Instituto Nacional Of Saude

Lisbon, Portugal

Instituto Nacional Of Saude

Lisbon, Portugal

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Sliwa K.,University of Cape Town | Sliwa K.,University of Witwatersrand | Sliwa K.,Medical Research Council of South Africa | Gersh B.J.,Rochester College | And 2 more authors.
Circulation | Year: 2016

Africa is a continent characterized by marked ethnic, sociodemographic, and economic diversity, with profound changes in many regions over the past 2 decades. This diversity has an impact on cardiovascular disease presentation and outcomes. Within Africa and within the individual countries, one can find regions having predominantly communicable diseases such as rheumatic heart disease, tuberculous pericarditis, or cardiomyopathy and others having a marked increase in noncommunicable disease such as hypertension and hypertensive heart disease. Ischemic heart disease remains rare in most countries. Difficulties in the planning and implementation of effective health care in most African countries are compounded by a paucity of studies and a low rate of investment in research and data acquisition. The fiduciary responsibilities of companies working in Africa should include the effective and efficient use of natural resources to promote the overall health of populations. © 2016 American Heart Association, Inc.


Medeiros A.M.,Instituto Nacional Of Saude | Medeiros A.M.,University of Lisbon | Alves A.C.,Instituto Nacional Of Saude | Alves A.C.,University of Lisbon | And 3 more authors.
Journal of Lipid Research | Year: 2014

The distinction between a monogenic dyslipidemia and a polygenic/ environmental dyslipidemia is important for the cardiovascular risk assessment, counseling, and treatment of these patients. The present work aims to perform the cardiovascular risk assessment of dyslipidemic children to identify useful biomarkers for clinical criteria improvement in clinical settings. Main cardiovascular risk factors were analyzed in a cohort of 237 unrelated children with clinical diagnosis of familial hypercholesterolemia (FH). About 40% carried at least two cardiovascular risk factors and 37.6% had FH, presenting mutations in LDLR and APOB . FH children showed significant elevated atherogenic markers and lower concentration of antiatherogenic particles. Children without a molecular diagnosis of FH had higher levels of TGs, apoC2, apoC3, and higher frequency of BMI and overweight/obesity, suggesting that environmental factors can be the underlying cause of their hypercholesterolem.ia. An apoB/apoA1 ratio ≥ 0.68 was identified as the best biomarker (area under the curve = 0.835) to differentiate FH from other dyslipidemias. The inclusion in clinical criteria of a higher cut-off point for LDL cholesterol or an apoB/apoA1 ratio ≥ 0.68 optimized the criteria sensitivity and specificity. The correct identification, at an early age, of all children at-risk is of great importance so that specific interventions can be implemented. apoB/apoA1 can improve the identification of FH patients. . Medeiros, A. M., A. C. Alves, P. Aguiar, and M. Bourbon on behalf of the Pediatric Investigators of the Portuguese Familial Hypercholesterolemia Study. Cardiovascular risk assessment of dyslipidemic children: analysis of biomarkers to identify monogenic dyslipidemia. J. Lipid Res. 2014. 55: 947.955. Copyright © 2014 by the American Society for Biochemistry and Molecular Biology, Inc.


Mocumbi A.O.,Instituto Nacional Of Saude | Mocumbi A.O.,Eduardo Mondlane University | Sliwa K.,University of Cape Town | Sliwa K.,University of Witwatersrand
Heart | Year: 2012

The predominant pattern of cardiovascular diseases in sub-Saharan Africa is that of poverty-related conditions (rheumatic heart valve disease, untreated congenital heart disease, tuberculous pericarditis) and diseases of unclear aetiology with a higher prevalence in this part of the world (peripartum cardiomyopathy, endomyocardial fibrosis). However, the prevalence of the traditional risk factors for cardiovascular diseases such as hypertension and marked obesity is high in a number of sub-Saharan settings, although they vary considerably among countries, urban/rural locations and specific subpopulations. In urban settings, hypertensive heart disease with systolic and diastolic function contributes substantially to morbidity. Awareness of the general public and health workers about the burden of cardiovascular diseases in women must be increased, and risk factor control programmes must be included in the health research agenda on the African continent. Improvement in health services with coordination of maternal health services and non-communicable diseases is also needed. This review focuses on the current knowledge of cardiovascular healthcare of women in sub-Saharan Africa, particularly their propensity for various forms of heart disease, access to healthcare, treatment received within the respective healthcare system, response to therapy and mortality. It highlights the gaps in knowledge and the paucity of data in most of these aspects.


