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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. publishersversion published

Objective: We aimed to compare patient's and physician's ratings of inhaled medication adherence and to identify predictors of patient-physician discordance. Design: Baseline data from two prospective multicentre observational studies. Setting: 29 allergy, pulmonology and paediatric secondary care outpatient clinics in Portugal. Participants: 395 patients (≥13 years old) with persistent asthma. Measures: Data on demographics, patient-physician relationship, upper airway control, asthma control, asthma treatment, forced expiratory volume in one second (FEV1) and healthcare use were collected. Patients and physicians independently assessed adherence to inhaled controller medication during the previous week using a 100 mm Visual Analogue Scale (VAS). Discordance was defined as classification in distinct VAS categories (low 0-50; medium 51-80; high 81-100) or as an absolute difference in VAS scores ≥10 mm. Correlation between patients' and physicians' VAS scores/categories was explored. A multinomial logistic regression identified the predictors of physician overestimation and underestimation. Results: High inhaler adherence was reported both by patients (median (percentile 25 to percentile 75) 85 (65-95) mm; 53% VAS>80) and by physicians (84 (68-95) mm; 53% VAS>80). Correlation between patient and physician VAS scores was moderate (rs=0.580; p

Epstein Barr virus (EBV) primoinfection may contribute to the development of post-mononucleosis lymphomas in EBV-seronegative adult males with inflammatory bowel disease (IBD) under thiopurine therapy, but data on children are sparse. Knowledge of the EBV status may influence the type of surveillance and therapy in a group particularly vulnerable to the occurrence of EBV primoinfection. We aimed to determine the EBV status at diagnosis, the primoinfection rate, and complications in a pediatric Portuguese population with IBD.This was a retrospective analysis of clinical records of pediatric patients with IBD. Demographic data, EBV status, as well as clinical and therapeutic data on primoinfection were collected.Of the 250 patients evaluated, 229 (91.6%) had documented EBV screening and 50.8% were male. Mean age ± SD was 13.0 ± 2.8 years at diagnosis and 14.7 ± 2.3 years at EBV screening. EBV IgG serology was positive in 76.0% of patients. A total of 218 patients had been on therapy with azathioprine at some point. The average length of exposure to azathioprine was 4 years, and 91 patients (39.7%) were on azathioprine at EBV assessment. EBV primoinfection was documented in 4 patients (1.6%), all females, 2 of whom were on azathioprine. Two presented clinical signs of infection and 2 were identified at diagnostic screening; the first 2 suspended azathioprine and the other 2 did not initiate it.A significant proportion of pediatric Portuguese IBD patients are EBV-naïve. Systematic screening of EBV status enables the identification of patients at risk of primoinfection, and the occurrence of symptoms suggestive of acute EBV infection in seronegative patients should lead to rapid confirmation of the diagnosis. Timely diagnosis may allow the adjustment of therapeutic strategy sparing patients from potentially severe iatrogeny.A primoinfecção pelo virus Epstein Barr (EBV) pode contribuir para o desenvolvimento de linfomas pós-mononucleose infecciosa em homens adultos EBV-seronegativos com doença inflamatória intestinal (Dll), sob terapéutica com tiopurinas. Os dados em crianças são escassos. O conhecimento do perfil serológico do EBV pode influenciar o tipo de vigilancia e terapéutica em doentes particularmente vulneráveis á ocorréncia de primoinfecção por EBV. Os autores têm como objetivo conhecer o perfil serológico do EBV ao diagnóstico de Dll, a taxa de primoinfecção e complicações numa população pediátrica portuguesa com Dll.Análise retrospectiva dos processos de doentes em idade pediátrica com Dll. Foram recolhidos dados demográficos, o perfil serológico do EBV e dados clínicos e terapéuticos aquando da primoinfecção.Dos 250 doentes avaliados, 229 (91.6%) tinham rastreio do EBV documentado, 50.8% dos quais do sexo masculino. A idade média (DP) ao diagnóstico de Dll foi de 13.0 ± 2.8 anos e no momento do rastreio do EBV de 14.7 ± 2.3 anos. A serologia para EBV foi IgG positiva em 76.0% dos doentes. 218 efetuaram terapéutica com azatioprina, com exposição média de quatro anos. 91 doentes (39.7%) estavam sob azatioprina aquando da avaliação do perfil serológico do EBV. A primoinfecção por EBV foi documentada em quatro doentes (1.6%), todos do sexo feminino, dois dos quais sob azatioprina. Dois doentes apresentaram sinais clínicos de infecção, dois foram identificados no rastreio infeccioso ao diagnóstico de Dll; os dois primeiros suspenderam a terapéutica com azatioprina, os outros dois não a iniciaram.Uma proporção significativa de crianças portuguesas com Dll é na'ïve para o EBV. Aavaliação sistemática do perfil serológico do EBV permite a identificação de doentes com risco de primoinfecção e a ocorréncia de sintomas sugestivos de infecção aguda pelo EBV em doentes soronegativos deve levar á rápida confirmação do diagnóstico. O diagnóstico oportuno permite o ajuste da estratégia terapêutica, evitando potencial iatrogenia grave.

