Browsing by Author "Mendes, Manuela"
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- Clinical features related to severity and mortality among COVID-19 patients in a pre-vaccine period in Luanda, AngolaPublication . Sebastião, Cruz S.; Cogle, Adis; Teixeira, Alice D’Alva; Cândido, Ana Micolo; Tchoni, Chissengo; Amorim, Maria João; Loureiro, N’gueza; Parimbelli, Paolo; Penha-Gonçalves, Carlos; Demengeot, Jocelyne; Sacomboio, Euclides; Mendes, Manuela; Arrais, Margarete; Morais, Joana; Vasconcelos, Jocelyne Neto de; Brito, MiguelBackground: Infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with clinical features of diverse severity. Few studies investigated the severity and mortality predictors of coronavirus disease 2019 (COVID-19) in Africa. Herein, we investigated the clinical features of severity and mortality among COVID-19 patients in Luanda, Angola. Methods: This multicenter cohort study involved 101 COVID-19 patients, between December 2020 and April 2021, with clinical and laboratory data collected. Analysis was done using independent-sample t-tests and Chi-square tests. The results were deemed significant when p < 0.05. Results: The mean age of patients was 51 years (ranging from 18 to 80 years) and 60.4% were male. Fever (46%), cough (47%), gastrointestinal symptoms (26.7%), and asthenia (26.7%), were the most common symptoms. About 64.4% of the patients presented coexistent disorders, including hypertension (42%), diabetes (17%), and chronic renal diseases (6%). About 23% were non-severe, 77% were severe, and 10% died during hospitalization. Variations in the concentration of neutrophil, urea, creatinine, c-reactive protein, sodium, creatine kinase, and chloride were independently associated with severity and/or mortality (p < 0.05). Conclusion: Several factors contributed to the severity and mortality among COVID-19 patients in Angola. Further studies related to clinical features should be carried out to help clinical decision-making and follow-up of COVID-19 patients in Angola.
- A implementação de um rastreio neonatal de doença das células falciformes em Angola: apoio à formação de técnicos de saúde no âmbito da cooperação Portugal-AngolaPublication . Brito, Miguel; Ginete, Catarina; Inusa, Baba; Mendes, Manuela; Vasconcelos, Jocelyne Neto; Veiga, LuisaIntrodução: A doença das células falciformes (DCF) é uma doença hereditária severa, com uma incidência especialmente elevada na África subsariana, sendo responsável por 50% da mortalidade em crianças com menos de 5 anos. A prevalência desta doença genética em Angola ronda os 2%, sendo a doença genética mais frequentes no mundo. A identificação da doença à nascença permite o seguimento das crianças em consultas especializadas reduzindo assim a mortalidade e morbilidade infantil. Objetivos: Implementação de um Rastreio neonatal em Luanda para diagnóstico de DCF, com treino na recolha e análise de amostras bem como apoio no follow up dos pacientes e redução da taxa de mortalidade abaixo dos 5 anos. Pretende-se ainda avaliar os custos da implementação do rastreio neonatal, bem como avaliar o impacto financeiro do diagnóstico precoce. Contexto: O nosso objetivo é a implementação do Rastreio Neonatal no Hospital Materno Infantil Dr. Manuel Pedro Azancot de Menezes, Luanda. Pretendemos realizar Treino in loco dos profissionais de saúde (técnicos de laboratório, médicos, enfermeiros e auxiliares de saúde) no processo de recolha de amostras e de dados, bem como, na deslocação de técnicos de Laboratório a Lisboa para formação na técnica de electroforese de hemoglobinas por focagem isoeléctrica no equipamento Migele (adquirido com o apoio da Perkin Elmer e do projeto ARISE). Os estágios em Lisboa estão integrados no projeto “ARISE- African Research and Innovative Initiative for Sickle cell Education”, financiado pela União Europeia no programa Marie Skłodowska-Curie Actions. Pretende-se que no futuro todo o processo relativo ao rastreio neonatal seja assegurado em Luanda pelos técnicos formados no nosso laboratório.
