Epidemiological and clinical features of the emergency visits in a rural hospital in Cubal, Angola

There is scarce information on the profiles of patients attended in the Emergency Departments (ED) in rural Angola. Retrospective descriptive study including all the patients treated in the ED in Hospital Nossa Senhora da Paz (Cubal) during 6 months (December 2014- May 2015). The epidemiological and clinical data collected were: age, sex, shift, service assignment, reason for consultation and outcome (discharge, admission, referral or death). A total of 2384 patients (53.4% women) were attended. The median age was 10 years (range: 0 - 96 years); 57.9% and 40.2% of them were under 17 and 5 years, respectively. No differences were observed regarding the assistance per shift, weekdays, weekends, or mean age per shift. The reason for consultation was registered in 69.9% of the patients; the most common were respiratory tract infections (20.5%), fever (14%), digestive diseases (13.6%) and malaria (10.4%). Up to 47.2% of the patients required in-hospital treatment and 1.3% were transferred to other hospitals. The patients admitted were significantly younger than the patients discharged (median age of 4 vs.16 years, p < 0.01). The mortality rate within the ED was 0.5%. Young patients were those who mostly required assistance in the ED. Infectious diseases were the most frequent reason for consultation. Pulmonary tuberculosis was suspected in one third of respiratory infections. The admission rate was high, especially in children under 5 years and in cases of malaria and malnutrition. Low referral rate and low mortality within the ED were observed

Utilidad de la definición de Neumonía asociada a los cuidados sanitarios, los Criterios de Shorr y los Criterios de Aliberti, para predecir la presencia de gérmenes resistentes en la neumonía extrahopsitalaria en nuestro medio

Es tracta d'un estudi prospectiu observacional de pacients atesos durant un any a Urgències per pneumònia. L'objectiu és valorar la utilitat de la definició de pneumònia associada a cures sanitàries (NACS), els criteris de Shorr i Aliberti per predir la presència de gèrmens resistents a la pneumònia extrahospitalària en el nostre medi. Concloent que la definició de NACS i la saturació d'oxigen són útils per predir el risc de pneumònia extrahospitalària per germen resistent. L'índex de Shorr i el de Aliberti no mostren utilitat en la predicció del risc de pneumònia per germen resistent al nostre medi.Se trata de un estudio prospectivo observacional de pacientes atendidos durante un año en Urgencias por neumonía. El objetivo es valorar la utilidad de la definición de Neumonía asociada a cuidados sanitarios (NACS), los criterios de Shorr y Aliberti para predecir la presencia de gérmenes resistentes en la neumonía extrahospitalaria en nuestro medio. Concluyendo que la definición de NACS y la saturación de oxígeno son útiles para predecir el riesgo de neumonía extrahospitalaria por germen resistente. El índice de Shorr y el de Aliberti no muestran utilidad en la predicción del riesgo de neumonía por germen resistente en nuestro medio