Objetivos: Caracterizar os conhecimentos, preocupações e atitudes dos pais perante uma criança com febre, de forma a traçar um plano futuro de intervenção nesta área junto da população. Tipo de estudo: Estudo transversal, descritivo e analítico. Local: USF Lagoa. População: Todos os pais ou cuidadores de crianças com idades entre os 29 dias e os 36 meses inscritos na USF Lagoa. Métodos: Estudo realizado entre setembro e dezembro de 2015, através da aplicação de um questionário por via telefónica ou diretamente com o cuidador, caso este tivesse consulta agendada durante o mesmo período de tempo. Foi feita uma análise descritiva simples, com recurso ao programa Microsoft Excel 2010®. Este estudo é reportado de acordo com as linhas de orientação STROBE. Resultados: Foram entrevistados 248 pais/cuidadores. Oitenta e três por cento fazem avaliação da temperatura na axila e 40% considera febre para valores inferiores a 37,5 °C. A maioria (54,7%) escolhe como principal fármaco a administrar o paracetamol e 30% sabe administrar doses corretas de medicação. As convulsões são consideradas a principal complicação associada à febre (62,1%). Cinquenta por cento recorre ao médico logo que surge febre ou no primeiro dia de doença, sendo o centro de saúde o local de eleição para a metade dos inquiridos. Conclusões: Perceções e atitudes erradas em relação à febre persistem nos dias de hoje. É fundamental reforçar os conhecimentos dos pais/cuidadores em relação à abordagem e tratamento da febre, de forma a diminuir a ansiedade e melhorar a prestação de cuidados à criança febril. Aim: To characterize parents’ knowledge, concerns, and attitudes towards a child with fever, in order to design a future intervention project on this subject for the population. Type of study: Descriptive and analytic cross-sectional study. Location: USF Lagoa. Population: All parents or caregivers of children aged between 29 days and 36 months, enrolled in USF Lagoa. Methods: Study conducted between September and December 2015, through the distribution of a survey to the caregiver, either by telephone or in person, in case the patient had an appointment during this time period. Data were analyzed with Microsoft Excel 2010®. This study is reported according to the STROBE guidelines. Results: A total of 248 parents/caregivers were interviewed. Eighty-three percent of the participants evaluated the temperature in the armpit and 40% considered fever for values below 37.5 °C. The majority (54.7%) chooses paracetamol as the drug of choice, and 30% knows the adequate dose to be administered. Seizures are considered the main complication associated with fever (62.1%). Fifty percent of the participants seek medical care as soon as the fever appears or in the first day of illness, and the primary care center is the care setting of election for half of the respondents. Conclusions: Wrong perceptions and attitudes towards fever persist nowadays. It is vital to reinforce parents’ and caregivers’ knowledge on the management and treatment of fever, in order to reduce anxiety and to improve care for febrile children.

Hepatitis B vaccination is included in the Portuguese national health plan. Vaccine-induced hepatitis B surface antigen positivity is described in literature, leading to diagnostic errors if the serological test is prematurely performed after vaccination. We report the case of a false positive transient B surface antigenemia in a premature baby born from a hepatitis B vaccinated mother. Caution is required when seropositivity is found after administration of hepatitis B vaccine in order to avoid anxiety in parents and unnecessary exams., A vacina da hepatite B faz parte do programa nacional de vacinação português. A positividade para o antigénio de superfície do vírus da hepatite b induzida pela vacina está descrita na literatura, o que pode conduzir a erros diagnósticos se a serologia for feita prematuramente após vacinação. Reporta-se um caso de deteção de um falso positivo transitório num recém-nascido prematuro de uma mãe vacinada. Sugere-se prudência na interpretação de um resultado seropositivo após administração da vacina da hepatite B, de forma a evitar a ansiedade parental e exames desnecessários.

A term newborn, from a medically supervised pregnancy, had a hypoplasia of the right leg bones and ipsilateral deviation of the foot on the obstetric ultrasounds and presented at birth with a medial deviation of the inferior third of the right leg and dorsiflexion of the right foot. A right leg x-ray showed a congenital posteromedial bowing of the tibia (CPMBT). A favorable outcome was achieved with a conservative approach at eleven months old. CPMBT is the most benign of all the congenital deformities of the tibia. Usually it is obvious at birth as a calcaneal valgus deformity. It tends to resolve spontaneously, thus a conservative approach is adopted in most cases. Limb length discrepancy is the main complication, and so follow-up is recommended until skeletal maturity. Due to the rarity of these deformities, an early recognition and referral are fundamental., NASCER E CRESCER - BIRTH AND GROWTH MEDICAL JOURNAL, Vol 26, No 4 (2017)