Oral challenge to drugs in pediatrics – casuistry 2015

Introdução: A suspeita de alergia a fármacos em idade pediátrica é um motivo frequente de consulta, que contudo raramente se confirma. Desta forma, a prova de provocação oral (PPO) assume um papel significativo na abordagem diagnóstica. Objetivos: Caracterizar a população pediátrica da consulta de um hospital de nível II, que realizou PPO a fármacos, avaliar os fármacos implicados e analisar os casos cujas PPO foram positivas. Material e métodos: Análise retrospetiva dos processos clínicos dos doentes com idade inferior a 18 anos que realizaram PPO a fármacos no período compreendido entre 1 de janeiro e 31 de dezembro de 2015. Resultados: A amostra incluiu 58 doentes, 53,4% do sexo masculino, sendo a mediana de idades cinco anos. A maioria foi referenciada a partir do serviço de urgência (39,7%) e da consulta externa (36,2%). A amoxicilina foi o fármaco suspeito em 46,6 %, associada com ácido clavulânico em 34,5%. Cerca de 93,1% apresentaram manifestações mucocutâneas, 5,2% gastrointestinais e mucocutâneas e 1,7% respiratórias e mucocutâneas. Em 20,7 % dos casos as manifestações surgiram nas primeiras 24h. As PPO foram positivas em três doentes e os fármacos responsáveis foram a amoxicilina (dois casos) e o ibuprofeno (um caso). Conclusões: Sendo a alergia a fármacos rara em crianças e tendo em conta a sua repercussão na decisão terapêutica em casos de situações infeciosas, é de extrema relevância a referenciação para esclarecimento diagnóstico.info:eu-repo/semantics/publishedVersio

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

Measuring adherence to inhaled control medication in patients with asthma: Comparison among an asthma app, patient self‐report and physician assessment

Background Previous studies have demonstrated the feasibility of using an asthma app to support medication management and adherence but failed to compare with other measures currently used in clinical practice. However, in a clinical setting, any additional adherence measurement must be evaluated in the context of both the patient and physician perspectives so that it can also help improve the process of shared decision making. Thus, we aimed to compare different measures of adherence to asthma control inhalers in clinical practice, namely through an app, patient self-report and physician assessment. Methods This study is a secondary analysis of three prospective multicentre observational studies with patients (≥13 years old) with persistent asthma recruited from 61 primary and secondary care centres in Portugal. Patients were invited to use the InspirerMundi app and register their inhaled medication. Adherence was measured by the app as the number of doses taken divided by the number of doses scheduled each day and two time points were considered for analysis: 1-week and 1-month. At baseline, patients and physicians independently assessed adherence to asthma control inhalers during the previous week using a Visual Analogue Scale (VAS 0–100). Results A total of 193 patients (72% female; median [P25–P75] age 28 [19–41] years old) were included in the analysis. Adherence measured by the app was lower (1 week: 31 [0–71]%; 1 month: 18 [0–48]%) than patient self-report (80 [60–95]) and physician assessment (82 [51–94]) (p 0.05). There was a moderate correlation between patient self-report and physician assessment (ρ = 0.596, p < 0.001). Conclusions Adherence measured by the app was lower than that reported by the patient or the physician. This was expected as objective measurements are commonly lower than subjective evaluations, which tend to overestimate adherence. Nevertheless, the low adherence measured by the app may also be influenced by the use of the app itself and this needs to be considered in future studies.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

Granulações de Pacchioni: Caso Clínico

Lactente de nove meses, sexo masculino, previamente saudável, observado por depressão craniana. Era negado traumatismo, infeção ou outros sinais ou sintomas. Ao exame objetivo palpava-se uma depressão na região occipital, com quinze milímetros de maior diâmetro, bordos regulares e indolor à palpação. Sem evidência de maus tratos. A radiografia do crânio mostrou uma imagem lítica de bordo esclerótico com 20 milímetros de maior diâmetro (Figura 1). Na tomografia computorizada cerebral observou-se  roeminência de granulações aracnoides causando indentações na escama occipital, associadas a soluções de continuidade óssea de contornos regulares, designadas granulações de Pacchioni (Figura 2).O líquido cefaloraquídeo (LCR) é reabsorvido pelas vilosidades da aracnóide que permitem o seu fluxo do espaço subaracnoideu para os seios venosos da dura-máter1-4. Habitualmente de dimensões milimétricas, podem crescer e expandir-se, causando indentações na calote craniana, mimetizando lesões osteolíticas4. As granulações de Pacchioni, mais frequentes nos adultos e assintomáticas, raramente foram descritas em crianças e associadas a sintomas inespecíficos como cefaleias e acufenos2. Excecionalmente causam sintomas de hipertensão intracraniana, por hipertensão venosa secundária a oclusão parcial dos seios durais, obrigando ao diagnóstico diferencial com trombose dos seios venosos1,4. A aparência osteolítica implica o diagnóstico diferencial com cistos dermóide/epidermóide, encondroma, displasia fibrosa, hemangioma e granuloma eosinofílico5

Esclerose Tuberosa: diagnóstico, seguimento e tratamento

 A esclerose tuberosa é um distúrbio sistémico, de hereditariedade autossómica dominante. As suas manifestações podem ser evidentes ainda no período pré-natal, mas a maioria dos sinais e sintomas clínicos surgem ao longo da infância, adolescência e idade adulta, pelo que se impõe uma abordagem multidisciplinar, sistemática e regular de eventuais problemas de saúde, procurando minimizar o risco de complicações potencialmente graves.Faz-se uma revisão actualizada dos aspectos genéticos, manifestações clínicas, critérios de diagnóstico, seguimento, abordagem clínica e terapêutica da esclerose tuberosa, numa tentativa de melhorar os cuidados prestados a estes doentes

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