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Dias JV, Varandas L, Gonçalves L, Kagina BM. An insight into the burden of drug-resistant tuberculosis in children. Acta Paediatr 2024; 113:781-782. [PMID: 38243684 DOI: 10.1111/apa.17120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/21/2024]
Affiliation(s)
- Joana Valente Dias
- Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal
- Department of Pediatrics, Beatriz Ângelo Hospital, Loures, Portugal
| | - Luís Varandas
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal
- NOVA Medical School, Nova University of Lisbon, Lisbon, Portugal
- Department of Pediatrics, Dona Estefânia Hospital, Lisbon, Portugal
| | - Luzia Gonçalves
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Nova University of Lisbon, Lisbon, Portugal
- Centre of Statistics and its Applications, University of Lisbon, Lisbon, Portugal
- z-Stat4life, Lisbon, Portugal
| | - Benjamin M Kagina
- Vaccines for Africa Initiative, School of Public Health, University of Cape Town, Cape Town, South Africa
- Institute of Molecular Medicine & Infectious Diseases (IDM), University of Cape Town, Cape Town, South Africa
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2
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Trindade Torres M, Sousa Nunes B, Varandas L, Maltez F. Actinomycetoma by Cellulosimicrobium cellulans in a Young Man from Guinea-Bissau: Short Literature Review Regarding a Case Report. ACTA MEDICA PORT 2024; 37:46-50. [PMID: 36919988 DOI: 10.20344/amp.17356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/09/2022] [Indexed: 03/16/2023]
Abstract
Mycetoma is caused by the subcutaneous inoculation of filamentous fungi or aerobic filamentous bacteria. Cellulosimicrobium cellulans is a gram-positive bacterium from the order Actinomycetales that rarely causes human disease. The diagnosis is based on the clinical presentation and identification of the causative microorganism. We present a short literature review regarding the case report of a young man diagnosed with actinomycetoma due to Cellulosimicrobium cellulans and who received treatment with an association of amikacin and sulfamethoxazole/ trimethoprim (Welsh regimen).
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Affiliation(s)
| | - Beatriz Sousa Nunes
- Serviço de Infeciologia Pediátrica. Hospital de Dona Estefânia. Lisboa. Portugal
| | - Luís Varandas
- Serviço de Infeciologia Pediátrica. Hospital de Dona Estefânia. Lisboa; NOVA Medical School. Faculdade de Ciências Médicas. Lisboa; Instituto de Higiene e Medicina Tropical. Lisboa. Portugal
| | - Fernando Maltez
- Serviço de Doenças Infeciosas. Hospital de Curry Cabral. Lisboa. Portugal
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3
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Gouveia C, Subtil A, Aguiar P, Canhão H, Norte S, Arcangelo J, Varandas L, Tavares D. Osteoarticular Infections: Younger Children With Septic Arthritis and Low Inflammatory Patterns Have a Better Prognosis in a European Cohort. Pediatr Infect Dis J 2023; 42:969-974. [PMID: 37625093 DOI: 10.1097/inf.0000000000004074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
BACKGROUND Osteoarticular infections (OAI) are associated with complications and sequelae in children, whose prediction are of great importance in improving outcomes. We aimed to design risk prediction models to identify early complications and sequelae in children with OAI. METHODS This observational study included children (>3 months-17 years old) with acute OAI admitted to a tertiary-care pediatric hospital between 2008 and 2018. Clinical treatment, complications and sequelae were recorded. We developed a multivariable logistic predictive model for an acute complicated course (ACC) and another for sequelae. RESULTS A total of 240 children were identified, 17.5% with ACC and 6.0% and 3.6% with sequelae at 6 and 12 months of follow-up, respectively. In the multivariable logistic predictive model for ACC, predictors were fever at admission [adjusted odds ratio (aOR): 2.98; 95% confidence interval (CI): 1.10-8.12], C-reactive protein ≥100 mg/L (aOR: 2.37; 95% CI: 1.05-5.35), osteomyelitis (aOR: 4.39; 95% CI: 2.04-9.46) and Staphylococcus aureus infection (aOR: 3.50; 95% CI: 1.39-8.77), with an area under the ROC curve of 0.831 (95% CI: 0.767-0.895). For sequelae at 6 months, predictors were age ≥4 years (aOR: 4.08; 95% CI: 1.00-16.53), C-reactive protein ≥110 mg/L (aOR: 4.59; 95% CI: 1.25-16.90), disseminated disease (aOR: 9.21; 95% CI: 1.82-46.73) and bone abscess (OR: 5.46; 95% CI: 1.23-24.21), with an area under the ROC curve of 0.887 (95% CI: 0.815-0.959). CONCLUSIONS In our model we could identify patients at low risk for complications and sequelae, probably requiring a less aggressive approach.
