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- Prevalência de fibrilhação auricular na Província do Bengo, Angola: resultados de um estudo de base populacionalPublication . Gonçalves, Mauer A. A.; Pedro, João Mário; Silva, Carina; Magalhães, Pedro; Brito, MiguelIntrodução: A fibrilhação auricular é a arritmia sustentada mais comum na população adulta com significado clínico, representando um importante problema de saúde pública. Não existe na literatura dados publicados acerca da prevalência da fibrilhação auricular em Angola. Objetivo: O presente estudo foi realizado com o objetivo de determinar a prevalência de fibrilhação auricular numa população do Bengo, uma província do norte de Angola, estratificada por sexo e idade e análise da sua relação com alguns fatores de risco cardiovascular. Materiais e Métodos: Os dados são provenientes do estudo CardioBengo, um estudo transversal de base comunitária, do qual foi selecionada uma amostra aleatória de indivíduos com idades compreendidas entre os 15 e os 84 anos. No total foram incluídos 2 379 indivíduos na análise final. Resultados: A idade média dos participantes foi de 35 anos e 63% da amostra era do sexo feminino. Verificou-se que a frequência de consumo de álcool era de 35,8%, a prevalência de acidente vascular isquémico ou acidente isquémico transitório foi de 0,4%; insuficiência cardíaca congestiva, 0,3%; doença cardíaca isquémica, 0,3% e hipertrofia ventricular esquerda, 37,2%. A fibrilhação auricular foi identificada em dois indivíduos, o que representa uma prevalência de 0,084%. Conclusão: O nosso estudo mostra uma baixa prevalência de fibrilhação auricular, quando comparada com as encontradas em estudos realizados em países desenvolvidos, mas semelhante à encontrada em estudos da África Subsariana.
- Are genetic modifiers the answer to different responses to hydroxyurea treatment? A pharmacogenetic study in sickle cell anemia Angolan childrenPublication . Ginete, Catarina; Delgadinho, Mariana; Santos, Brígida; Pinto, Vera; Silva, Carina; Miranda, Armandina; Brito, MiguelSickle cell anemia (SCA) is an inherited disease affecting the hemoglobin that is particularly common in sub-Saharan Africa. Although monogenic, phenotypes are markedly heterogeneous in terms of severity and life span. Hydroxyurea is still the most common treatment for these patients, and the response to treatment is highly variable and seems to be an inherited trait. Therefore, identifying the variants that might predict hydroxyurea response is important for identifying patients who will have a poorer or non-response to treatment, and the ones that are more prone to suffer from severe side effects. In the present pharmacogenetic study, we analyzed the exons of 77 genes described in the literature as potentially associated with hydroxyurea metabolism in Angolan children treated with hydroxyurea and evaluated the drug response considering fetal hemoglobin levels, other hematological and biochemical parameters, hemolysis, number of vaso-occlusive crises and hospitalizations. Thirty variants were identified in 18 of those genes as possibly associated with drug response, five of them in gene DCHS2. Other polymorphisms in this gene were also associated with hematological, biochemical, and clinical parameters. Further research examining the maximum tolerated dose and fixed-dose with a larger sample size is necessary to corroborate these findings.
- Sistema de vigilância de morbilidade pediátrica no Hospital Geral do BengoPublication . Oliveira, Ana; Gasparinho, Carolina; Mayer, António Carlos; Ribeiro, Natália; Brito, MiguelAngola tem registado avanços significativos na redução da mortalidade infantil. Não obstante, verifica-se ainda a necessidade de implementar novas medidas no sentido de reduzir a morbimortalidade infantil. Para atingir este objectivo foi implementado um Sistema de Vigilância de Morbilidade (SVM) no serviço de Pediatria do Hospital Geral do Bengo (HGB). O objectivo deste trabalho é a identificação das doenças mais frequentes detectadas no serviço de urgência do HGB.
- Deficiência em micronutrientes em crianças de idade pré-escolar: método de quantificação laboratorialPublication . Pádua, Mário; Santos, Sofia; Brito, MiguelA má nutrição conduz geralmente à deficiência em micronutrientes, contribuindo para o aumento dos riscos de morbilidade, mortalidade, estatura reduzida e perturbações cognitivas. As técnicas laboratoriais que permitem determinar os micronutrientes em estudos epidemiológicos de campo são em geral dispendiosas e com recurso a metodologias complexas, dai a necessidade de desenvolver metodologias mais rápidas e económicas. Assim, este estudo tem por objectivo: 1. Desenvolvimento de uma metodologia laboratorial para a quantificação simultânea das vitaminas A e E; 2. Avaliação dos níveis de deficiência de micronutrientes e de desnutrição nos primeiros 5 anos de vida, numa zona semi-rural de Angola.
