Browsing by Author "Furtado, Ana"
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- Learner-low dose aspirin preterm trial (Angola) – Low dose aspirin in pregnant women with sickle cell disease when started in the first versus second trimester: a clinical control study in AngolaPublication . Brito, Miguel; Ginete, Catarina; Gomes, Tatiana; Pitangueira, Helena; Mendes, Manuela; Furtado, Ana; Alves, Ligia; Simão, Fernanda; Gonçalves, Mauer; Morais, JoanaSickle Cell Disease (SCD) is marked by episodes of acute vaso-occlusive crises, severe anemia, acute chest syndrome, multi-organ damage and stroke, among others. Pregnancy in these patients is associated with an increased risk of adverse outcomes, such as intrauterine growth restriction, perinatal and maternal mortality, low birth weight, eclampsia, pre-eclampsia, and stroke. Therefore, increasing the surveillance during pregnancy and searching prophylactic solutions for early prevention of pregnancy complications in women with SCD in African countries, where the burden of SCD is disproportionally higher, is an urgent need. Aspirin is already widely prescribed for the prevention of cardiovascular complications, and at a low daily dose, is used during pregnancy to prevent preeclampsia, intrauterine growth restriction, and other maternal-and-fetal disorders. In pregnant women with SCD, low dose aspirin is considered safe and is recommended for those who are at severe risk of pre-eclampsia. LEARNER (ClinicalTrials.gov ID, NCT06417411), is a prospective, opened label study to evaluate the effects of daily low dose aspirin in pregnant women with SCD when initiated at the first trimester versus the second trimester of the gestational period (where it is frequently started). We hypothesize that a low dose of aspirin (100 mg/daily) initiated early in pregnancy (weeks 6-13) can be more beneficial, than when it is started in the second trimester (weeks 14-27), reducing the incidence of fetal and maternal complications. This study intends to quantify the reduction in preterm delivery, perinatal death/miscarriage, and the risk of other maternal complications including pre-eclampsia, hypertensive disorders, number of vaso-occlusive crises, need for blood transfusion, urinary tract infections, respiratory tract infections, acute chest syndrome, retained placenta, placental abruption, and vaginal bleeding, when initiating low dose aspirin in the earliest stage of the gestation period. A total of 450 pregnant women, with confirmed diagnosis of SCD, will be enrolled in this study. Enrollment is taking place at maternity and infant hospitals in Luanda, Angola. Patients who consent to participate in the study will be assigned to one of two groups based on their gestational age, confirmed through ultrasound. Participants will then start daily use of 100 mg aspirin; dosing will be suspended at time of delivery, week 36, or earlier, if deemed necessary by the clinical team. Participants will be followed from the consenting visit to 6 weeks post-partum. Recruitment started in April 2024, after regulatory approval (local EC approval nº52/CEMS/2023, and national IRB approval 99/ARMED/MINSA/2024), and to date, 15 participants have been consented and 10 are in the treatment period. The biggest challenge to date is recruiting participants in the first trimester as most pregnant women that visit the hospital, in Angola, are already at the end of the second or in the third trimester. Our strategy to increase the study's visibility and facilitate patient recruitment will be advertisements in social media and patient support groups and to reach out to local health centers around Luanda. Additionally, this study aims to build capacity in Angola for the conduction of future clinical trials, involving local research sites and hospitals, capacitating Angolan institutions and professionals in clinical trial conduction and data capture abilities, promoting national and international collaborations, and creating population awareness for clinical research studies. The study team is comprised of the scientific team, local clinical team, an electronic data capture specialty team, a site management organization (SMO), and a Contract Research Organization (CRO). This is the first of its kind in Angola, which will revolutionize research in the country and help with our understanding of many diseases by diversifying the studied population pool for SCD and all other research that will be conducted in the country following the model established by this study.
- SGRT no tratamento de mama esquerda em inspiração forçada: revisão sistemática de literaturaPublication . Pires, Pedro; Monsanto, Fátima; Furtado, AnaIntrodução – A radioterapia em doentes com cancro de mama à esquerda pode afetar negativamente o coração e as artérias coronárias, aumentando a toxicidade cardíaca e o risco de problemas cardíacos. Com as técnicas inovadoras de Surface Guided Radiation Therapy (SGRT) e Deep Inspiration Breath Hold (DIBH) utilizadas em conjunto pretende-se avaliar os benefícios deste tratamento, aumentando a reprodutibilidade do mesmo e reduzindo a toxicidade nos órgãos de risco. Métodos – A realização desta revisão sistemática da literatura seguiu as orientações Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), utilizando quatro bases de dados: Scopus, Web of Science, PubMed e ScienceDirect, recorrendo ao operador booleano AND e aos seguintes descritores: SGRT, left breast cancer e DIBH. O processo de seleção dos estudos foi dividido em três etapas: identificação, triagem e inclusão, com o objetivo de selecionar e analisar os estudos. Os critérios de inclusão aplicados foram: estudos publicados entre 2017 e 2022, em texto integral de acesso livre, artigos redigidos em inglês e artigos de fonte primária. Os critérios de exclusão utilizados foram: estudos que não avaliassem as técnicas de DIBH e SGRT em conjunto, artigos de revisão e estudos que não avaliassem exclusivamente cancro de mama esquerda. Adicionalmente a estes critérios excluíram-se technical notes e estudos que contrariassem os objetivos do presente estudo. Terminado o processo de seleção obteve-se um total de sete artigos. Resultados – Selecionaram-se sete estudos para análise quantitativa e elaborou-se uma tabela síntese dos mesmos. Estes estudos refletem a prática clínica atual do uso conjunto das técnicas em estudo. Não se evidenciaram desvios significativos. Na generalidade, as doses foram reduzidas no coração e nos pulmões e na artéria coronária anterior descendente esquerda. Discussão – Os protocolos de workflow clínico dos diferentes autores mostram concordância entre si. Segundo os estudos de Zhang et al., Rice et al. e Kügele et al., o uso de DIBH com SGRT diminui a dose nos órgãos de risco, diminuindo a probabilidade de morbilidades radioinduzidas. Os estudos demonstram ainda que estas técnicas permitem manter a estabilidade e a reprodutibilidade durante o tratamento. Conclusão – A SGRT em conjunto com DIBH reduz o risco de toxicidade cardiovascular e pulmonar nos doentes que realizam radioterapia à mama esquerda, possibilitando a diminuição de complicações adjacentes a este tratamento, como: pericardites, isquemia cardíaca, enfarte do miocárdio e diminuindo as mortes por patologia cardiovascular. Os sistemas de SGRT estão em constante evolução e recentemente foram publicadas guidelines para garantir a implementação segura e eficiente desta técnica.