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Affiliation(s)
- Catarina Gouveia
- Faculdade de Ciências Médicas, Nova Medical School
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Subtil
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- CEMAT, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Aguiar
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Helena Canhão
- NOVA Medical School, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Orthopaedic Unit, Paediatric Department, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Susana Norte
- NOVA Medical School, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Orthopaedic Unit, Paediatric Department, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Joana Arcangelo
- NOVA Medical School, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Orthopaedic Unit, Paediatric Department, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Luís Varandas
- Faculdade de Ciências Médicas, Nova Medical School
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Delfin Tavares
- NOVA Medical School, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Orthopaedic Unit, Paediatric Department, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
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Sousa A, Silva TM, Conceição C, Vieira JP, Gouveia C, Varandas L. Cerebral Malaria and Cytotoxic Lesions of the Corpus Callosum. Pediatr Infect Dis J 2023; 42:e358-e359. [PMID: 37184269 DOI: 10.1097/inf.0000000000003963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Afonso Sousa
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Dona Estefania Lisbon, Portugal
| | - Tiago Milheiro Silva
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Dona Estefania Lisbon, Portugal
| | - Carla Conceição
- Neuroradiology Unit, Hospital Dona, Estefania. Lisbon, Portugal
| | | | - Catarina Gouveia
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Dona Estefania. Lisbon, Portugal
- Nova Medical School, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Portugal
| | - Luís Varandas
- Nova Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Portugal
- Department of Pediatrics, Hospital Dona Estefânia Lisbon, Portugal
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5
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Craveiro Costa R, Schrempp Esteves C, Flores P, Varandas L. Acute Hepatitis of Unknown Origin in Children: Two Cases in a Portuguese Hospital. ACTA MEDICA PORT 2023. [PMID: 36696594 DOI: 10.20344/amp.18690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/03/2022] [Indexed: 01/26/2023]
Abstract
Several cases of paediatric acute hepatitis of an unknown aetiology have been described in these last few months and in several countries worldwide. We present two patients, a 7-month-old girl and an 8-year-old boy, with gastrointestinal symptoms and lethargy, associated with elevation of transaminase levels. Serologies for hepatitis A-E virus and PCR test to SARS-CoV-2 were all negative. In the first case, an adenovirus serotype C could be isolated in a respiratory sample as well as cytomegalovirus (CMV) in the blood (100 copies/mL). In both children, there was a progressive decrease in the hepatic markers and symptomatic resolution, compatible with a good prognosis, also seen globally in most cases. To date, infection remains the most plausible cause to consider, especially when it is presumed to be linked to adenovirus. Other potential agents and causes are still being evaluated, thus emphasizing the importance of continuous epidemiological surveillance, notification, and detailed study of all hepatitis cases.
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Affiliation(s)
| | | | - Pedro Flores
- Centro da Criança e do Adolescente. Hospital CUF Descobertas. Lisboa. Portugal
| | - Luís Varandas
- Centro da Criança e do Adolescente. Hospital CUF Descobertas. Lisboa; Institute of Hygiene and Tropical Medicine. Universidade NOVA de Lisboa. Lisboa; Faculdade de Ciências Médicas
- NOVA Medical School. Universidade Nova de Lisboa. Lisboa. Portugal
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Maulide Cane R, Keita Y, Lambo L, Pambo E, Gonçalves MP, Varandas L, Craveiro I. Prevalence and factors related to anaemia in children aged 6-59 months attending a quaternary health facility in Maputo, Mozambique. Glob Public Health 2023; 18:2278876. [PMID: 37932958 DOI: 10.1080/17441692.2023.2278876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023]
Abstract
Globally, anaemia prevails as a public health issue, being also a concern in Mozambique, where about two-thirds of children 6-59 months of age are affected by this condition. We carried out this study to estimate anaemia prevalence and evaluate structural determinants and haematological parameters association among children aged 6-59 months attending pediatric inpatient and outpatient services in a Quaternary Health Facility in Maputo City Province, Mozambique. We collected data from 637 inpatients or outpatients who attended pediatric consultations at the Maputo Central Hospital. The overall rate of anaemia in children aged 6-59 months was 62.2% (396/637), with 30.9% moderate anaemia (197/637), 23.9% mild anaemia (152/637), and 7.4% severe anaemia (47/637). Among our study participants, critical factors for anaemia were those concerning the age group, child´s caregiver schooling, malaria and size of the liver.
