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Jorge Meira, 1,* Maria Luís Marques, 2,* Fernando Falcão-Reis, 1, 3 Eva Rebelo Gomes, 2 Ângela Carneiro 1, 3 1Department of Ophthalmology, Centro Hospitalar Universitário São João, Porto, Portugal; 2Department of Allergy and Clinical Immunology, Centro Hospitalar Universitário do Porto, Porto, Portugal; 3Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal*These authors contributed equally to this workCorrespondence: Jorge MeiraDepartment of Ophthalmology of São João Hospital, Avenida Prof. Hernâni Monteiro, Porto 4202 – 451, PortugalTel +351225512100Fax +351225513669Email jorgesmeira@gmail.comIntroduction: Contrast rapid sequence angiography with fluorescein or indocyanine green (ICG) is a diagnostic procedure commonly used in ophthalmology. Adverse reactions to fluorescein and ICG are rare and may be classified as toxic, of hypersensitivity and non-specific. The evaluation and management of a patient with an adverse reaction is a challenge for the majority of ophthalmologists, as is the assessment of risk factors that may contraindicate the procedure.Purpose: We aim to review the concepts underlying adverse reactions to fluorescein and ICG, especially those of hypersensitivity, and present a proposal or the evaluation of the patients in need to perform retinal angiography and for the treatment of immediate reactions to fluorescein and ICG.Methods: The available literature was examined using PubMed-Medline, and using the MeSH terms “fluorescein”, “Indocyanine green”, “ophthalmic dyes”, “retinal angiography”, “adverse reactions”, and “allergic reaction”.Conclusion: This review may help ophthalmologists to identify patients with higher risk of a hypersensitivity reaction and give them tools to recognize patients with suspected hypersensitivity that may benefit from an allergy study.Keywords: fluorescein, indocyanine green, ophthalmic dyes, retinal angiography, adverse reactions, hypersensitivity reaction

This study aims to assess the determinants of the coronavirus disease 2019 (COVID-19) vaccination hesitancy and refusal (VHR) among teachers, from pre-school to higher education, through an online survey. A logistic regression analysis was used to determine the adjusted odds ratio (OR) of the independent variables (perceptions, knowledge, and attitudes) per 1-point increase in the Likert scale, and VHR. Concerns about the vaccines' efficacy and safety increase the risk of VHR (OR = 6.97, 95 %CI: 4.82-10.09 and OR = 8.71, 95 %CI: 5.52-13.73, respectively). Higher risk perceptions of getting infected (1/OR = 3.94, 95 %CI: 2.93-5.29), trust in the effectiveness of vaccines in reducing this risk or protecting against suffering complications (OR = 3.52, 95 %CI: 2.72-4.55 and OR = 10.94, 95 %CI: 7.16-16.68, respectively), and higher trust levels on the information transmitted regarding COVID-19 vaccination, are associated to lower VHR. As VHR appears to be highly influenced by perceptions, knowledge, and attitudes, it is crucial to promote and design interventions targeted to transforming these determinants., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: All authors report financial support was provided by LaCaixa Foundation.., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Introduction: To contain the COVID-19 pandemic, higher vaccination rates are essential. However, as vaccine hesitancy is a reality, it is important to understand what drives health professionals to refuse getting vaccinated against COVID-19, who have been in the frontline of this pandemic since its beginning and may be key actors to improve vaccine coverage among their patients., Purpose: This study aims to assess the factors associated with vaccine hesitancy (VH) among health professionals (physicians, nurses, pharmacists and dentists)., Methods: A nationwide cross-sectional study was conducted through an online survey, with 890 Portuguese health professionals. A logistic regression analysis was used to determine the adjusted odds ratio (OR) of the independent variables (perceptions, knowledge and attitudes) per 1-point increase in the Likert scale and VH., Results: Complacency, communications, confidence and convenience were strongly associated with VH probability. Concerns about vaccines' efficacy (OR Physicians  = 8.33, 95% CI: 4.51-15.36) and safety (OR Nurses  = 11.07, 95% CI: 4.12-29.77) increase the risk of VH on all health professional groups. A reduction of VH probability is associated with higher risk perceptions of getting infected (1/OR Nurses  = 2.76, 95% CI: 1.52-5.02) and suffering complications (1/OR Nurses  = 33.72, 95% CI: 8.48-134.13), higher confidence in the effectiveness of COVID-19 vaccines (1/OR Dentists  = 12.29, 95% CI: 2.91-51.89), risk perception of getting infected if vaccinated (1/OR Physicians  = 14.92, 95% CI: 6.85-32.50), risk of suffering from complications after getting vaccinated, and higher trust levels on the information transmitted by competent authorities (1/OR Dentists  = 17.76, 95% CI: 3.83-82.22)., Conclusions: To reduce COVID-19 VH, which appears to be highly influenced by perceptions, knowledge and attitudes, it is essential to promote interventions directed to transforming these potentially modifiable determinants., (© 2022 Stichting European Society for Clinical Investigation Journal Foundation. Published by John Wiley & Sons Ltd.)