Tuberculosis contact tracing, Angola

Seguimiento; Tuberculosis; AngolaSeguiment; Tuberculosi; AngolaContact tracing; Tuberculosis; AngolaObjective: To assess the outcomes of a contact-tracing programme to increase the diagnosis of tuberculosis in Cubal, Angola and offer preventive treatment to high-risk groups. Methods: A health centre-based contact-tracing programme was launched in Hospital Nossa Senhora da Paz in March 2015 and we followed the programme until 2022. In that time, staffing and testing varied which we categorized as four periods: medical staff reinforcement, 2015-2017, with a doctor seconded from Vall d'Hebron University Hospital, Spain; routine staff, 2017-2021, with no external medical support; community directly observed treatment (DOT), 2018-2019 with community worker support; and enhanced contact tracing, 2021-2022, with funding that allowed free chest radiographs, molecular and gastric aspirate testing. We assessed differences in contacts seen each month, and testing and treatment offered across the four periods. Findings: Overall, the programme evaluated 1978 contacts from 969 index cases. Participation in the programme was low, although it increased significantly during the community DOT period. Only 16.6% (329/1978) of contacts had a chest radiograph. Microbiological confirmation increased to 72.2% (26/36) after including molecular testing, and 10.1% (200/1978) of contacts received treatment for tuberculosis. Of 457 contacts younger than 5 years, 36 (7.9%) received preventive tuberculosis treatment. Half of the contacts were lost to follow-up before a final decision was taken on treatment. Conclusion: Contact tracing increased the diagnosis of tuberculosis although engagement with the programme was low and loss to follow-up was high. Participation increased during community DOT. Community-based screening should be explored to improve participation and diagnosis.Objetivo: Evaluar los resultados de un programa de rastreo de contactos para aumentar el diagnóstico de la tuberculosis en Cubal (Angola) y ofrecer tratamiento preventivo a los grupos de alto riesgo. Métodos En marzo de 2015, se inició un programa de rastreo de contactos basado en centros sanitarios en el Hospital Nossa Senhora da Paz y se siguió hasta 2022. En ese tiempo, la dotación de personal y las pruebas variaron, lo que clasificamos en cuatro periodos: refuerzo Research Bull World Health Organ 2024;102:196–203| doi: http://dx.doi.org/10.2471/BLT.23.290068 203 Joan Martínez-Campreciós et al. Tuberculosis contact tracing, Angola del personal médico, de 2015 a 2017, con un médico enviado en comisión de servicios desde el Hospital Universitario Vall d'Hebron (España); personal de rutina, de 2017 a 2021, sin apoyo médico externo; tratamiento directamente observado (TDO) en la población, de 2018 a 2019, con apoyo de trabajadores comunitarios; y rastreo de contactos mejorado, de 2021 a 2022, con financiación que permitió realizar radiografías de tórax y pruebas moleculares y de aspirado gástrico gratuitas. Se evaluaron las diferencias en los contactos atendidos al mes y las pruebas y el tratamiento ofrecidos en los cuatro periodos. Resultados En total, el programa evaluó 1978 contactos de 969 casos de referencia. La participación en el programa fue baja, aunque aumentó de manera significativa durante el periodo de TDO en la población. Solo el 16,6% (329/1978) de los contactos se sometieron a una radiografía de tórax. La confirmación microbiológica aumentó al 72,2% (26/36) tras incluir las pruebas moleculares y el 10,1% (200/1978) de los contactos recibieron tratamiento para la tuberculosis. De 457 contactos menores de 5 años, 36 (7,9%) recibieron tratamiento preventivo contra la tuberculosis. Se perdió el seguimiento de la mitad de los contactos antes de que se tomara una decisión final sobre el tratamiento. Conclusión El rastreo de contactos aumentó el diagnóstico de la tuberculosis, aunque el compromiso con el programa fue bajo y la pérdida del seguimiento fue alta. La participación aumentó durante el TDO en la población. Se debe explorar el cribado en la población para mejorar la participación y el diagnóstico

Molecular characterization of rpoB gene mutations in isolates from tuberculosis patients in Cubal, Republic of Angola

Angola; Rifampicina; Mutaciones rpoBAngola; Rifampicina; Mutacions rpoBAngola; Rifampicin; rpoB mutationsBackground The importance of Mycobacterium tuberculosis strains with disputed rpoB mutations remains to be defined. This study aimed to assess the frequency and types of rpoB mutations in M. tuberculosis isolates from Cubal, Angola, a country with a high incidence of tuberculosis. Methods All isolates included (n = 308) were analyzed using phenotypic drug susceptibility testing and GenoType MTBDRplus assay. DNA sequencing of the rpoB gene and determination of rifampicin MIC by macrodilution method were additionally performed on isolates yielding discordant results (n = 12) and those in which the mutation detected was not characterized (n = 8). Results In total, 85.1% (74/87) of rifampicin-resistant strains had undisputed rpoB mutations -S450L (49), D435V (15), H445D (3), H445Y (2), Q432ins (1), L449M plus S450F (1), S450F (1), S450W (1) and S450Y (1)-; 10.3% (9/87) had disputed rpoB mutations—L430P plus S493L (1), N437del (1), H445L (3), D435Y (2), L452P (2)-, 2.3% (2.3%) showed no rpoB mutations and 2.3% (2/87) showed heteroresistance—D435Y plus L452P and L430P plus S493L-. Conclusion Disputed rpoB mutations were common, occurring in 10.3% of rifampicin resistant isolates. Current phenotyping techniques may be unable to detect this resistance pattern. To increase their sensitivity, a lower concentration of RIF could be used in these tests or alternatively, rpoB mutations could be screened and characterized in all M. tuberculosis strains.This work was supported by Probitas Foundation. Thanks to the financial support received from Probitas Foundation it was possible not only purchase the equipment and reagents to launch the study but to strengthen the capacity of the laboratory and local staff