Bonnet M.,Epicentre | Bhatt N.,Instituto Nacional Of Saude | Baudin E.,Epicentre | Silva C.,Epicentre | And 9 more authors.
The Lancet Infectious Diseases | Year: 2013

Background: In countries with a high incidence of HIV and tuberculosis co-infection, nevirapine and efavirenz are widely used as antiretroviral therapy but both interact with antituberculosis drugs. We aimed to compare efficacy and safety of a nevirapine-based antiretroviral therapy (started at full dose) with an efavirenz-based regimen in co-infected patients. Methods: We did a multicentre, open-label, randomised, non-inferiority trial at three health centres in Maputo, Mozambique. We enrolled adults (≥18 years) with tuberculosis and previously untreated HIV infection (CD4 cell counts <250 cells per μL) and alanine aminotransferase and total bilirubin concentrations of less than five times the upper limit of normal. 4-6 weeks after the start of tuberculosis treatment, we randomly allocated patients (1:1) with central randomisation, block sizes of two to six, and stratified by site and CD4 cell count to nevirapine (200 mg twice daily) or efavirenz (600 mg once daily), plus lamivudine and stavudine. The primary endpoint was virological suppression at 48 weeks (HIV-1 RNA <50 copies per mL) in all patients who received at least one dose of study drug (intention-to-treat population); death and loss to follow-up were recorded as treatment failure. The non-inferiority margin for the difference of efficacy was 10%. We assessed efficacy in intention-to-treat and per-protocol populations and safety in all patients who received study drug. This study is registered with ClinicalTrials.gov, number NCT00495326. Findings: Between October, 2007, and March, 2010, we enrolled 285 patients into each group. 242 (85%) patients in the nevirapine group and 233 (82%) patients in the efavirenz group completed follow-up. In the intention-to-treat population, 184 patients (64·6%, 95% CI 58·7-70·1) allocated nevirapine achieved virological suppression at week 48, as did 199 patients (69·8%, 64·1-75·1) allocated efavirenz (one-sided 95% CI of the difference of efficacy 11·7%). In the per-protocol population, 170 (70·0%, 63·8-75·7) of 243 patients allocated nevirapine achieved virological suppression at week 48, as did 194 (78·9%, 73·2-83·8) of 246 patients allocated efavirenz (one-sided 95% CI 15·4%). The median CD4 cell count at randomisation was 89 cells per μL. 15 patients substituted nevirapine with efavirenz and six patients substituted efavirenz with nevirapine. 20 patients allocated nevirapine (7%) had grade 3-4 increase of alanine aminotransferase compared with 17 patients allocated efavirenz (6%). Three patients had severe rash after receipt of nevirapine (1%) but no patients did after receipt of efavirenz. 18 patients in the nevirapine group died, as did 17 patients in the efavirenz group. Interpretation: Although non-inferiority of the nevirapine-regimen was not shown, nevirapine at full dose could be a safe, acceptable alternative for patients unable to tolerate efavirenz. Funding: French Research Agency for HIV/AIDS and hepatitis (ANRS). © 2013 Elsevier Ltd.


Charlwood J.D.,Center for Health Research Development | Charlwood J.D.,Instituto Nacional Of Saude | Tomas E.V.E.,MOZDAN Project
Transactions of the Royal Society of Tropical Medicine and Hygiene | Year: 2011

Mosquito survival is linked to the activities performed in each oviposition cycle, whilst development of malaria parasites in them is largely temperature dependent. Extending the oviposition cycle of the mosquito, even as a side effect of normal development of the parasite, may enhance malaria transmission. A study was therefore undertaken to compare the time spent before returning to feed among infected and uninfected host seeking Anopheles funestus from a village in southern Mozambique. The stomachs of 2073 parous mosquitoes (1289 with sacs, indicative of a rapid return to host-seeking and 784 without sacs indicating a delay in host-seeking) from four extended sampling periods were examined for oocysts. From three of these, and overall, significantly more mosquitoes without sacs had oocysts than mosquitoes with sacs (Fishers Exact Test P=0.0051). This is the first time that possible effects on oviposition cycle length among infected vectors of human malaria have been demonstrated. © 2011 Royal Society of Tropical Medicine and Hygiene.


