Pedro Carreiro-Martins

Background: Oral and ocular medications are frequently used in the treatment of allergic rhinitis (AR). As part of the update of the Allergic Rhinitis and its Impact on Asthma (ARIA)‐EAACI guidelines, this manuscript presents the ARIA‐EAACI 2024–2025 recommendations for oral and ocular treatments. Methods: The ARIA‐EAACI 2024–2025 guideline panel issued recommendations following the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) evidence‐to‐decision framework. Several sources of evidence were used to inform panel judgements and recommendations, including systematic reviews, mHealth and pharmacovigilance data as well as a survey on costs. Results: Eight guideline questions concerning oral treatments for AR and three questions concerning ocular treatments were addressed. These questions led to the recommendations. Overall, these questions concern the choice between different classes of medication. They also discuss the role of oral antihistamines (OAH), leukotriene receptor antagonists (LTRA), ocular antihistamines (OcAH) and ocular mast cell stabilisers. Four questions had not been previously evaluated in ARIA guidelines, while, for the other four, there was a change in the strength or directionality of the recommendations. Overall, these guidelines recommend using intranasal corticosteroids over OAH and using OAH over LTRA. Moreover, they suggest using OAH over OcAH and suggest being against adding LTRA to OAH. Finally, considerations for choosing between different individual OAHs are presented. Conclusion: This ARIA‐EAACI 2024–2025 article supports patients, their caregivers and healthcare professionals in choosing oral and ocular treatments for AR. Decisions on treatment should consider the clinical variability of the disease, patients' values and the affordability of medications.

Gon?alo Martins dos Santos 12 Pedro Sim?o Coelho 12 Jo?o Gaspar Marques 123 Sara Serranho 12 Sandra Santos 12 Ana Brito 12 Pedro Carreiro Martins...

We reviewed an innovative project in undergraduate medical education, which used problem-based learning and concept maps in pathophysiology teaching. We analyzed publications starting in 1995 and until 2024, to identify factors contributing to its continuity and impact, nationally and internationally.Problem-based learning was based on the methodology developed by Howard Barrows, a founder of the method. In 1998, we published, internationally, the results of this initial experience, completed by three international publications.In the early 21st century, this methodology became closer to case-based learning but maintained tutorial sessions, self-directed orientation and small group learning. Simultaneously, concept maps, developed by Novak, as leading promoter of the method, began to be used and were part of final assessment tools. In 2006, an international publication emphasized meaningful learning, recognized by tutors and students, as facilitator to understanding pathophysiological mechanisms of disease, applying basic science to explain clinical manifestations. In 2020, another international publication revisited the whole teaching and learning process.In 2023 and 2024, two international papers were published, a BEME systematic review on the effectiveness of concept maps in critical thinking and a scoping review on the need to standardize concept maps methodology. In 2024, for the first time in Portugal, we published two international papers on the use of concept maps to promote clinical reasoning in the undergraduate teaching of Family Medicine.Key elements of continuity and impact were: inclusion in the core curriculum, open information to students, training medical tutors, use of educational methods and materials validated internationally.

Background: Chronic cough is associated with high individual and social costs, mainly due to doctor visits and diagnostic investigations. The aim of the present study was to estimate the prevalence of chronic cough and identify risk factors associated with chronic cough in a community-based sample in the scope of the EpiCOUGH study.Methods: From 1 June to 31 August 2023, we recruited adults from the largest primary healthcare centres in Lisbon, Portugal, and invited them to participate in an online survey. Participants aged ≥20 years with a registered email address were eligible. Data collection included a health questionnaire that recorded the presence, duration, frequency and impact of cough on daily activities. Chronic cough was defined as lasting longer than 8 weeks.Results: Of the 7285 adult healthcare users who agreed to participate, 2309 (31.7%) completed the questionnaire. Most were female (59.2%) and the mean±sdage was 51.6±13.5 years. The estimated prevalence of chronic cough was 7.23% (95% CI 6.24–8.36%). Chronic cough was associated with older age, being divorced/widowed, current smoking, obesity, asthma, working in a dusty environment and pet ownership. No cause was diagnosed in 23.36% of patients who consulted a doctor.Conclusion: Chronic cough was relatively common in the population studied. Our data emphasise the need to treat patients with chronic cough with strategies that address risk factors. This study also highlights the complexity of chronic cough management and the need for further research and diagnostic tools to improve patient outcomes.