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Utilidad de la definición de Neumonía asociada a los cuidados sanitarios, los Criterios de Shorr y los Criterios de Aliberti, para predecir la presencia de gérmenes resistentes en la neumonía extrahopsitalaria en nuestro medio.

Es tracta d'un estudi prospectiu observacional de pacients atesos durant un any a Urgències per pneumònia. L'objectiu és valorar la utilitat de la definició de pneumònia associada a cures sanitàries (NACS), els criteris de Shorr i Aliberti per predir la presència de gèrmens resistents a la pneumònia extrahospitalària en el nostre medi. Concloent que la definició de NACS i la saturació d'oxigen són útils per predir el risc de pneumònia extrahospitalària per germen resistent. L'índex de Shorr i el de Aliberti no mostren utilitat en la predicció del risc de pneumònia per germen resistent al nostre medi.Se trata de un estudio prospectivo observacional de pacientes atendidos durante un año en Urgencias por neumonía. El objetivo es valorar la utilidad de la definición de Neumonía asociada a cuidados sanitarios (NACS), los criterios de Shorr y Aliberti para predecir la presencia de gérmenes resistentes en la neumonía extrahospitalaria en nuestro medio. Concluyendo que la definición de NACS y la saturación de oxígeno son útiles para predecir el riesgo de neumonía extrahospitalaria por germen resistente. El índice de Shorr y el de Aliberti no muestran utilidad en la predicción del riesgo de neumonía por germen resistente en nuestro medio

Epidemiological and clinical features of the emergency visits in a rural hospital in Cubal, Angola

There is scarce information on the profiles of patients attended in the Emergency Departments (ED) in rural Angola. Retrospective descriptive study including all the patients treated in the ED in Hospital Nossa Senhora da Paz (Cubal) during 6 months (December 2014- May 2015). The epidemiological and clinical data collected were: age, sex, shift, service assignment, reason for consultation and outcome (discharge, admission, referral or death). A total of 2384 patients (53.4% women) were attended. The median age was 10 years (range: 0 - 96 years); 57.9% and 40.2% of them were under 17 and 5 years, respectively. No differences were observed regarding the assistance per shift, weekdays, weekends, or mean age per shift. The reason for consultation was registered in 69.9% of the patients; the most common were respiratory tract infections (20.5%), fever (14%), digestive diseases (13.6%) and malaria (10.4%). Up to 47.2% of the patients required in-hospital treatment and 1.3% were transferred to other hospitals. The patients admitted were significantly younger than the patients discharged (median age of 4 vs.16 years, p < 0.01). The mortality rate within the ED was 0.5%. Young patients were those who mostly required assistance in the ED. Infectious diseases were the most frequent reason for consultation. Pulmonary tuberculosis was suspected in one third of respiratory infections. The admission rate was high, especially in children under 5 years and in cases of malaria and malnutrition. Low referral rate and low mortality within the ED were observed

Utilidad de la definición de Neumonía asociada a los cuidados sanitarios, los Criterios de Shorr y los Criterios de Aliberti, para predecir la presencia de gérmenes resistentes en la neumonía extrahopsitalaria en nuestro medio

