Allergic sensitization to Storage Dust Mites: a prospective study of patients with respiratory allergy

Summary: Objectives. To describe the prevalence of allergic sensitization to Storage Dust Mites (SDM), access whether the place of living and occupational exposure were determinants for SDM sensitization and study association between Lepidoglyphus destructor and other SDM sensitization. Methods. Prospective analysis of patients evaluated for suspected allergic rhinitis and/or asthma that performed Skin Prick Tests (SPT) to SDM between January and December 2018 in our Department. Results. Two hundred consecutive patients were evaluated for rhinitis and/or asthma in our outpatient consultation: 123 (61.5%) presented positivity for at least one SDM, 68.3% were female and the mean age was 33.1 ± 12.12. Lepidoglyphus destructor (69.9%) was the most prevalent, followed by Tyrophagus putrescentiae (50.4%), Blomia tropicalis and Glycyphagus domesticus (48.8%) and Acarus siro (24.4%). Living in a rural place was not associated with a higher prevalence of sensitization to SDM, except for Acarus siro (p = 0.032), and working in a place with storage areas was not associated with sensitization to any of SDM. Sensitization to Lepidoglyphus destructor was associated with sensitization to Blomia tropicalis, Glycyphagus domesticus and Tyrophagus putrescentiae (p less than 0.005), but not with Acarus siro.Conclusions. Our study suggests that our population, independently of their occupational exposure and place of residency, are sensitized to SDM and that evaluation of sensitization to SDM should be considered as standard practice.

Programme for the surveillance of influenza in Portugal: results of the period 1990-1996.

OBJECTIVES: To describe the situation of the influenza in Portugal through the estimates of the incidence rates and the identification of the viral strains implicated on it during the period 1990-1996. DESIGN: The integrated clinical and laboratory surveillance system for influenza in Portugal is based on the Portuguese sentinel network. Influenza cases are identified by general practitioners (GP) and notified to Division of Epidemiology (DEP) and to National Influenza Centre. Clinical and epidemiological data based on the clinical diagnosis are recorded and incidence rates are computed for the whole country. Throat swabs and blood samples are taken from the patients with influenza and sent to the National Influenza Centre to identify and classify the viral strains implicated. PARTICIPANTS: Lists of patients of the GPs collaborating on "Médicos-Sentinela" network. RESULTS: In 1990-1991, 1992-1993, and 1994-1995 there was a higher prevalence of influenza B virus and the highest influenza activity occurred in February and March in contrast with 1991-1992, 1993-1994, and 1995-1996 where the highest numbers of influenza cases occurred in November and December, and were associated with influenza A. CONCLUSIONS: During the past six years, 1990-1996, the influenza activity has been moderate in Portugal. From 1990-1996 influenza A and B viruses were prevalent every second year. The prevalence of influenza A was associated with the occurrence of the highest number of influenza cases during December and January and the prevalence of influenza B with the occurrence of the highest number of influenza cases during February and March.

[Chickenpox: an estimate of its incidence in patients enrolled in the Médicos-Sentinela Project]. / Varicela: estimativa de incidência nos utentes inscritos em Médicos-Sentinela.

During 1992, the Médicos-Sentinela Project surveyed about 215,728 persons, among which 1270 cases of chicken pox were notified. Upon these data, the annual incidence rate, by sex and age group, was estimated. For males, the rate was 4172.2, 2190.3 and 1298.0 per 100,000, respectively; for females, the rates were 3894.3, 2379.7 and 1620.9 per 100,000, for the same age groups. Two of the reported cases were hospitalized for more than 24 hours.

The incidence of chickenpox in the community. Lessons for disease surveillance in sentinel practice networks.