- Prevalence and determinants of under and overnutrition among under five children in Bengo Province, AngolaPublication . Brito, Miguel; Tamayo, Sara; Fançony, Cláudia; Soares, ÂniaIntroduction - Children malnutrition is a major public health problem in developing countries. Identifying the risk factors of malnutrition and determining their magnitude is necessary to develop nutritional interventions to confront this problem. Aim - The aim of this study is to assess the determinants associated to under and overnutrition in children under 5 years in Bengo Province, Angola. Methods - A community-based cross-sectional study was used during August to September 2014. A questionnaire adapted from ProPAN 14, willing to collect data on children’s general health care, breastfeeding and feeding practices, food ingestion in the previous 24 hours, socioeconomic characteristics and water supply, was applied. Anthropometric measures were collected from all children and mothers to determine their nutritional status Univariate and multivariate analysis were performed to identify factors related to malnutrition. Results - The survey was conducted during 30 days and comprehended 808 children aged 0 to 59 months, from which 50.5% were male Infant wasting, stunting, and underweight prevalence were 7.7%, 35.8%, and 15.2% respectively. The prevalence of overnutrition was 4.2%, with 3.4% of overweight and 0.8% obese. Risk factors significantly associated with stunting were increased age of children (OR = 4.45, 95%CI 1.98, 9.95), low birth weight (OR = 2.23; 95%CI 1.20, 4.11), insufficient information about child feeding among caregivers (OR = 2.23; 95%CI 1.20, 4.15), and non-exclusive breastfeeding (OR = 1.88; 95%CI 1.30, 2.76). Inadequate dietary diversity was significantly associated with a higher risk of wasting (OR = 2.97; 95%CI 1.21, 7.32). Both stunting and wasting were significantly associated with diarrhea in the previous two weeks (OR = 1.50; 95%CI 1.07, 2.08 and OR = 3.08; 95%CI 1.48, 6.41, respectively) and living in a household with more than two children aged under five (OR = 1.50; 95%CI 1.04, 2.18 and OR = 3.19; 95%CI 1.51, 6.77, respectively). Conclusion - Undernutrition is common among children under 5 years in Bengo province. Age, birth weight, child feeding knowledge, type of breastfeeding, dietary diversity, diarrhea morbidity and the number of under-five children living at household were related to undernutrition. The presented results evidence the need of nutritional interventions in order to control children malnutrition risk factors.
- Normal limits of the electrocardiogram in AngolansPublication . Gonçalves, Mauer; Pedro, João Mário; Silva, Carina; Magalhães, Pedro; Brito, MiguelIntroduction: Studies on the normal electrocardiogram limits in African populations are limited, especially in sub-Saharan Africa. There is no literature describing normal ECG limits in Angolans. Objectives: The aim of this study is to establish the normal ECG limits for adult Angolans, without established heart disease, stratified by gender and age. Methods: A cross-sectional study was performed, involving 2179 participants from a population in northern Angola, without established heart disease, aged between 15 and 74 years. A 12‑lead ECG and a rhythm strip were recorded for all participants and analyzed and processed by the University of Glasgow software and encoded by the Minnesota Code. The normal range of the electrocardiographic parameters was established as the 2nd and 98th percentiles of the measurement distribution per age group and gender. Mann-Whitney and Kruskal-Wallis tests were used for two independent groups and Bonferroni adjustments were used for multiple testing. GAMLSS models were used to obtain the continuous age-dependent percentile curves. Results: The normal range of the ECG differed between men and women: heart rate 49 to 100 bpm vs. 55 to 108 bpm, P wave duration 81 to 130 ms vs. 84 to 130 ms, PR interval 119 to 210 ms vs. 120 to 202 ms, QRS duration 74 to 110 ms vs. 70 to 104 ms, QT interval 324 to 441 ms vs. 314 and 438 ms, P-wave axis − 29 to 850 vs. -18 to 810, QRS-wave axis − 13 to 850 vs. -180 and 820, T-wave axis 0 to 720 vs. -8 to 730, Sokolow-Lyon index 2.13 to 6.21 mV vs. 1.60 to 4.87 mV, Cornell index 0.17 to 6.24 mV vs. 0.14 mV to 4.35 mV. Conclusions: The values described for the electrocardiographic measurements above can act as a reference framework for Angolan adults without established heart disease. Our study suggests that the normal range of most ECG parameters varies according to age and sex and the ECG diagnostic criteria must therefore be specific for these demographic measures.
- Physicians’ perceptions of their knowledge and the preparedness of health facilities in Angola to diagnose and manage COVID-19Publication . Arrais, Margarete; Dias, Welwitschia; Gama, Jorge M. R.; Brito, MiguelBackground: Healthcare professionals represent a vulnerable group in terms of responding to COVID-19. Knowledge can influence healthcare professionals through the adoption of the correct attitudes and practices. The aim of this study was to evaluate, by a questionnaire, the perceptions of physicians about their level of knowledge as well as conditions in their workplaces for dealing with COVID-19. Methods: A cross-sectional study of Angolan physicians took place from 11 May to 23 June 2020. A questionnaire was electronically shared across social media and via email. Results: The sample consisted of 637 valid questionnaires; 53% of respondents were female, 41% were aged 31-40 y and 79% were from Luanda province. About 51% of physicians perceived that they had adequate knowledge about COVID-19 and 64% used personal protective equipment. These figures were higher among specialists from the province of Luanda. About 81% stated that their health units lacked the technical capacity to diagnose COVID-19. Only 35% of health units have chest tomography equipment; 44% are prepared for the care and/or isolation of patients. Only 33% of units are running intensive care units. The main concerns of physicians were training opportunities and limited access to personal protective equipment. Conclusion: The results show that it is necessary to strengthen physicians' knowledge about COVID-19, as well as to improve the conditions of the health units, so as to promote safe practices.
