy symptoms on sleep). Test–retest reliability ICCs ranged between 0.604 and 0.878—“VAS Work” and “VAS asthma” presented the highest ICCs. Moderate/large responsiveness effect sizes were observed—the sleep VAS was associated with lower responsiveness, while the global allergy symptoms VAS demonstrated higher responsiveness. Conclusion: In MASK-air®, daily monitoring VASs have high intra-rater reliability and moderate–high validity, reliability, and responsiveness, pointing to a reliable measure of symptom loads

Behavioural patterns in allergic rhinitis medication in Europe : A study using MASK-air(R) real-world data

Background Co-medication is common among patients with allergic rhinitis (AR), but its dimension and patterns are unknown. This is particularly relevant since AR is understood differently across European countries, as reflected by rhinitis-related search patterns in Google Trends. This study aims to assess AR co-medication and its regional patterns in Europe, using real-world data. Methods We analysed 2015-2020 MASK-air(R) European data. We compared days under no medication, monotherapy and co-medication using the visual analogue scale (VAS) levels for overall allergic symptoms ('VAS Global Symptoms') and impact of AR on work. We assessed the monthly use of different medication schemes, performing separate analyses by region (defined geographically or by Google Trends patterns). We estimated the average number of different drugs reported per patient within 1 year. Results We analysed 222,024 days (13,122 users), including 63,887 days (28.8%) under monotherapy and 38,315 (17.3%) under co-medication. The median 'VAS Global Symptoms' was 7 for no medication days, 14 for monotherapy and 21 for co-medication (p < .001). Medication use peaked during the spring, with similar patterns across different European regions (defined geographically or by Google Trends). Oral H-1-antihistamines were the most common medication in single and co-medication. Each patient reported using an annual average of 2.7 drugs, with 80% reporting two or more. Conclusions Allergic rhinitis medication patterns are similar across European regions. One third of treatment days involved co-medication. These findings suggest that patients treat themselves according to their symptoms (irrespective of how they understand AR) and that co-medication use is driven by symptom severity.Peer reviewe