Es tracta d'un estudi prospectiu observacional de pacients atesos durant un any a Urgències per pneumònia. L'objectiu és valorar la utilitat de la definició de pneumònia associada a cures sanitàries (NACS), els criteris de Shorr i Aliberti per predir la presència de gèrmens resistents a la pneumònia extrahospitalària en el nostre medi. Concloent que la definició de NACS i la saturació d'oxigen són útils per predir el risc de pneumònia extrahospitalària per germen resistent. L'índex de Shorr i el de Aliberti no mostren utilitat en la predicció del risc de pneumònia per germen resistent al nostre medi.Se trata de un estudio prospectivo observacional de pacientes atendidos durante un año en Urgencias por neumonía. El objetivo es valorar la utilidad de la definición de Neumonía asociada a cuidados sanitarios (NACS), los criterios de Shorr y Aliberti para predecir la presencia de gérmenes resistentes en la neumonía extrahospitalaria en nuestro medio. Concluyendo que la definición de NACS y la saturación de oxígeno son útiles para predecir el riesgo de neumonía extrahospitalaria por germen resistente. El índice de Shorr y el de Aliberti no muestran utilidad en la predicción del riesgo de neumonía por germen resistente en nuestro medio

Epidemiological and clinical features of the emergency visits in a rural hospital in Cubal, Angola

There is scarce information on the profiles of patients attended in the Emergency Departments (ED) in rural Angola. Retrospective descriptive study including all the patients treated in the ED in Hospital Nossa Senhora da Paz (Cubal) during 6 months (December 2014- May 2015). The epidemiological and clinical data collected were: age, sex, shift, service assignment, reason for consultation and outcome (discharge, admission, referral or death). A total of 2384 patients (53.4% women) were attended. The median age was 10 years (range: 0 - 96 years); 57.9% and 40.2% of them were under 17 and 5 years, respectively. No differences were observed regarding the assistance per shift, weekdays, weekends, or mean age per shift. The reason for consultation was registered in 69.9% of the patients; the most common were respiratory tract infections (20.5%), fever (14%), digestive diseases (13.6%) and malaria (10.4%). Up to 47.2% of the patients required in-hospital treatment and 1.3% were transferred to other hospitals. The patients admitted were significantly younger than the patients discharged (median age of 4 vs.16 years, p < 0.01). The mortality rate within the ED was 0.5%. Young patients were those who mostly required assistance in the ED. Infectious diseases were the most frequent reason for consultation. Pulmonary tuberculosis was suspected in one third of respiratory infections. The admission rate was high, especially in children under 5 years and in cases of malaria and malnutrition. Low referral rate and low mortality within the ED were observed

Molecular characterization of rpoB gene mutations in isolates from tuberculosis patients in Cubal, Republic of Angola

Background: The importance of Mycobacterium tuberculosis strains with disputed rpoB mutations remains to be defined. This study aimed to assess the frequency and types of rpoB mutations in M. tuberculosis isolates from Cubal, Angola, a country with a high incidence of tuberculosis. Methods: All isolates included (n = 308) were analyzed using phenotypic drug susceptibility testing and GenoType MTBDRplus assay. DNA sequencing of the rpoB gene and determination of rifampicin MIC by macrodilution method were additionally performed on isolates yielding discordant results (n = 12) and those in which the mutation detected was not characterized (n = 8). Results: In total, 85.1% (74/87) of rifampicin-resistant strains had undisputed rpoB mutations -S450L (49), D435V (15), H445D (3), H445Y (2), Q432ins (1), L449M plus S450F (1), S450F (1), S450W (1) and S450Y (1)-; 10.3% (9/87) had disputed rpoB mutations-L430P plus S493L (1), N437del (1), H445L (3), D435Y (2), L452P (2)-, 2.3% (2.3%) showed no rpoB mutations and 2.3% (2/87) showed heteroresistance-D435Y plus L452P and L430P plus S493L-. Conclusion: Disputed rpoB mutations were common, occurring in 10.3% of rifampicin resistant isolates. Current phenotyping techniques may be unable to detect this resistance pattern. To increase their sensitivity, a lower concentration of RIF could be used in these tests or alternatively, rpoB mutations could be screened and characterized in all M. tuberculosis strains