Pista A.,Instituto Nacional Of Saude | De Oliveira C.F.,Federation for the Gynaecological | Lopes C.,Abel Salazar Biomedical Sciences Institute | Cunha M.J.,Sanofi S.A.
International Journal of Gynecological Cancer | Year: 2013

Objective: Cervical cancer is the third most frequent cancer in women, worldwide and etiologically associated with infection by human papillomavirus (HPV). Following the results of the first epidemiologic population-based CLEOPATRE study in Portugal, it was important to understand the HPV type-specific distribution in women with cervical intraepithelial neoplasia (CIN) grades 2 and 3 and invasive cervical cancer (ICC). Methods: This was an observational, multicenter, cross-sectional study with retrospective data collection. Between January 2008 and May 2009, paraffin-embedded samples of histologically confirmed cases of CIN2, CIN3, and ICC were collected from the 5 regional health administrations in mainland Portugal. Eligible samples were sent to 2 central laboratories for histological reassessment and HPV genotyping. Prevalence estimateswere calculated together with 95% confidence intervals. Results: Atotal of 582 samples, 177 cases of CIN2, 341 of CIN3, and 64 of ICC,were included. The mean age of participants was 41.8 years (range, 20Y88 years). The overall HPV prevalence was 97.9% with a higher prevalence of high-risk genotypes, particularly HPV 16. Multiple infections were observed in 11.2% of the cases. Human papillomavirus prevalence was 95.5% in CIN2,99.4%in CIN3, and96.9%inICC.The8more frequent genotypes in order ofdecreasing frequencywereHPV16, 31, 58, 33, 51, 52, 18, and 35 inCIN2 andHPV16, 31, 33, 58, 52, 35, 18, and 51 in CIN3. In ICC cases, the 12 detected HPV genotypes were HPV 16, 18, 31, 33, 45, 51, 52, 53, 56, 58, 59, and 73. However, HPV 53 and 73 were always associated to other high-risk genotypes. Human papillomavirus types 31, 51, 52, 56, and 59 were detected in 1 case each. Conclusions: Human papillomavirus prevalence and patterns of type-specific HPV positivity were comparable with other studies. Current HPV vaccines should protect against HPV genotypes responsible for 77.4% of ICC in Portugal. © 2013 by IGCS and ESGO.


Jani I.V.,Instituto Nacional Of Saude | Sitoe N.E.,Instituto Nacional Of Saude | Chongo P.L.,Instituto Nacional Of Saude | Alfai E.R.,Instituto Nacional Of Saude | And 4 more authors.
AIDS | Year: 2011

OBJECTIVE: To evaluate the accuracy of point-of-care tests (POCTs) for CD4 cell, clinical chemistry and hemoglobin in primary healthcare clinics in Mozambique. DESIGN AND METHODS: POCT and laboratory-based assays were conducted on adult HIV-positive patients enrolled consecutively at primary healthcare clinics in Mozambique. Patients were tested on-site with POCT CD4 (Pima), clinical chemistry (Reflotron) and hemoglobin (HemoCue) devices using finger prick blood. Results obtained on paired blood samples were used for agreement analysis (bias and limits of agreement). Repeatability analysis was also performed for POCT CD4 cell counting. RESULTS: Primary health nurses operating the Pima, Reflotron and HemoCue POCT devices produced results with low levels of bias for CD4 T-cell counts (-52.8 cells/μl), alanine aminotransferase (-0.2 U/l), aspartate aminotransferase (-4.0 U/l) and hemoglobin (0.95 g/dl). CD4 T-cell counts in paired specimens of finger prick and venous blood tested on the POCT CD4 device were in close agreement (bias -9 cells/μl, coefficient of variation 10.6%). The repeatability of POCT CD4 cell counting was similar to that observed with laboratory instruments (bias -6.2 cells/μl, coefficient of variation 10.7% vs. bias -5.7 cells/μl, coefficient of variation 7.5%). CONCLUSION: Primary health clinic nurses generated accurate results for CD4 T-cell counts, liver enzymes and hemoglobin using simple POC devices on finger prick samples at decentralized antiretroviral therapy (ART) clinics. POC diagnostics to monitor ART at primary healthcare level is technically feasible and should be utilized in efforts to decentralize HIV care and treatment. © 2011 Lippincott Williams & Wilkins, Inc.


