SummaryAim To estimate the prevalence of self-reported drug allergy in adults. Methods Cross-sectional survey of a general adult population from Porto (all of whom were living with children involved in the International Study of Asthma and Allergies in Childhood-phase three), during the year 2002, using a self-administered questionnaire. Results The prevalence of self-reported drug allergy was 7.8% (181/2309): 4.5% to penicillins or other b-lactams, 1.9% to aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) and 1.5% to other drugs. In the group 'allergic to b-lactams', the most frequently implicated drug was penicillin G or V (76.2%) followed by the association of amoxicillin and clavulanic acids (14.3%). In the group 'allergic to NSAIDs', acetylsalicylic acid (18.2%) and ibuprofen (18.2%) were the most frequently identified drugs, followed by nimesulide and meloxicam. Identification of the exact name of the involved drug was possible in less than one-third of the patients, more often within the NSAID group (59.5%). Women were significantly more likely to claim a drug allergy than men (10.2% vs. 5.3%). The most common manifestations were cutaneous (63.5%), followed by cardiovascular symptoms (35.9%). Most of the reactions were immediate, occurring on the first day of treatment (78.5%). Only half of the patients were submitted to drug allergy investigations. The majority (86.8%) completely avoided the suspected culprit drug thereafter. Conclusions The results showed that self-reported allergy to drugs is highly prevalent and poorly explored. Women seem to be more susceptible. b-lactams and NSAIDs are the most frequently concerned drugs.

Better prognostic models can be achieved by adopting low cost and real-time intermediate outcomes rather than static data.

Adverse events, taken from bedside monitored data, are important intermediate outcomes, contributing to a timely recognition of organ dysfunction and failure during ICU length of stay. The obtained results show that it is possible to use DM methods to get knowledge from easy obtainable data, thus making room for the development of intelligent clinical alarm monitoring.

ABSTRACT. This paper introduces the

Candidemia is associated with high morbidity and mortality resulting in significant increases in the length of patients' hospitalization and in healthcare costs. Critically ill patients are at particular risk for candidemia because of their debilitated condition and frequent need for invasive procedures. The aim of this study was to characterize the incidence and epidemiology of candidemia over a seven-year period in intensive care units (ICUs) and the use of fluconazole and caspofungin in a large university-affiliated hospital. All cases of candidemia were identified by surveillance, using the Centers for Diseases Control and Prevention criteria. Demographic variables, use of antifungal (fluconazole and caspofungin) and patient outcomes were evaluated. The chi2 test for linear trend was employed to evaluate the distribution of Candida spp. and the use of fluconazole and caspofungin by defined daily dose (DDD) per 1,000 patients-days during the study period. One hundred and eight episodes of candidemia were identified. The overall incidence of candidemia (P=0.20) and incidence of non-Candida albicans Candida infections (P=0.32) remained stable over the study period and ranged from 0.3-0.9 episodes per 1,000 catheter-days and 0.39-0.83 episodes per 1,000 patients-days. However, the use of fluconazole and caspofungin increased significantly (P<0.001). While there were no reports of the use of fluconazole for prophylaxis in 1999, its use for this purpose increased from 3% in 2000 to 7.0% (P=0.07) in 2006. C. albicans was the most frequent specie isolated and burns and cancer were the most frequent underlying conditions. The overall mortality was 76%. There was no difference between C. albicans and non-C. albicans Candida infections when the crude and 14-day mortality rates were compared. Our data demonstrated that C. albicans is still the most frequent species causing candidemia in our intensive care units. Our rates of candidemia are lower than those reported from the region and similar to American and European hospitals. Although the incidence of blood stream infections (BSI) and candidemia remained stable, the use of fluconazole and caspofungin increased significantly over the years included in this study but had no impact on the incidence of infections caused by non-C. albicans Candida species.

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Delayed drug allergy reactions (DDAR) are potentially fatal. Certain human leukocyte antigen (HLA) alleles have been associated with delayed allergy reactions following the administration of particular drugs. Examples are HLA-B*57:01 (abacavir), HLA-B*15:02/HLA-A*31:01 (carbamazepine), and HLA-B*58:01 (allopurinol). Based on the identification of these associations, it may now be possible to prevent certain allergy reactions that were, until recently, considered unpredictable. In this review, we will focus on the pharmacogenetics of the best-studied associations between specific HLA alleles and delayed allergy reactions and describe the pathogenesis models proposed so far. Finally, we will evaluate the genetic screening strategies available and discuss the clinical relevance of a better understanding of the immunogenetics and mechanisms involved in DDAR.

Nosocomial bloodstream infections (BSI) are associated with high morbidity and mortality resulting in increased healthcare costs. 1,2 BSI rates in Latin America range from 11.3 to 23 cases per 1000 catheter-days and are higher than those in the USA and Europe. [3][4][5] This study characterized the trends in the agents causing BSI in intensive care units (ICUs), and the risk factors associated with death, at a large university hospital in Brazil.All cases of BSI were identified by surveillance using Centers for Disease Control and Prevention criteria. 6 Crude mortality and mortality that occurred during the14 days from first blood isolation were evaluated. The Chi-square test for linear trends was used to evaluate the distribution of the most common agents. A logistic regression model was developed to identify factors associated with mortality.Over 5 years, 1121 episodes of BSI were detected in 1004 patients. The incidence of BSI did not change significantly, ranging from 11.2 to 10.2 episodes per 1000 catheter-days ( p = 0.61). Forty-nine percent of the episodes were caused by Gram-negative rods, 45% by Gram-positive cocci, and 6% by fungi. The incidence of Gram-negative rods increased ( p = 0.04), Gram-positive cocci decreased ( p = 0.01), and fungi remained stable ( p = 0.20). The mean time from admission into the ICU to the development of BSI was 16.9 days,