ALER - Artigos
Permanent URI for this collection
Browse
Recent Submissions
- Acoustic and Clinical Data Analysis of Vocal Recordings: Pandemic Insights and Lessons.Publication . Carreiro-Martins, Pedro; Paixão, Paulo; Caires, Iolanda; Matias, Pedro; Gamboa, Hugo; Soares, Filipe; Gomez, Pedro; Sousa, Joana; Neuparth, NunoBackground/Objectives: The interest in processing human speech and other human-generated audio signals as a diagnostic tool has increased due to the COVID-19 pandemic. The project OSCAR (vOice Screening of CoronA viRus) aimed to develop an algorithm to screen for COVID-19 using a dataset of Portuguese participants with voice recordings and clinical data. Methods: This cross-sectional study aimed to characterise the pattern of sounds produced by the vocal apparatus in patients with SARS-CoV-2 infection documented by a positive RT-PCR test, and to develop and validate a screening algorithm. In Phase II, the algorithm developed in Phase I was tested in a real-world setting. Results: In Phase I, after filtering, the training group consisted of 166 subjects who were effectively available to train the classification model (34.3% SARS-CoV-2 positive/65.7% SARS-CoV-2 negative). Phase II enrolled 58 participants (69.0% SARS-CoV-2 positive/31.0% SARS-CoV-2 negative). The final model achieved a sensitivity of 85%, a specificity of 88.9%, and an F1-score of 84.7%, suggesting voice screening algorithms as an attractive strategy for COVID-19 diagnosis. Conclusions: Our findings highlight the potential of a voice-based detection strategy as an alternative method for respiratory tract screening.
- Recommendations for Reducing the Environmental Impact of Inhalers in Portugal: Consensus DocumentPublication . Campos, Luís; Rosa, Paula; Carreiro Martins, Pedro; Xavier, Bilhota; Leuschner, Pedro; M Marques, Maria Inês; Albino, José; Robalo Cordeiro, Carlos; Ordem dos MédicosThis consensus document addresses the reduction of the environmental impact of inhalers in Portugal. It was prepared by the Portuguese Council for Health and the Environment and the societies representing the specialties that account for these drugs' largest volume of prescriptions, namely the Portuguese Society of Pulmonology, the Portuguese Society of Allergology and Clinical Immunology, the Portuguese Society of Pediatrics, the Portuguese Society of Internal Medicine, the Portuguese Association of General and Family Medicine and also a patient association, the Respira Association. The document acknowledges the significant impact of pressurized metered-dose inhalers on greenhouse gas emissions and highlights the need to transition to more sustainable alternatives. The carbon footprint of pressurized metered-dose inhalers and dry powder inhalers in Portugal was calculated, and the level of awareness among prescribing physicians on this topic was also estimated. Finally, recommendations were developed to accelerate the reduction of the ecological footprint of inhalers.
- Recomendações para a Redução do Impacto Ambiental dos Inaladores em Portugal: Documento de ConsensoPublication . Campos, L; Rosa, P; Carreiro-Martins, P; Xavier, B; Leuschner, P; Marques, MI; Albino, J; Robalo Cordeiro, CThis consensus document addresses the reduction of the environmental impact of inhalers in Portugal. It was prepared by the Portuguese Council for Health and the Environment and the societies representing the specialties that account for these drugs’ largest volume of prescriptions, namely the Portuguese Society of Pulmonology, the Portuguese Society of Allergology and Clinical Immunology, the Portuguese Society of Pediatrics, the Portuguese Society of Internal Medicine, the Portuguese Association of General and Family Medicine and also a patient association, the Respira Association. The document acknowledges the significant impact of pressurized metered-dose inhalers on greenhouse gas emissions and highlights the need to transition to more sustainable alternatives. The carbon footprint of pressurized metered-dose inhalers and dry powder inhalers in Portugal was calculated, and the level of awareness among prescribing physicians on this topic was also estimated. Finally, recommendations were developed to accelerate the reduction of the ecological footprint of inhalers.