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Affiliation(s)
- Réka Maulide Cane
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
- Unidade de Ensino e Investigação de Saúde Pública Global, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Youssouf Keita
- Public Health Independent Consultant, Deutsche Gesellschaft fur Internationale Zusammenarbeit (GIZ)/C4N-NIPN/ Clinton Health Access Initiative, Bamako, Mali
| | - Luisa Lambo
- Hospital Central de Maputo, Ministério da Saúde, Maputo, Mozambique
| | - Elcidio Pambo
- Hospital Central de Maputo, Ministério da Saúde, Maputo, Mozambique
| | | | - Luís Varandas
- Unidade de Ensino e Investigação de Clínica das Doenças Tropicais, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
- Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
- NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Isabel Craveiro
- Unidade de Ensino e Investigação de Saúde Pública Global, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
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Gouveia C, Cabral MF, Jordão P, Campagnolo J, Mineiro J, Peres H, Conceição C, Silva TM, Varandas L, Brito MJ. Bone and joint tuberculosis in paediatrics: a 13-year retrospective study. J Med Microbiol 2022; 71. [PMID: 36748626 DOI: 10.1099/jmm.0.001610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction. Bone and joint tuberculosis (BJTB) is rare in developed countries, particularly in the paediatric population.Hypothesis/Gap Statement. The clinical features and sequelae of paediatric BJTB in Europe are not well characterized and should be assessed to achieve a better approach.Aim. To assess the management and outcomes of paediatric BJTB.Methodology. Longitudinal observational study of all paediatric patients (0-17 years old) diagnosed with BJTB between 2008 to 2020 in a tertiary-care hospital.Results. We identified 18 patients with BJTB, with a median age of 10 years (IQR 6-14.8), 66.7 % male. Most (72 %) were diagnosed after 2015 and were foreign-born (88.9 %), mainly from Portuguese-speaking African countries, and none had HIV. The most common symptoms were pain (77.8 %), fever (50 %) and bone deformity (44.4 %). Spinal TB (STB) affected 13 (72.2 %) and extra-spinal TB (ESTB) 9 (50 %) patients, and 4 (27.7 %) had both conditions. Diagnostic positive procedures included positive nucleic acid amplification technique (NAAT) (44.4 %), Mycobacterium tuberculosis isolation (44.4 %) and compatible histology (33.3 %). All completed antituberculous drugs for a median of 12 months (IQR 12-13) and nine (50 %) had surgery. Overall, acute complications occurred in 16 (88.9 %) patients - 11/13 (84.6 %) with STB and 5/5 (100 %) with ESTB - and included abscesses, spinal compression, spine deformity and pathological fractures. Sequelae were still present at the 12-month follow-up in seven cases (46.7 %), and were more common in foreign-born patients sent to Portugal to receive medical treatment (66.7 vs 20 %).Conclusions. Paediatric BJTB is difficult to diagnose and has high morbidity, requiring long-term follow-up. Over the last decade, foreign-born TB seems to be increasing, with still longer treatment courses and more acute complications and sequelae.