Background. Childhood asthma, a chronic inflammatory disease, is linked to sleep-breathing disorders (SBD). The vulnerability of asthmatic children to SBDs is well-established, yet limited research focuses on adolescents. This study addresses the research gap, exploring the frequency and risk factors of SBD in adolescents with asthma. Methods. A cross-sectional study was conducted among 98 adolescents (12-17 years) with asthma at a Lisbon healthcare facility. Comprehensive assessments, including sociodemographic data, medical history, lung function variables, and validated questionnaires for SBD risk (Pediatric Sleep Questionnaire), rhinitis control, and asthma control (Control of Allergic Rhinitis and Asthma Test and Asthma Control Test), were employed. Results. The study revealed a substantial frequency of SBD symptoms, with 25.5% of adolescents classified as high-risk based on the Pediatric Sleep Questionnaire. Significant associations were identified between high SBD risk and elevated body mass index (BMI), uncontrolled rhinitis, and uncontrolled asthma. Logistic regression analysis confirmed elevated BMI as a robust predictor of SBD risk, indicating a 5.9-fold increase compared to normal-weight counterparts. Conclusions. This study contributes valuable insights into the interplay between asthma and SBD in adolescents. The high prevalence of SBD symptoms, particularly among those with excess weight and uncontrolled respiratory symptoms, underscores the need for targeted preventive strategies. The identified risk factors, notably elevated BMI, provide clinicians with actionable information for intervention, emphasizing the importance of addressing modifiable factors associated with asthma and SBD in this specific population.

Background/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.

To quantify the impact of different air pollutants on respiratory health based on robust estimates based on international data and to summarise the evidence of associations between indoor exposure to those pollutants and respiratory morbidity in the Portuguese population. Several systematic reviews and meta-analyses (MA) at the world level demonstrate the impact of indoor air quality on respiratory health, with indoor particulate matter and gasses exerting a significant effect on the airways. Volatile organic compounds (VOC) have been related to asthma and lung cancer. However, only meta-analyses on biomass use allowed documentation of long-term respiratory effects. While early publications concerning Portuguese-based populations mainly focused on indoor exposure to environmental tobacco smoke, later studies relocated the attention to relevant exposure environments, such as day care buildings, schools, residences and nursing homes. Looking at the pooled effects from the reviewed studies, high levels of carbon dioxide and particulate matter in Portuguese buildings were significantly associated with asthma and wheezing, with VOC and fungi showing a similar effect in some instances. Despite the significant reduction of indoor air pollution effects after the 2008 indoor smoking prohibition in public buildings, studies show that several indoor air parameters are still significantly associated with respiratory health in Portugal. The country shares the worldwide necessity of standardisation of methods and contextual data to increase the reach of epidemiological studies on household air pollution, allowing a weighted evaluation of interventions and policies focused on reducing the associated respiratory morbidity.

Aerobiology could be used as complementary data or proxy for studying phenology, especially in species which usually are not long-distance transported, such as grasses. This 21-year aerobiological study took place in Évora (South Portugal), using a seven-day recording volumetric pollen trap with the aim of analysing the temporal trends of grass pollen seasons. To this end, data were statistically tested for correlation and regression to determine the features and temporal trends of pollen seasons. Main results show that Poaceae pollen has a high representation in pollen spectrum, 20% (min: 7%; max: 44%), with a long season starting in March and lasting till August/September or October. There was an overall, but not statistically significant trend, towards an increase in the annual pollen integral and peak values, and also an overall non-statistically significant trend towards an earlier start and later end of the pollen season. Main and high pollen seasons have been lasting longer, and the days with allergenic potential have been rising in line with the local temperature rising trend. It seems that grass pollen production is being aided by warmer temperatures and increased grassland areas in Alentejo region. This could promote the increase in annual pollen levels and in the number of high pollen days over the years. In clinical terms, it means that grass allergic patients are exposed to longer periods of airborne pollen and to higher counts over a longer time. The climate conditions projected for Alentejo region, including rising temperature, and the changes in local grassland areas may help to clarify the trends of grass pollen seasons in the next decades.