- Optimizing the Use of Systemic Corticosteroids in Severe Ssthma (ROSA II Project): a National Delphi Consensus StudyPublication . Marques, J; Duarte-Ramos, F; Ferreira, MB; Lima, R; Lopes, C; Sokolova, A; Tonin, FS; Loureiro, CC
- Laringoscopia Contínua Durante o Exercício: Proposta de um Protocolo Clínico com Base em Revisão BibliográficaPublication . Chantre, T; Moreira, I; Barroso, M; Oliveira, M; Leiria Pinto, P; Sousa, HObjetivos - Estabelecimento de um protocolo de Laringoscopia Contínua durante o Exercício (LCE). Desenho do Estudo – Revisão Bibliográfca Sistemática. Material e Métodos - Revisão bibliográfca nas bases de dados MEDLINE, Cochrane Central Register of Controlled Trials and Cumulative Index to Nursing and Allied Health Literature, baseada no modelo PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), entre 2001 e 2021. Os estudos incluídos na revisão bibliográfica analisaram protocolos de LCE tanto em idade pediátrica como em adultos e foram escritos em língua inglesa ou portuguesa. Foram excluídos os artigos que apenas discutiram a Obstrução Laríngea Induzida pelo Exercício, mas não o protocolo de LCE e os artigos cujo objetivo de estudo não foi o de investigar os resultados do protocolo de LCE. A partir dos resultados obtidos, foi elaborado um protocolo clínico para o Centro Hospitalar Universitário Lisboa Central e testado num grupo de 10 voluntários sadios. Resultados – A pesquisa produziu um total de 679 artigos, sendo que após aplicação dos critérios de inclusão e exclusão foram selecionados 21 estudos. Nesses houve um total de 1026 doentes analisados, com um rácio masculino: feminino de 1:1.7. A idade média à realização da LCE variou de 9 a 45 anos. O método de exercício preferencial nos protocolos estudados foi a passadeira de corrida (n = 17; 81%), seguida da bicicleta estática (n = 4, 19%) e da máquina de remo (n = 1; 4.8%). O protocolo de LCE proposto incluí um protocolo de Bruce modificado, sendo a LCE terminada quando os doentes se encontravam em exaustão ou com sintomas respiratórios limitantes. Imediatamente antes e após a LCE foi realizada uma espirometria. Os movimentos glóticos e supraglóticos foram avaliados em repouso, com esforço moderado e esforço máximo, em cada fase do ciclo respiratório. Conclusões - A partir dos dados de uma revisão bibliográfica, foi desenvolvido um protocolo para a realização de LCE, demonstrando viabilidade e adequação à realidade de uma instituição portuguesa quando testado em voluntários sadios. São necessários novos estudos com pacientes doentes para validar esses resultados
- Molecular Profile of Sensitization to Dermatophagoides Pteronyssinus Dust Mite in PortugalPublication . Limão, R; Spínola Santos, A; Araújo, L; Cosme, J; Inácio, F; Tomaz, E; Ferrão, A; Santos, N; Sokolova, A; Môrete, A; Falcão, H; Cunha, L; Ferreira, A; Bras, A; Ribeiro, F; Lozoya, C; Leiria-Pinto, P; Prates, S; Plácido, J; Coimbra, A; Taborda-Barata, L; Pereira Santos, MC; Pereira Barbosa, M; Pineda, FBackground and objectives: To analyze component-resolved diagnosis of sensitization to Dermatophagoides pteronyssinus (Der p) in patients with respiratory allergy and the association between diagnostic findings and clinical severity in different geographical areas. Methods: The study population comprised 217 patients (mean age, 25.85 [12.7] years; 51.16% female) selected from 13 centers in Portugal (5 from the North, n=65). All had allergic rhinitis with or without asthma and positive skin prick test results to at least 1 dust mite. Specific IgE (sIgE) to Der p, Dermatophagoides farinae, Lepidoglyphus destructor, Der p 1, Der p 2, Der p 10, and Der p 23 was determined using ImmunoCAP. The Mann-Whitney test was applied for the following comparisons: rhinitis vs rhinitis and asthma; mild vs moderate-to-severe rhinitis; North vs South. Results: The prevalence of sensitization was 98.2% for Der p, and 72.4%, 89.4%, 9.7%, and 77% for Der p 1, Der p 2, Der p 10, and Der p 23, respectively. The corresponding median sIgE levels were 8.56, 17.7, 0.01, and 3.95 kUA/L. sIgE to all allergens was higher in patients with moderate-to-severe rhinitis and rhinitis with asthma (nonsignficant). Concentrations of sIgE to Der p 2 were significantly higher in the South than in the North (P=.0496). Conclusion: The most common sensitization in Portugal was to Der p. The highest prevalence and median sIgE level were observed for Der p 2. All sIgE values for molecular components were higher in more symptomatic patients (nonsignificant). Concentrations of sIgE to Der p 2 were higher in the South, probably because of the warmer temperature and/or the larger sample size.
