40 research outputs found
Epidemiologia molecular da infecção por VIH/SIDA, em Angola
Tese de mestrado, Doenças Infecciosas Emergentes, Faculdade de Medicina, Universidade de Lisboa, 2011Segundo a Organização Mundial da SaĂșde (OMS), estima-se que, no Mundo, em 2008, viviam 33,4 milhĂ”es de pessoas infectadas por VIH. A Ăfrica sub - sariana, continua a ser a regiĂŁo mais afectada pela epidemia, tendo 22,8 milhĂ”es de infectados.
O primeiro caso de sida, em Angola, foi diagnosticado em 1985 e atĂ© ao primeiro semestre de 2009 foram notificados 48.651 casos de infecção por VIH (64). A prevalĂȘncia ronda os 5,0 %, em 16 milhĂ”es de habitantes, mas nas zonas fronteiriças com a RepĂșblica do Congo (Kinshasa), ZĂąmbia e NamĂbia pode atingir os 10,0 %.
O objectivo do presente trabalho Ă©: a) determinar o perfil epidemiolĂłgico, demogrĂĄfico, clĂnico e imunolĂłgico dos indivĂduos em estudo, b) estudar a diversidade genĂ©tica de VIH em Angola, assim como investigar a frequĂȘncia e distribuiçÔes de polimorfismos na protease (PR) e na transcriptase reversa (TR) associados Ă resistĂȘncia aos anti-retrovĂricos, nos indivĂduos nĂŁo tratados.
As 219 amostras foram recolhidas dos 302 indivĂduos infectados por VIH-1, no Hospital da Divina ProvidĂȘncia, em Luanda, de Setembro de 2008 a Janeiro de 2009. Para o presente estudo foram recrutados 57 indivĂduos, cujos critĂ©rios de inclusĂŁo seguiram algumas das recomendaçÔes da OMS, para este tipo de trabalho.
Cento e cinco sequĂȘncias foram realizadas, 57 da proteĂna PR e 48 da TR no gene pol, usando um mĂ©todo in-house.
O perfil epidemiolĂłgico, clĂnico, demogrĂĄfico e imunolĂłgico da população estudada Ă© caracterizada, maioritariamente por pertencerem ao sexo feminino (67,5%), com mĂ©dia de idades de 31 anos, a via de transmissĂŁo predominante foi a heterossexual (86,8%) e a maior parte estava em estado avançado de doença.
A anĂĄlise filogenĂ©tica das sequĂȘncias revelou uma elevada heterogeneidade genĂ©tica de VIH-1 em Angola. Foram detectados vĂrus de todos os subtipos pertencentes ao grupo M e 5,3% a subtipos nĂŁo classificĂĄveis. A anĂĄlise filogenĂ©tica das sequĂȘncias revelou que, somente, 16 (37%) indivĂduos albergavam vĂrus de um Ășnico subtipo (subtipo puro). Os restantes indivĂduos (n=30, 65%) estavam, na sua maioria, infectados por vĂrus recombinantes, incluindo formas recombinantes circulantes (CRFs) e outros recombinantes. Um doente (d94) estava infectado por um isolado nĂŁo tipĂĄvel (U). O subtipo mais prevalente na PR foi o G (n=12; 21%) seguido do D (n=7; 13%) e C (n=6; 11%). Na TR os subtipos mais prevalentes foram o A, C e F1 todos presentes em cinco indivĂduos (10%). SequĂȘncias nĂŁo tipĂĄveis foram detectadas em seis (11%) indivĂduos na PR e quatro (8%) indivĂduos na TR. Vinte e quatro indivĂduos estavam infectados por vĂrus contendo PRs e TRs pertencentes a diferentes subtipos, a vĂrus nĂŁo tipĂĄveis ou a CRFs. O recombinante deste gĂ©nero mais frequente foi o G/U que estava presente em trĂȘs indivĂduos (13%).
A CRF mais prevalente foi a CRF02_AG tanto na PR (n=5; 9%) como na TR (n=5; 10%), seguida da CRF01_AE (PR - n=4; 7%; TR - n=4; 8%).
Detectaram-se oito (14%) indivĂduos, potencialmente, infectados com vĂrus recombinantes constituĂdos por CRF01_AE na PR ou na TR.
De salientar que 13 (54%) destes indivĂduos albergavam recombinantes de 2ÂȘ geração, ou seja, vĂrus que resultam da recombinação entre um CRF e um vĂrus de um subtipo puro ou um vĂrus nĂŁo tipĂĄvel (U).
A anĂĄlise das sequĂȘncias na base de dados de Stanford para as mutaçÔes de resistĂȘncia, inequivocamente, associadas com a transmissĂŁo de vĂrus resistentes aos anti-retrovĂricos revelou que, nĂŁo obstante a presença de numerosos polimorfismos invulgares na PR e TR, nenhum dos indivĂduos estava infectado por este tipo de vĂrus.According to the World Health Organization in 2008 an estimated 33,4 million people were infected with HIV. Sub-Saharan Africa continues to be the region with the most infected by the epidemic with 22, 8 million infected.