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Affiliation(s)
- Catarina Gouveia
- Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitàrio Lisboa Central (CHULC) - EPE, Lisbon, Portugal.,Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Mafalda Félix Cabral
- Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitàrio Lisboa Central (CHULC) - EPE, Lisbon, Portugal
| | - Pedro Jordão
- Paediatric Orthopaedic Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - João Campagnolo
- Paediatric Orthopaedic Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Jorge Mineiro
- Paediatric Orthopaedic Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Helena Peres
- Clinical Pathology, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Carla Conceição
- Neuroradiology Unit, Hospital Dona Estefânia, CHULC, Lisbon, Portugal
| | - Tiago Milheiro Silva
- Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitàrio Lisboa Central (CHULC) - EPE, Lisbon, Portugal
| | - Luís Varandas
- Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitàrio Lisboa Central (CHULC) - EPE, Lisbon, Portugal.,Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal.,Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Maria João Brito
- Paediatric Infectious Diseases Unit, Hospital de Dona Estefânia, Centro Hospitalar Universitàrio Lisboa Central (CHULC) - EPE, Lisbon, Portugal
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8
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Maulide Cane R, Keita Y, Varandas L, Craveiro I. Anemia in children aged 6 to 59 months attending a quaternary health facility in Maputo, Mozambique. Eur J Public Health 2022; 32:ckac129.697. [PMCID: PMC9594247 DOI: 10.1093/eurpub/ckac129.697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
Background Globally, anemia prevails as a public health issue, being also a concern in Mozambique, where about two-thirds of children 6-59 months of age are affected by anemia. We carried out this study to estimate anemia prevalence and evaluate structural determinants and hematological parameters association among children aged 6 to 59 months attending pediatric inpatient and outpatient services in a Quaternary Health Facility in Maputo City Province, Mozambique. Methods From August 2021 to January 2022, we conducted a cross-sectional study at the ‘Maputo Central Hospital’ where we collected data from 397 inpatients or outpatients who attended pediatric consultations. The cut-off values for anemia were: mild (10g/dL≤Hb≤10.9g/dL), moderate (7g/dL≤Hb≤9.9g/dL), severe (Hb < 7.0g/dL). We used SPSS 28.0 software to perform descriptive analyses and Chi-Square tests. Results Our preliminary findings show that the total rate of positive cases was 30.0% moderate anemia (119/397), 23.9% mild anemia (95/397), and 7.3% severe anemia (29/397). Anemia frequencies were higher in male patients unregarding the type (54.2% moderate, 62.1% mild, 67.9% severe). Anemia prevalence was higher among children aged 24-59 months (41.2% moderate, 47.4% mild, 51.7% severe; p < 0.05). The rate of all anemia types was higher in children from rural areas and Maputo City province relative to those from urban areas and other country provinces. The level of education of the child's companion to the consultations was associated with anemia (p ≤ 0,05), with higher rates observed in secondary level education. We observed no association between iron or serum ferritin values to anemia. Key messages • Children aged 24-59 months, children from rural areas, and who are male are more vulnerable to suffering anemia than their peers, thus needing more monitoring during their growth. • Nutritional-anemia-specific interventions targeting the first 1000 days of life may be helpful to its reduction in children.
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Affiliation(s)
- R Maulide Cane
- Instituto Nacional de Saude, National Institute of Health, MoH, Maputo, Mozambique
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, UNL, Lisbon, Portugal
| | - Y Keita
- GIZ/C4N-NIPN, Clinton Health Access Initiative, Bamako, Mali
| | - L Varandas
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, UNL, Lisbon, Portugal
- Hospital CUF, Descobertas, Lisbon, Portugal
- Faculdade de Ciências Medicas, NOVA Medical School, UNL, Lisbon, Portugal
| | - I Craveiro
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, UNL, Lisbon, Portugal
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9