- Clinical Standards for Diagnosis, Treatment and Prevention of Post-COVID-19 Lung DiseasePublication . Visca, D; Centis, R; Pontali, E; Zampogna, E; Russell, AM; Migliori, GB; Andrejak, C; Aro, M; Bayram, H; Berkani, K; Bruchfeld, J; Chakaya, JM; Chorostowska-Wynimko, J; Crestani, B; Dalcolmo, MP; D’Ambrosio, L; Dinh-Xuan, AT; Duong-Quy, S; Fernandes, C; García-García, JM; de Melo Kawassaki, A; Carrozzi, L; Martinez-Garcia, MA; Carreiro Martins, P; Mirsaeidi, M; Mohammad, Y; Naidoo, RN; Neuparth, N; Sese, L; Silva, DR; Solovic, I; Sooronbaev, TM; Spanevello, A; Sverzellati, N; Tanno, L; Tiberi, S; Vasankari, T; Vasarmidi, E; Vitacca, M; Annesi-Maesano, IBACKGROUND: The aim of these clinical standards is to provide guidance on 'best practice' care for the diagnosis, treatment and prevention of post-COVID-19 lung disease.METHODS: A panel of international experts representing scientific societies, associations and groups active in post-COVID-19 lung disease was identified; 45 completed a Delphi process. A 5-point Likert scale indicated level of agreement with the draft standards. The final version was approved by consensus (with 100% agreement).RESULTS: Four clinical standards were agreed for patients with a previous history of COVID-19: Standard 1, Patients with sequelae not explained by an alternative diagnosis should be evaluated for possible post-COVID-19 lung disease; Standard 2, Patients with lung function impairment, reduced exercise tolerance, reduced quality of life (QoL) or other relevant signs or ongoing symptoms ≥4 weeks after the onset of first symptoms should be evaluated for treatment and pulmonary rehabilitation (PR); Standard 3, The PR programme should be based on feasibility, effectiveness and cost-effectiveness criteria, organised according to local health services and tailored to an individual patient's needs; and Standard 4, Each patient undergoing and completing PR should be evaluated to determine its effectiveness and have access to a counselling/health education session.CONCLUSION: This is the first consensus-based set of clinical standards for the diagnosis, treatment and prevention of post-COVID-19 lung disease. Our aim is to improve patient care and QoL by guiding clinicians, programme managers and public health officers in planning and implementing a PR programme to manage post-COVID-19 lung disease.
- Validation of App and Phone Versions of the Control of Allergic Rhinitis and Asthma Test (CARAT)Publication . Jácome, C; Pereira, AM; Almeida, R; Amaral, R; Correia, MA; Mendes, S; Vieira-Marques, P; Ferreira, JA; Lopes, I; Gomes, J; Vidal, C; López Freire, S; Méndez Brea, P; Arrobas, A; Valério, M; Chaves Loureiro, C; Santos, LM; Couto, M; Araujo, L; Todo Bom, A; Azevedo, JP; Cardoso, J; Emiliano, M; Gerardo, R; Lozoya, C; Pinto, PL; Castro Neves, A; Pinto, N; Palhinha, A; Teixeira, F; Ferreira-Magalhães, M; Alves, C; Coelho, D; Santos, N; Menezes, F; Gomes, R; Cidrais Rodrigues, JC; Oliveira, G; Carvalho, J; Rodrigues Alves, R; Moreira, AS; Costa, A; Abreu, C; Silva, R; Morête, A; Falcão, H; Marques, ML; Câmara, R; Cálix, MJ; Bordalo, D; Silva, D; Vasconcelos, MJ; Fernandes, RM; Ferreira, R; Freitas, P; Lopes, F; Almeida Fonseca, J