The first case of aids in Angola was diagnosed in 1985 and until the first semester of 2009 forty eight thousand six hundred and fifty cases of HIV/aids (64) were notified. The spread is around 5, 0% in 16 million inhabitants although in the neighboring borders of the Congo Republic (Kinshasa), Zambia and Namibia it can hit 10, 0 %.
The objective of this project is to determine the epidemiological, demographical, clinical and immunological profile of the individuals under case study. Explore the genetic diversity of HIV in Angola as well as investigate the frequency and distribution of polymorphisms in protease PR and in reverse transcriptase TR associated to the resistance to ARV, in non treated individuals.
The 219 samples were collected from HIV 1 infected individuals 302 from the Hospital of Divine Providence in Luanda in September of 2008 to January of 2009, for the present study 57 individuals were included following the WHO recommendationsâ for this type of study.
The samples of the 57 individuals were genotopically analysed to determine their subtype and the profile potential to the resistance to ARV using the in house method one hundred and five sequences were done (57 protein PR and 48 TR) in the Pol gene. The profile epidemiologist, clinical, demographic and immunologic of the studied population were characterized were mostly by the feminine sex (67.5%), with average of age of 31 years, the way of predominant transmission was heterosexual (86.8%) and most was in advanced state of imunossupressĂŁo.
The phylogenetic sequential analysis revealed highly heterogeneity of HIV-1 Angola. That study revealed all subtypes belonging to group M.
The phylogenetic sequential analyses revealed that only 16 (37 %) patients had the virus of only one subtype pure subtype the remaining patient (30, 65 %) were mostly infected by recombinant virus including circular recombinant forms CRFs. One patients (d94) were infected by classification was not possible sequences (U). The most prevalent subtype in PR was the G (12; 21%) followed by D (7; 13%) and C (6; 11%).The prevalent subtypes were A, C e F1. All present in 5 patients (10%). Unclassified sequences were detected in 6 (11%) patients in PR and 4 (8%) patients in TR. Twenty four patients were infected with the virus containing PRs and TRs belonging to different subtypes, unclassified virus or CRFs.
The CRF most prevalent was CRF02_ AG both in PR (5 patients, 9%) and TR (5; 10%) followed by CRF01_AE [PR: 4; 7%; TR: 4; 8%].
In this study we detected 8 (14%), potentially infected patients with recombinant virus made of CRF01_AE in PR or TR.
It is to point out that 13 (54%) these patients lodged/possessed/had recombinant virus of second generation ,that is, that result of recombination between one CRF and a virus a pure subtype or one unclassified virus.
The sequential analyses of the Stanford data base for the resistant mutations unequivocally associates with the transmission of resistant viruses to the ARV revealed that notwithstanding the presence of numerous unusual polymorphisms in PR and TR, none of the patients were infected with this type of virus.Fundação Glaxo Smithkline das CiĂȘncias da SaĂșd
SleepâWake Patterns Reported by Parents in Hyperactive Children Diagnosed According to ICD-10, as Compared to Paired Controls
This study aimed primarily to compare the parent-reported sleep of children with ICD-10 hyperkinetic disorder (HKD) versus community children. Thirty children aged 5-13 years (83.3% boys) diagnosed with HKD by their child and adolescent psychiatrists took part in this study, plus 30 community children, matched for sex, age, and school year. Compared to the controls, the HKD children showed significantly later bedtimes, stronger bedtime resistance, longer sleep latency, shorter sleep; more frequent behaviors and symptoms concerning falling asleep into parents bed, needing something special to initiate sleep, nightmares, sleep talking, sleep bruxism, fear from darkness, bedwetting, and, most notably, loud snoring (26.7%); they also tended to show higher daytime somnolence. Attention deficit/hyperactivity disorder (ADHD)/HKD children may thus have more sleep-related problems than typically developing children. Alternatively, our results may reflect misdiagnoses; thus, special attention should be directed to comorbidity and differential diagnosis issues between sleep disturbances and ADHD/HKD
Effectiveness of a Prevention of Mother-to-Child HIV Transmission Programme in an Urban Hospital in Angola
BACKGROUND: Antiretroviral therapy is effective in reducing rates of mother-to child transmission of HIV to low levels in resource-limited contexts but the applicability and efficacy of these programs in the field are scarcely known. In order to explore such issues, we performed a descriptive study on retrospective data from hospital records of HIV-infected pregnant women who accessed in 2007-2010 the Luanda Municipal Hospital service for prevention of mother-to-child transmission (PMTCT). The main outcome measure was infant survival and HIV transmission. Our aim was to evaluate PMTCT programme in a local hospital setting in Africa. RESULTS: Data for 104 pregnancies and 107 infants were analysed. Sixty-eight women (65.4%) had a first visit before or during pregnancy and received combination antiretroviral treatment (ART) in pregnancy. The remaining 36 women (34.6%) presented after delivery and received no ART during pregnancy. Across a median cohort follow-up time of 73 weeks, mortality among women with and without ART in pregnancy was 4.4% and 16.7%, respectively (death hazard ratio: 0.30, 95% CI 0.07-1.20, p = 0.089). The estimated rates of HIV transmission or death in the infants over a median follow up time of 74 weeks were 8.5% with maternal ART during pregnancy and 38.9% without maternal ART during pregnancy. Following adjustment for use of oral zidovudine in the newborn and exposure to maternal milk, no ART in pregnancy remained associated with a 5-fold higher infant risk of HIV transmission or death (adjusted odds ratio: 5.13, 95% CI: 1.31-20.15, p = 0.019). CONCLUSIONS: Among the women and infants adhering to the PMTCT programme, HIV transmission and mortality were low. However, many women presented too late for PMTCT, and about 20% of infants did not complete follow up. This suggests the need of targeted interventions that maintain the access of mothers and infants to prevention and care services for HIV