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Ribeiro AF, Inacio Oliveira M, Jordão P, Tavares D, Varandas L, Gouveia C. Mycobacterium tuberculosis prosthesis joint infection. Pediatr Int 2020; 62:97-99. [PMID: 31916331 DOI: 10.1111/ped.14037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/10/2019] [Accepted: 09/03/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Andreia Fiúza Ribeiro
- Infectious Diseases Unit, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal
| | - Marisa Inacio Oliveira
- Infectious Diseases Unit, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal
| | - Pedro Jordão
- Pediatric Orthopedic Unit, Área da Mulher, Criança e Adolescente, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal
| | - Delfin Tavares
- Pediatric Orthopedic Unit, Área da Mulher, Criança e Adolescente, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal
| | - Luís Varandas
- Infectious Diseases Unit, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal
| | - Catarina Gouveia
- Infectious Diseases Unit, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, EPE, Lisbon, Portugal
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Domingos J, Casimiro A, Portugal-Calisto D, Varandas L, Nogueira F, Silva MS. Clinical, laboratorial and immunological aspects of severe malaria in children from Guinea-Bissau. Acta Trop 2018; 185:46-51. [PMID: 29684356 DOI: 10.1016/j.actatropica.2018.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 04/17/2018] [Accepted: 04/17/2018] [Indexed: 11/15/2022]
Abstract
Malaria is a parasitic disease of which Plasmodium falciparum causes the most severe form of the disease. The immune response against Plasmodium spp. is complex and remains unclear. The present report aimed to better understand the humoral immune response in severe malaria and analyse new immunodominant antigen candidates as possible serological marker in severe malaria in children. This study included children aged 0-16 years from Guinea-Bissau with clinical signs of severe malaria. Serological and immunochemical characterisation of different anti-P. falciparum antibodies were made by ELISA and immunoblotting using a crude protein extract of P. falciparum. Sera from 12 children with severe malaria were analysed. Nine samples were positive for total anti-P. falciparum antibodies, seven for IgM and eight for total IgG anti-P. falciparum. There was a predominance of IgG1 response, suggesting a cytophilic action in severe malaria and a major role of IgG1 over other immunoglobulins. The antigenic profile of P. falciparum showed a consistent immunoblotting pattern of approximately 180 kDa, 100 kDa and around 50-40 kDa. The serological reactivity found in protein bands makes them as immunodominant antigens and promising candidates for serological markers in the context of severe malaria.
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Affiliation(s)
- Janine Domingos
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal
| | - Anaxore Casimiro
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal
| | - Daniela Portugal-Calisto
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal; Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Luís Varandas
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal; Infectious Disease Unit, Hospital Dona Estefânia. Lisbon, Portugal
| | - Fátima Nogueira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal
| | - Marcelo Sousa Silva
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal; Imunoparasitology Laboratory, Department of Clinical and Toxicological Analysis, Health Sciences Centre, Federal University of Rio Grande do Norte, Natal, Brazil; Programa de Pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Norte, Natal, Brazil; Programa de Pós-graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Norte, Natal, Brazil.
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Milheiro Silva T, Farela Neves J, Casimiro A, Varandas L, Gouveia C. Severe Stevens-Johnson syndrome/toxic epidermal necrolysis overlap syndrome-beyond skin involvement. Pediatr Dermatol 2018; 35:e17-e19. [PMID: 29159901 DOI: 10.1111/pde.13328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but serious dermatologic diseases with many potential multisystem complications. We describe the case of an 8-year-old girl who developed severe SJS/TEN overlap syndrome (25% of her body surface area was affected) complicated by pancreatitis and bronchiolitis obliterans. These rare complications emphasize the need for careful, intensive monitoring of possible complications and an interdisciplinary team approach to provide optimal treatment and follow-up.