Objective: Adverse drug reactions (ADR) cause significant morbidity, mortality and health costs and have an important prevalence in all ages. Few studies focus on ADR in adolescents. The goal of this study was to characterize a case series of ADR reported to the Portuguese Pharmacovigilance System (PPS) of the National Authority of Medicines and Health Products (INFARMED, I.P.) during an eleven-year period (from 2006 to 2016) concerning this specific population., Methods: Retrospective analysis of reports concerning patients from 10 to 18 years received by the PPS between 2006 and 2016. The authors evaluated patients' demographics (age and sex). The characteristics and seriousness of the reactions, the type of reaction reported, and the drugs involved were assessed., Results: The authors found 782 reports (59% females). Most reports came from physicians (61%). Overall 80% of the reports described serious ADR. A greater proportion of serious events was found among males. Most reactions referred to general disorders and administration site conditions (38%), followed by skin and subcutaneous tissue reactions (33%). In 3 rd and 4 th were gastrointestinal disorders (24%) and the nervous system disorders (23%), the former more frequent among females. Vaccines were the most represented group (42%) followed by antibacterials for systemic use (19%)., Conclusion: Major findings considering drugs involved and the reported reactions varied according to age and sex.

Background: Nonsteroidal anti-inflammatory drugs (NSAIDS) are among the most common causes of drug hypersensitivity (HS) reactions. The diagnosis is based on a careful clinical history, and provocation tests are considered the gold standard for diagnosis. Skin tests have some value to study reactions to pyrazolones. Laboratory investigations are mostly used for research purposes. Different phenotypes have been described., Objective and Methods: Our aim was to describe the most common clinical manifestations of NSAID HS in a large population of adult patients, the drugs involved, the association with previously described risk factors, and the outcome of diagnostic procedures. The classification of reactions proposed by the European Academy of Allergy and Clinical Immunology (EAACI) Drug Allergy Interest Group was adopted., Results: Acetylsalicylic acid was the drug most often involved in reactions (34%), isolated cutaneous symptoms were the most reported (60%), and immediate reactions (58%) were the most common. There was an overall female predominance (64%) and 35% of the patients were atopic. HS to NSAIDs was confirmed in 21% of the patients. The most common phenotypes encountered among HS patients were NSAID-induced urticaria/angioedema and single-NSAID-induced urticaria/angioedema or anaphylaxis. Logistic regression analysis showed that gender and atopy were not significant risk factors for HS confirmation, but diagnosis depended on the number of previous reactions, the type of reaction, and the time interval between drug intake and reaction., Conclusion: Only 21% of suspected HS reactions were confirmed after diagnostic workup. Patients describing >1 previous reaction and suffering immediate reactions had a higher probability of a positive investigation., (© 2017 S. Karger AG, Basel.)

Objective: Adverse drug reactions (ADR) are a public health problem. They cause significant morbidity, mortality and health costs. Less is known about pediatric ADR. Our goal was to characterize a pediatric case series of ADR reported to the Portuguese Pharmacovigilance System (PPS) during the past 10 years., Research Design and Methods: Retrospective analysis of ADR reports concerning patients till 17 years old received by the PPS between 2003 and 2012. We evaluated patients' demographic data and involved drugs, as well as characteristics and seriousness of reactions, stratified by age groups., Results: We found 1742 reports (50% females) corresponding to 9.7% of the total received. The age of the patients varied from 0 to 17 years (median: 5 years, interquartile range: 10.6), with 566 cases (32%) occurring in patients younger than 2y. Among the 1195 serious cases, 31% (370) episodes led to hospitalization. In 32 cases (2%) there was a fatal outcome. Most of the ADR reported referred to general disorders and administration site conditions, followed by skin and subcutaneous tissue reactions. Vaccines were the most represented group (42%) followed by antibacterials for systemic use (17%)., Conclusions: Pediatric ADR represents about 10% of the reports received by the PPS. Most ADR were considered serious. Major findings varied according to age groups.