Predictors of Bacterial Meningitis in Resource-Limited Contexts: An Angolan Case
BACKGROUND: Despite the great morbidity and mortality that childhood bacterial meningitis (BM) is experiencing in Africa, diagnosis of BM in resource-limited contexts is still a challenge. Several algorithms and clinical predictors have been proposed to help physicians in decision-making but a lot of these markers used variables that are calculable only in well-equipped laboratories. Predictors or algorithm based on parameters that can be easily performed in basic laboratories can help significantly in BM diagnosis, even in resource-limited settings, rural hospitals or health centers. RESULTS: This retrospective study examined 145 cerebral-spinal fluid (CSF) specimens from children from 2 months to 14 years. CSF specimens were divided into two groups, according to the presence or not of a clinical diagnosis of BM. For each specimen, CSF aspect, CSF white blood cells (WBC) count, CSF glucose and protein concentration were analyzed and statistical analysis were performed. CSF WBC count â„10/”l is no more a valuable predictor of BM. CSF protein concentration â„50 mg/dl has a better sensitivity for BM diagnosis and when used with CSF glucose concentration â€40 mg/dl, can help to diagnose correctly almost all the BM cases. An algorithm including CSF protein concentration, glucose concentration and WBC count has been proposed to rule out BM and to correctly diagnose it. CONCLUSIONS: In resource-limited health centers, the availability of a combination of easy-to-obtain parameters can significantly help physicians in BM diagnosis. The prompt identification of a BM case can be rapid treated or transferred to adequate structures and can modify the outcome in the patient
Hyperarousal and failure to inhibit wakefulness in primary insomnia: âBirds of a featherâ?
Narcolepsy in pediatric age â Experience of a tertiary pediatric hospital
Narcolepsy, a chronic disorder of the sleepâwake cycle of multifactorial etiology, is characterized by excessive daytime sleepiness, often associated with cataplexy, hypnagogic/hypnopompic hallucinations and sleep paralysis. Both early clinical suspicion and therapeutic approach are essential for promotion of cognitive development and social integration of these children. The authors present a descriptive retrospective study of a series of eight children in whom symptoms first started between 6.8 and 10.5 years of age. Diagnostic delay ranged from 4 months to 2 years. One child had H1N1 flu vaccination eight months before the clinical onset. The first multiple sleep latency test was positive in 6 of 8 cases. All cases were treated with methylphenidate, and venlafaxine was associated in 4 of them. In one case the initial therapy was exclusively behavioral. In all cases, symptomatic improvement, better school performance and social integration were achieved after therapeutic adjustment
Default-mode network activity and its role in comprehension and management of psychophysiological insomnia: A new perspective
The dysfunctional beliefs and attitudes about sleep scale: dimensions of the European Portuguese DBAS-30 and development of a new short version (DBAS-SF-16)
Objectives: The Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS) is the most widely validated
instrument for assessing sleep-related cognitions. This study aimed to examine the reliability of the
DBAS-30 European Portuguese version, explore its dimensionality, and develop a new short version
suitable for differentiating the presence/absence of insomnia.
Methods: From 824 participants aged 18e85 years, the Insomnia Group (IG, n Œ 355, 261 females and 94
males) and Normal Sleepers Group (NSG, n Œ 292, 237 females, 54 males and 1 with no response) were
constituted. Thirty-one patients with Obstructive Sleep Apnea Syndrome were also recruited. For the
DBAS 16-items version, the ability to differentiate dysfunctional beliefs between people with and
without insomnia was used as the main criterion for item retention.
Results: DBAS-30 PT demonstrated good internal consistency and significantly discriminated IG from
NSG. Based on a robust EFA (RDWLS), a three-dimensional structure was determined for IG (Ageing and
Hopelessness, Sleep Expectations, and Consequences and Helplessness). DBASeSFe16 presented as an
internally-consistent measure with a reliable two-factor structure (Consequences and Helplessness,
Medication and Hopelessness) and showed construct and known groups validity. ROC analysis demon-
strated DBASeSFe16's relevant clinical accuracy, and 4.3 provides the best cut-off score in detecting the
level of dysfunctional beliefs associated with clinical insomnia.
Conclusions: A new and meaningful dimensionality of the DBAS-30 was found. DBASeSFe16 showed to
be a reliable, valid, and robust tool for evaluating dysfunctional beliefs about insomnia in clinical and
non-clinical populations.publishe