- Advances in Food Allergy DiagnosisPublication . Gomes-Belo, J; Hannachi, F; Swan, K; Santos, AFAn accurate diagnosis of food allergy is extremely important to guide safe and yet not overly restrictive dietary management. The cornerstone of the diagnosis of food allergy is the clinical history; it allows appropriate selection of the allergens to be tested and interpretation of the results of allergy tests, namely Skin Prick Test (SPT), Specific IgE (sIgE) to allergen extracts and, more recently, specific IgE to allergen components and the Basophil Activation Test (BAT). SPT and sIgE to allergen extracts are very sensitive methods to detect IgE sensitization to a specific food and assess the possibility of spontaneous resolution. Cut-offs have been generated based on the probability of clinical reactivity during oral food challenges and can improve the specificity of SPT and sIgE, helping to confirm the diagnosis of food allergy. Specific IgE to allergen components refines food allergy diagnosis as it allows differentiating species-specific from cross-reactive allergens, aiding the differential diagnosis between a true and potentially severe food allergy from pollen-food syndrome or clinically irrelevant sensitization. The BAT is a new diagnostic test which has high specificity and sensitivity and can complement specific IgE, allowing the deferral of OFC in patients with a positive BAT. Depending on the likelihood of clinical allergy determined based on the combination of the history and the results of allergy tests, an oral food challenge may be indicated to confirm or exclude the diagnosis. Oral food challenge is the gold standard for the diagnosis of food allergy, but is a resource-intensive procedure with some level of risk involved; thus they are reserved for the equivocal cases. This review article discusses the above diagnostic techniques detailing the methods, utility, advantages and disadvantages.
- Rhinitis Associated with Asthma is Distinct from Rhinitis Alone: The ARIA‐MeDALL HypothesisPublication . Bousquet, J; Melén, E; Haahtela, T; Koppelman, GH; Togias, A; Valenta, R; Akdis, CA; Czarlewski, W; Rothenberg, M; Valiulis, A; Wickman, M; Akdis, M; Aguilar, D; Bedbrook, A; Bindslev‐Jensen, C; Bosnic‐Anticevich, S; Boulet, LP; Brightling, CE; Brussino, L; Burte, E; Bustamante, M; Canonica, GW; Cecchi, L; Celedon, JC; Chaves Loureiro, C; Costa, E; Cruz, AA; Erhola, M; Gemicioglu, B; Fokkens, WJ; Garcia‐Aymerich, J; Guerra, S; Heinrich, J; Ivancevich, JC; Keil, T; Klimek, L; Kuna, P; Kupczyk, M; Kvedariene, V; Larenas‐Linnemann, DE; Lemonnier, N; Lodrup Carlsen, KC; Louis, R; Makela, M; Makris, M; Maurer, M; Momas, I; Morais‐Almeida, M; Mullol, J.; Naclerio, RN; Nadeau, K; Nadif, R; Niedoszytko, M; Okamoto, Y; Ollert, M; Papadopoulos, NG; Passalacqua, G; Patella, V; Pawankar, R; Pham‐Thi, N; Pfaar, O; Regateiro, FS; Ring, J; Rouadi, PW; Samolinski, B; Sastre, J; Savouré, M; Scichilone, N; Shamji, MH; Sheikh, A; Siroux, V; Sousa‐Pinto, B; Standl, M; Sunyer, J; Taborda‐Barata, L; Toppila‐Salmi, S; Torres, MJ; Tsiligianni, I; Valovirta, E; Vandenplas, O; Ventura, MT; Weiss, S; Yorgancioglu, A; Zhang, L; Abdul Latiff, AH; Aberer, W; Agache, I; Al‐Ahmad, M; Alobid, I; Ansotegui, IJ; Arshad, SH; Asayag, E; Barbara, C; Baharudin, A; Battur, L; Bennoor, KS; Berghea, EC; Bergmann, KC; Bernstein, D; Bewick, M; Blain, H; Bonini, M; Braido, F; Buhl, R; Bumbacea, RS; Bush, A; Calderon, M; Calvo‐Gil, M; Camargos, P; Caraballo, L; Cardona, V; Carr, W; Carreiro‐Martins, P; Casale, T; Cepeda Sarabia, AM; Chandrasekharan, R; Charpin, D; Chen, YZ; Cherrez‐Ojeda, I; Chivato, T; Chkhartishvili, E; Christoff, G; Chu, DK; Cingi, C; Correia de Sousa, J; Corrigan, C; Custovic, A; D’Amato, G; Del