Um caso clínico

Publisher Copyright: © 2021, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved.The increasing use of ophthalmic medication has led to the emergence of a greater number of hypersensitivity reactions (HR) associated with it. These are mostly type IV HR and, rarely, immediate. The agents involved are diverse, from active substances such as mydriatic eye drops (CM) to inactive substances (preservatives). We report the case of a patient with suspected immediate and non-immediate HR to ophthalmic medication (tropicamide 10mg/ml, phenylephrine 100mg/ml and cyclopentolate 10mg/ml), whose investigation included skin prick tests (SPT) and patch tests (PT) with the mentioned drugs. SPT were positive for cyclopentolate, with immediate reaction, and for phenylephrine at 48 and 96 hours. The PT were positive at 48 and 96 hours for phenylephrine. According to these results, we assumed allergy to phenylephrine and cyclopentolate and an ocular provocation test was performed with tropicamide which was tolerated by the patient.publishersversionpublishe

Beta-lactams anaphylaxis – When tolerance doesn’t exclude allergy

Publisher Copyright: © 2022, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved.Beta-lactams are a major cause of anaphylaxis in adults. We describe two cases of patients with symptoms of anaphyla-xis after taking beta-lactams that after the resolution of the initial reaction were able to keep the drug and tolerated a com-pleted treatment period. During the investigation, the skin tests were positive for the suspected beta-lactam and the patients underwent a drug provocation test, which identified an alternative beta-lactam. We suggest that anaphylaxis led to a con-sumption of mediators of the allergic inflammation, allowing a temporary tolerance of mast cells and basophils to the drugs in question, which was maintained by continuous exposure. We intent to alert to the possibility that tolerance after an allergic reaction to drugs may be misleading. Thus, the importance of carrying out allergic investigation in situations of tolerance im-mediately after anaphylaxis, which will allow to exclude/confirm the existence of hypersensitivity and reduce the risk of recurrence of potentially fatal conditions.publishersversionpublishe

A propósito de um caso clínico

Publisher Copyright: © 2021 Sociedade Portuguesa de Alergologia e Imunologia Clínica. Published by Publicações Ciência & Vida.Anaphylaxis triggered by ingestion of dust mite contaminated flour, namely wheat flour (WF), is a rare entity. We describe the case of a twelve-year-old male patient with a previous history of allergic rhinitis and suspicion of non-steroidal anti-inflam-matory drugs hypersensitivity, who developed two anaphylactic reactions to an unidentified trigger. Both episodes took place after ingestion of food that was subsequently tolerated. We performed cutaneous skin prick tests to aeroallergens and to the food ingested previously to the reactions, with positive results to numerous mite species and WF from the implicated package and with negative results to commercial extracts of wheat, gliadin, WF with/without baker’s yeast from new packages. We assumed the diagnosis of “pancake syndrome” and confirmed the ibuprofen hypersensitivity with a positive drug provocation test. We present this case because identifying this syndrome requires a high level of suspicion and it should be considered in the differential diagnoses of anaphylaxis of unknown cause.publishersversionpublishe

Patient-physician discordance in assessment of adherence to inhaled controller medication: a cross-sectional analysis of two cohorts

We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance.(SFRH/BPD/115169/2016) funded by Fundação para a Ciência e Tecnologia (FCT); ERDF (European Regional Development Fund) through the operations: POCI-01-0145-FEDER-029130 ('mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases—generalisation and evaluation of gamification, peer support and advanced image processing technologies') cofunded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).info:eu-repo/semantics/publishedVersio

Identification of clusters of asthma control: A preliminary analysis of the inspirers studies

This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia).© 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified.publishersversionpublishe

Relatório estágio profissional

Relatório final do estágio profissionalizante do 6.º ano

Relatório estágio profissional

Relatório final do estágio profissionalizante do 6.º ano

A repetição como tempo e prática artística

In the first part, after the circumscription of the theme of time and the perspective from which it is understood in the western tradition, it is made an analysis of the works of Jacques Derrida's La différance and La voix et le phénomène. Various concepts are examined, including the différance, retention, protention, the trace, the other and archi-writing, tracing the particular view of this author which operates (in the theme of time) in the line of thought of Heidegger, Levinas and Husserl. Afterwards it is highlighted the importance of repetition in artistic creation, relating it to the routine and giving as an example the Béla Tarr´s film, The Turin Horse, which is analyzed. In the second part it is presented the practical work of painting that was developed in parallel with this assa

Feasibility and Acceptability of an Asthma App to Monitor Medication Adherence : Mixed Methods Study

Background: Poor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. Objective: This study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). Methods: A 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients' asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. Results: A total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring >= 4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). Conclusions: The InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app