Sentinel practice networks have been established in many European countries to monitor disease incidence in the community. To demonstrate the value of sentinel networks an international study on the incidence of chicken pox has been undertaken. Chickenpox was chosen as an acute condition for which incidence data are important to the determination of health policy on vaccine use. The project examined the incidence of chickenpox reported in sentinel networks in England and Wales, The Netherlands, Portugal and Spain (two regional networks) in January-June 2000 and the potential underestimate from patients who did not consult. An investigation of secondary household contact cases was undertaken. Reported incidence of chickenpox (all ages) in England and Wales was 25 per 10,000, in The Netherlands 13 per 10,000, in Portugal 21 per 10,000, in Spain Castilla y Leon 27 per 10,000 and in Spain Basque 55 per 10,000. Analysis of secondary contact cases suggested underestimation of incidence between 2.4% in Spain Castilla y Leon and 32.2% in The Netherlands. There was a trend towards incidence at an earlier age in England and Wales and in The Netherlands compared with Portugal and Spain. Whilst there was little problem in reliably identifying the number of incident cases in the recording networks and relating the non-consulting contact cases to them, the security of the denominator remains a problem where networks are comprised of differing categories of health care provider. It is essential that numerator and denominator information are made available specifically for each category.

Diagnosis of transient ischemic attack by the nonneurologist. A validation study.

BACKGROUND AND PURPOSE: Interobserver reliability of the diagnosis of transient ischemic attack (TIA) is low, and diagnosis of TIA made by nonneurologists is often erroneous. We sought to validate the diagnosis of TIA made by general practitioners (GPs) and by hospital emergency service physicians (emergency MDs). METHODS: A list of 20 neurological symptoms was distributed to 20 GPs and 22 neurologists who graded the compatibility of each symptom with the TIA diagnosis. At least two neurologists validated TIA diagnoses made by GPs for patients under their care or by emergency MDs. RESULTS: Compared with neurologists, GPs considered "confusion" and "unexplained fall" more often compatible with TIA and "lower facial palsy" and "monocular blindness" less often compatible with TIA. Validation of diagnosis by GP was confirmed in 10 patients (19%); 26 patients had strokes, and 16 (31%) had a noncerebrovascular disorder. Validation of diagnosis by emergency MD was confirmed in 4 patients (13%); 10 patients had strokes, and 17 (55%) had noncerebrovascular disorders. The most frequent conditions misdiagnosed as TIAs were transient disturbances of consciousness, mental status, and balance. CONCLUSIONS: The TIA concept is understood differently by neurologists and nonneurologists. GPs and emergency MDs often label minor strokes and several nonvascular transient neurological disturbances as TIAs. Until this misconception of TIA is changed, the term TIA should probably be avoided in the communication between referring physicians and neurologists. If not referred to a neurologist, one third to one half of patients labeled with a diagnosis of TIA will be inappropriately managed.

Diagnosis of stroke by the nonneurologist. A validation study.

BACKGROUND AND PURPOSE: The first medical contact of an acute stroke victim is often a nonneurologist. Validation of stroke diagnosis made by these medical doctors is poorly known. The present study seeks to validate the stroke diagnoses made by general practitioners (GPs) and hospital emergency service physicians (ESPs). METHODS: Validation through direct interview and examination by a neurologist was performed for diagnoses of stroke made by GPs in patients under their care and doctors working at the emergency departments of 3 hospitals. RESULTS: Validation of the GP diagnosis was confirmed in 44 cases (85%); 3 patients (6%) had transient ischemic attacks and 5 (9%) suffered from noncerebrovascular disorders. Validation of the ESP diagnosis was confirmed in 169 patients (91%); 16 (9%) had a noncerebrovascular diagnosis. Overall, the most frequent conditions misdiagnosed as stroke were neurological in nature (cerebral tumor, 3; subdural hematoma, 1; seizure, 1; benign paroxysmal postural vertigo, 1; peripheral facial palsy, 2; psychiatric condition, 6; and other medical disorders, 7). CONCLUSIONS: In the majority of cases, nonneurologists (either GPs or ESPs) can make a correct diagnosis of acute stroke. Treatment of acute stroke with drugs that do not cause serious side effects can be started before evaluation by a neurologist and CT scan.