- Implementation of a newborn screening for sickle cell disease, at the Hospital Materno Infantil Dr Manuel Pedro Azancot de Menezes, AngolaPublication . Brito, Miguel; Inusa, Baba P.; Ginete, Catarina; Mendes, Manuela; Afonso, Roberto; Valentim, Isabel; Siatembo, Adriano; Vasconcelos, Jocelyne NetoSickle Cell Disease (SCD) is a hereditary disease, and a worldwide public health problem, with a higher incidence in sub-Saharan Africa, where the prevalence is very high (about 80%). SCD prevalence can reach 3,3 % in Angola, while carriers of the sickle cell trait account for more than 25% of the population. The early identification of patients and their follow-up in consultation are an added value for the reduction of morbidity and mortality of children with SCD. The implementation of early infant screening and follow-up programs for children with SCD showed excellent results in increasing the survival of these children. With this project we intend to implement a Newborn screening in Hospital Materno Infantil Dr Manuel Pedro Azancot de Menezes, a referral of the main maternity in Angola, located in Luanda, the country capital, that could be replicated in other hospitals, giving training to the health professionals, and to the laboratory technicians, to diagnose the SCD patients. The objective of this project is to establish a neonatal screening for SCD at a main Hospital in Angola, contributing to reducing under-5 mortality and supporting pediatric follow-up consultations of children diagnosed with SCD. Specific aims include: recording the data and medical history of babies diagnosed with SCD up to 5 years of age at regular appointments; estimating the prevalence of SCD in the municipality of Camama, Luanda; and evaluating the costs of neonatal screening and early interventions in Angola, by supporting a registry of SCD.
- 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.
- Pregnancy surveillance in sickle cell disease patients: a cohort study in an African country – AngolaPublication . Brito, Miguel; Ginete, Catarina; Ferreira, Joana; Mendes, Manuela; Vasconcelos, Jocelyne; Delgadinho, Mariana; Sebastião, Cruz; Quinto, Francisco; Simão, Fernanda; Mateus, Anabela; Fernandes, FilipeSickle Cell Disease (SCD) is a severe monogenic disease caused by the inherence of a recessive mutation in the β-globin gene, with an especially high prevalence in sub-Saharan Africa. In Angola, the prevalence of the disease is almost 2%, and the carriers reach 21% of the population. Although its presentation tends to be very heterogeneous, chronic hemolytic anemia, frequent painful crises, and extensive organ damage are common features of these patients. Pregnancy in SCD patients is associated with an increase in severe outcomes, namely, a high risk of eclampsia and pre-eclampsia, stroke, and even death. Therefore, it is crucial to maintain continuous medical surveillance during pregnancy, especially in women with previous strokes. Moreover, health services in low- and middle-income countries are generally not prepared to follow these patients. The present cohort study, conducted at the Lucrecia Paim Maternity Hospital (Luanda, Angola), aims to determine pregnancy complications in SCD women, especially those responsible for maternal death, and, by supporting the obstetric consultations in this hospital, contribute to the reduction of mortality and morbidity rates. Pregnancy monitoring includes analysis of clinical history and incidents (number of hospitalizations, blood transfusions, strokes, and other clinical complications), hematological and biochemical analysis, transcranial Doppler to assess cerebral hemodynamics, and genetic analysis (confirmation of the diagnosis, genotyping of four SNPs in the β-cluster to assess the haplotype, and evaluation of the presence of the 3.7kb deletion of the α-globin gene).
- Prevalence and risk factors of SARS-CoV-2 infection among parturients and newborns from Luanda, AngolaPublication . Sebastião, Cruz S.; Parimbelli, Paolo; Mendes, Manuela; Sacomboio, Euclides; Morais, Joana; Vasconcelos, Jocelyne Neto de; Brito, MiguelSARS-CoV-2 emerged in China in December 2019, creating a massive public health concern. Although previous studies have identified SARS-CoV-2 in pregnant women, the possibility of transmission to newborns remains uncertain. Herein, we investigated SARS-CoV-2 infection and risk factors among parturients and newborns. This was a cross-sectional study carried out with 3633 parturients from Luanda, Angola, between January and April 2021, with an age ranging from 13 to 48 years. SARS-CoV-2 infection of the parturients was further confirmed with RT-PCR after COVID-19 Ag Rapid Testing. About 0.4% of parturients tested positive on the day of delivery. Surprisingly, parturients from urbanized areas (OR: 0.18, p = 0.025) had a low chance of infection. None of the newborns tested positive in the first 24 h after birth, while one (9.1%, 1/10) of the newborns tested positive with pharyngeal swabs seven days after birth. However, whether the case was due to vertical transmission from mother to child remains to be confirmed. The mother’s residence, education level, antenatal follow-up, and delivery category were related to SARS-CoV-2 transmission (p < 0.05). Our findings showed a relatively low SARS-CoV-2 infection from parturients to newborns, regardless of the severity of the maternal disease. Furthermore, these findings are an early assessment of COVID-19 cases in late pregnancy, which could indicate the need for intensive management of SARS-CoV-2 infection among parturients in Angola. Further studies are needed on the consequences of SARS-CoV-2 among pregnant women and neonates from Angola.