Industry payments to family medicine residents in Portugal: a descriptive analysis of the national transparency database.

OBJECTIVE: To analyse payments made to family medicine residents by the pharmaceutical industry during their residency in Portugal, using mandatory disclosure data. DESIGN AND PARTICIPANTS: Cohort study of residents starting their family medicine training in 2015, using data collected from the public national transparency database (Plataforma de Comunicações Transparência e Publicidade). Payments were categorised into six groups, including scientific meetings, educational activities, travel allowances, fees, gifts and undetermined. MAIN OUTCOME MEASURES: Number of payments and the total value received by family medicine residents during their training period; number of payments according to their nature (six categories); number of payments and total value by paying entity. RESULTS: We analysed data of 457 family medicine residents. A total of 2790 payments were made to 424 (92.8%) residents, amounting to €826 271.14. Thirty-three residents did not receive any payment. The median number of payments per resident was 5 and the median amount received per resident was €1309.51. Residents who ranked in the top 25%, according to value received, were subsidised more than €2500.90 over the course of their residency. This subset of residents received 59.1% of the total amount disbursed in payments. Payments were primarily for attending scientific meetings (80.9%) and educational activities (17.1%). The top 10 paying entities accounted for 69.2% of the total amount paid. CONCLUSION: Pharmaceutical industry funding for family medicine residents was highly prevalent, raising concerns over industry influence on medical education, while payment distribution was heterogeneous.

[A rare presentation of kidney allograft intolerance syndrome: Bullous pemphigoid]. / Une présentation rare du syndrome d'intolérance au greffon renal : la pemphigoïde bulleuse.

Bullous pemphigoid is an autoimmune bullous cutaneous disease. We report the case of a 60 year-old male patient whose kidney allograft failed and was on hemodialysis for the previous 16 months. After tapering immunosuppressive medication, he presented simultaneous bullous eruption and kidney allograft intolerance syndrome. Investigation showed a positive BP180 anti-basement membrane zone antibody and skin biopsy was consistent with bullous pemphigoid. The patient was treated with corticotherapy and bullous pemphigoid resolved. The development of new onset diabetes and concerns over long term immunosuppression, halted the decision to continue corticotherapy and the patient underwent graft nephrectomy, with resolution of the kidney allograft intolerance syndrome without recurrence of the bullous disease. The occurrence of bullous pemphigoid in patients with failed renal allograft is rare, with only eleven cases reported in literature. This case illustrates how graft nephrectomy can provide a definitive cure to bullous pemphigoid in this setting.