- The impact of the ABO/Rh blood group on susceptibility and severity among COVID-19 patients in Luanda, AngolaPublication . Sebastião, Cruz S.; Teixeira, Alice; Luísa, Ana; Arrais, Margarete; Tchonhi, Chissengo; Cogle, Adis; Sacomboio, Euclides; Cardoso, Bruno; Morais, Joana; Vasconcelos, Jocelyne Neto de; Brito, MiguelSARS-CoV-2 is a public health concern worldwide. Identification of biological factors that could influence transmission and worsen the disease has been the subject of extensive investigation. Herein, we investigate the impact of the ABO/Rh blood group on susceptibility and severity among COVID-19 patients in Luanda, Angola. This was a multicentric cohort study conducted with 101 COVID-19 patients. Chi-square and logistic regression were calculated to check factors related to the worsening of the disease and deemed significant when p<0.05. Blood type O (51.5%) and Rh-positive (93.1%) were the most frequent. Patients from blood type O had a high risk to severe disease [OR: 1.33 (95% CI: 0.42 - 4.18), p=0.630] and hospitalization [OR: 2.59 (95% CI: 0.84 - 8.00), p=0.099]. Also, Rh-positive blood type presented a high risk for severe disease (OR: 10.6, p=0.007) and hospitalization (OR: 6.04, p=0.026). We find a high susceptibility, severity, hospitalization, and mortality, respectively, among blood group O and Rh-positive patients, while blood group AB presented a low susceptibility, severity, hospitalization, and mortality, respectively. Our findings add to the body of evidence suggesting that ABO/Rh blood groups play an important role in the course of SARS-CoV-2 infection.
- Estudo dos agentes causais de diarreia em crianças menores de 5 anos no Hospital Geral do BengoPublication . Gasparinho, C.; Mirante, M.C.; Lima, S.; Nery, S.; Istrate, C.; Mayer, A. C.; Brito, MiguelA diarreia pode ser causada por vírus, parasitas e bactérias e constitui uma das principais causas de doença e morte em crianças menores de cinco anos em Angola. O presente estude assume como principal objectivo identificar os agentes patogénicos causadores de diarreia em crianças admitidas no Hospital Geral do Bengo.
- Impact of a training course on the quality of malaria diagnosis by microscopy in AngolaPublication . Moura, Sofia; Fançony, Cláudia; Mirante, Clara; Neves, Marcela; Bernardino, Luís; Fortes, Filomeno; Sambo, Maria do Rosário; Brito, MiguelBackground: In Angola, malaria is an endemic disease having a major impact on the economy. The WHO recommends testing for all suspected malaria cases, to avoid the presumptive treatment of this disease. In malaria endemic regions laboratory technicians must be very comfortable with microscopy, the golden standard for malaria diagnosis, to avoid the incorrect diagnosis. The improper use of medication promotes drug resistance and undesirable side effects. The present study aims to assess the impact of a three-day refresher course on the knowledge of technicians, quality of blood smears preparation and accuracy of microscopy malaria diagnosis, using qPCR as reference method. Methods: This study was implemented in laboratories from three hospitals in different provinces of Angola: Bengo, Benguela and Luanda. In each laboratory samples were collected before and after the training course (slide with thin and thick blood smears, a dried blood spot and a form). The impact of the intervention was evaluated through a written test, the quality of slide preparation and the performance of microscopy. Results: It was found a significant increase on the written test median score, from 52.5% to 65.0%. A total of 973 slides were analysed to evaluate the quality of thick and thin blood smears. Considering all laboratories there was a significant increase in quality of thick and thin blood smears. To determine the performance of microscopy using qPCR as the reference method we used 1,028 samples. Benguela presented the highest values for specificity, 92.9% and 98.8% pre and post-course, respectively and for sensitivity the best pre-course was Benguela (75.9%) and post-course Luanda (75.0%). However, no significant increase in sensitivity and specificity after the training course was registered in any laboratory analysed. Discussion: The findings of this study support the need of continuous refresher training for microscopists and other laboratory staff. The laboratories should have a quality control programme to supervise the diagnosis and also to assess the periodicity of new training. However, other variables needed to be considered to have a correct malaria diagnosis, such as adequate equipment and reagents for staining and visualization, good working conditions, motivated and qualified personnel.