Giacco, S; De Blay, F; Devillier, P; Didier, A; do Ceu Teixeira, M; Dokic, D; Douagui, H; Doulaptsi, M; Durham, S; Dykewicz, M; Eiwegger, T; El‐Sayed, ZA; Emuzyte, R; Fiocchi, A; Fyhrquist, N; Gomez, RM; Gotua, M; Guzman, MA; Hagemann, J; Hamamah, S; Halken, S; Halpin, DMG; Hofmann, M; Hossny, E; Hrubiško, M; Irani, C; Ispayeva, Z; Jares, E; Jartti, T; Jassem, E; Julge, K; Just, J; Jutel, M; Kaidashev, I; Kalayci, O; Kalyoncu, AF; Kardas, P; Kirenga, B; Kraxner, H; Kull, I; Kulus, M; La Grutta, S; Lau, S; Le Tuyet Thi, L; Levin, M; Lipworth, B; Lourenço, O; Mahboub, B; Martinez‐Infante, E; Matricardi, P; Miculinic, N; Migueres, N; Mihaltan, F; Mohammad, Y; Moniuszko, M; Montefort, S; Neffen, H; Nekam, K; Nunes, E; Nyembue Tshipukane, D; O’Hehir, R; Ogulur, I; Ohta, K; Okubo, K; Ouedraogo, S; Olze, H; Pali‐Schöll, I; Palomares, O; Palosuo, K; Panaitescu, C; Panzner, P; Park, HS; Pitsios, C; Plavec, D; Popov, TA; Puggioni, F; Quirce, S; Recto, M; Repka‐Ramirez, MS; Robalo Cordeiro, C; Roche, N; Rodriguez‐Gonzalez, M; Romantowski, J; Rosario Filho, N; Rottem, M; Sagara, H; Serpa, FS; Sayah, Z; Scheire, S; Schmid‐Grendelmeier, P; Sisul, JC; Sole, D; Soto‐Martinez, M; Sova, M; Sperl, A; Spranger, O; Stelmach, R; Suppli Ulrik, C; Thomas, M; To, T; Todo‐Bom, A; Tomazic, PV; Urrutia‐Pereira, M; Valentin‐Rostan, M; Van Ganse, E; van Hage, M; Vasankari, T; Vichyanond, P; Viegi, G; Wallace, D; Wang, DY; Williams, S; Worm, M; Yiallouros, P; Yusuf, O; Zaitoun, F; Zernotti, M; Zidarn, M; Zuberbier, J; Fonseca, JA; Zuberbier, T; Anto, JMAsthma, rhinitis, and atopic dermatitis (AD) are interrelated clinical phenotypes that partly overlap in the human interactome. The concept of "one-airway-one-disease," coined over 20 years ago, is a simplistic approach of the links between upper- and lower-airway allergic diseases. With new data, it is time to reassess the concept. This article reviews (i) the clinical observations that led to Allergic Rhinitis and its Impact on Asthma (ARIA), (ii) new insights into polysensitization and multimorbidity, (iii) advances in mHealth for novel phenotype definitions, (iv) confirmation in canonical epidemiologic studies, (v) genomic findings, (vi) treatment approaches, and (vii) novel concepts on the onset of rhinitis and multimorbidity. One recent concept, bringing together upper- and lower-airway allergic diseases with skin, gut, and neuropsychiatric multimorbidities, is the "Epithelial Barrier Hypothesis." This review determined that the "one-airway-one-disease" concept does not always hold true and that several phenotypes of disease can be defined. These phenotypes include an extreme "allergic" (asthma) phenotype combining asthma, rhinitis, and conjunctivitis. Rhinitis alone and rhinitis and asthma multimorbidity represent two distinct diseases with the following differences: (i) genomic and transcriptomic background (Toll-Like Receptors and IL-17 for rhinitis alone as a local disease; IL-33 and IL-5 for allergic and non-allergic multimorbidity as a systemic disease), (ii) allergen sensitization patterns (mono- or pauci-sensitization versus polysensitization), (iii) severity of symptoms, and (iv) treatment response. In conclusion, rhinitis alone (local disease) and rhinitis with asthma multimorbidity (systemic disease) should be considered as two distinct diseases, possibly modulated by the microbiome, and may be a model for understanding the epidemics of chronic and autoimmune diseases.