Charlwood J.D.,Center for Health | Charlwood J.D.,Instituto Nacional Of Saude
Journal of Vector Ecology | Year: 2011

Little is known about the fitness of wild male mosquitoes, the females of which are vectors of malaria. The problem of studying male biology has been exacerbated by difficulties associated with catching them. In southern Mozambique, however, almost the entire adult population of An. funestus and An. gambiae s.l. rest inside houses. They leave in a dusk exodus, which makes them easy to collect. In 8,348 exit collections from a village from 2003 to 2009, 567,195 male An. funestus and 34,591 male An. gambiae s.l. were collected. During the study, numbers of An. funestus increased but numbers of An. gambiae s.l. declined to the point of extinction. Overall numbers of An. gambiae s.l. were positively correlated with temperature, whilst the relationship between temperature and numbers of An. funestus changed from an initially positive one in the first three years of the study to a negative one in the last three years. Marked males were recaptured up to 300 m from the release site, with most recaptures occurring within 150 m. Estimated mean daily survival of male An. funestus was 0.86 (95% C.I. 0.869-0.850). For the years 2003-2007, estimated mean daily survival of male An gambiae s.l. was 0.660 (95% C.I. 0.682-0.638). For either species, there was no relationship between mean weekly temperature and estimated daily survival. These results imply that males of An. funestus live as long as females but have a relatively short flight range. They are discussed in the light of possible release strategies of sterile or genetically modified mosquitoes. © 2011 The Society for Vector Ecology.


Gudo E.S.,Instituto Nacional Of Saude | Prista A.,University Pedagogica | Jani I.V.,Instituto Nacional Of Saude
BMC Infectious Diseases | Year: 2013

Background: Asymptomatic Plasmodium falciparum parasitemia (APFP) has been reported to be highly prevalent in Sub-Saharan Africa, a region heavily burdened by malaria, yet, the impact of APFP on the immunological reference values have not yet been established. This study was aimed at i) determine the prevalence of APFP in children and adolescents living in a region highly endemic for malaria in southern Mozambique and its impact on the immuno-hematological indices and ii) determine the factors independently associated with APFP. Methods: A cross sectional study was conducted in a rural area highly endemic for Malaria in southern Mozambique during the dry season. Apparently healthy children and adolescents were selected for the study. Results: Blood samples were collected from 348 participants. Plasmodium falciparum was detected in 56.5% (194/343) of study subjects. APFP was more frequent in males and was associated with lower values of hemoglobin and platelets measurements. Parasitized and not parasitized individuals were similar in terms of lymphocyte counts, CD4+ and CD8+ T cells counts. Platelet count was the parameter with strongest association with APFP (OR: 0.991, p= 0.000) in children and its performance in guiding clinical suspicion was moderate (AUC: 0.70, p=0.000). Contrarily, in adolescents, the predictive value of platelets counts was low (AUC: 0.55).Conclusion: Overall, our finding demonstrated that APFP is highly prevalent in regions endemic for malaria in southern Mozambique and was associated with lower hematological parameters but unaltered lymphocyte counts, CD4+ and CD8+ T cells counts. Platelets count was of moderate performance in guiding clinical suspicion of APFP in children but not in adolescents. © 2013 Gudo et al.; licensee BioMed Central Ltd.


Antunes P.,University of Porto | Mourao J.,University of Porto | Machado J.,Instituto Nacional Of Saude | Peixe L.,University of Porto
Diagnostic Microbiology and Infectious Disease | Year: 2011

The presence of qnr and qepA genes was investigated among 300 nontyphoidal Salmonella showing decreased susceptibility to ciprofloxacin obtained from different sources in Portugal (2002-2004). The qnrS1 gene was located within a conjugative IncN plasmid in a ST11 Salmonella Enteritidis strain from human origin, a serotype commonly implicated in human infections and frequently encountered in poultry. © 2011 Elsevier Inc.

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