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Affiliation(s)
- Tiago Milheiro Silva
- Centro Hospitalar de Lisboa Central-EPE, Hospital Dona Estefânia, Lisbon, Portugal
| | - João Farela Neves
- Centro Hospitalar de Lisboa Central-EPE, Hospital Dona Estefânia, Lisbon, Portugal
| | - Ana Casimiro
- Centro Hospitalar de Lisboa Central-EPE, Hospital Dona Estefânia, Lisbon, Portugal
| | - Luís Varandas
- Centro Hospitalar de Lisboa Central-EPE, Hospital Dona Estefânia, Lisbon, Portugal
| | - Catarina Gouveia
- Centro Hospitalar de Lisboa Central-EPE, Hospital Dona Estefânia, Lisbon, Portugal
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12
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Bota S, de Sousa R, Santos M, Varandas L, Gouveia CF. Severe Israeli spotted fever with multiorgan failure in a child. Ticks Tick Borne Dis 2016; 7:663-664. [DOI: 10.1016/j.ttbdis.2016.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/07/2016] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
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Marques P, Varandas L, Lopes L. Severe gastrointestinal autonomic dysfunction in a diabetic boy. Endocrine 2015; 50:262-3. [PMID: 25754916 DOI: 10.1007/s12020-015-0573-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Pedro Marques
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa, Rua Professor Lima Basto, 1099-023, Lisbon, Portugal,
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Affiliation(s)
| | - Luís Varandas
- Centro Hospitalar Lisboa Central, Lisbon, Portugal New University of Lisbon, Lisbon, Portugal
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15
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Santos JA, Neves JF, Venâncio P, Gouveia C, Varandas L. Hemophagocytic lymphohistiocytosis secondary to Falciparum malaria in a 5 year-old boy. Ann Hematol 2014; 94:161-3. [PMID: 24880248 DOI: 10.1007/s00277-014-2118-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 05/20/2014] [Indexed: 02/08/2023]
Affiliation(s)
- Joana Almeida Santos
- Pediatric Department, Hospital Dona Estefânia, Centro Hospitalar Lisboa Central, EPE, Rua Jacinta Marto, 1169-045, Lisbon, Portugal,
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Sousa MV, Malheiro R, Neves J, Varandas L, Conde M. [Unifocal chronic non-bacterial osteomyielitis of mandible]. Acta Reumatol Port 2014; 39:94-95. [PMID: 24811469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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17
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Affiliation(s)
- Joao Brissos
- Department of Pediatrics, Hospital Dona Estefânia, Lisboa, Portugal.
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Dent AJ, Cibin G, Ramos S, Parry SA, Gianolio D, Smith AD, Scott SM, Varandas L, Patel S, Pearson MR, Hudson L, Krumpa NA, Marsch AS, Robbins PE. Performance of B18, the Core EXAFS Bending Magnet beamline at Diamond. ACTA ACUST UNITED AC 2013. [DOI: 10.1088/1742-6596/430/1/012023] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Campos PA, Valente B, Campos RB, Gonçalves L, Rosário VE, Varandas L, Silveira H. Plasmodium falciparum infection in pregnant women attending antenatal care in Luanda, Angola. Rev Soc Bras Med Trop 2012; 45:369-74. [DOI: 10.1590/s0037-86822012000300017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 11/11/2011] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION: Malaria during pregnancy remains a serious public health problem. The aim of this study was to establish the prevalence and possible risk factors for malaria in pregnant women attending antenatal care at Augusto Ngangula Specialized General Hospital in Luanda, Angola. METHODS: Pregnant women (679 total) who attended antenatal care from April to September 2008 were included in the study after signing informed consent. For each participant, the social-demographic profile and malaria and obstetric histories were investigated via a questionnaire. Diagnosis was made by optic microscopy, and hemoglobin concentration measured. The associations between age, parity, gestational age, residence, schooling, malaria during gravity, anemia and treatment with incidence of Plasmodium falciparum infection were analyzed through logistic regression. RESULTS: During the period of study, 74 (10.9%) out of 679 women were infected by P. falciparum. The average concentration of hemoglobin was 11.1 ± 0.07g/dL, and there were significant associations between the history of malaria during pregnancy, P. falciparum infection (p<0.01) and anemia at the time of observation (p<0.001). CONCLUSIONS: Previous history of malaria during pregnancy represents a risk factor for current infection and anemia was an important complication associated with malaria, even in women who were treated with sulfadoxine-pyrimethamine during pregnancy.
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Affiliation(s)
- Paulo Adão Campos
- Universidade Nova de Lisboa, Portugal; Universidade Agostinho Neto, Angola
| | | | | | - Luzia Gonçalves
- Universidade Nova de Lisboa, Portugal; Universidade de Lisboa, Portugal
| | | | - Luís Varandas
- Universidade Nova de Lisboa, Portugal; Universidade Nova de Lisboa, Portugal
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20
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Kjöllerström P, Brito MJ, Gouveia C, Ferreira G, Varandas L. Linezolid in the treatment of multidrug-resistant/extensively drug-resistant tuberculosis in paediatric patients: experience of a paediatric infectious diseases unit. ACTA ACUST UNITED AC 2011; 43:556-9. [PMID: 21391771 DOI: 10.3109/00365548.2011.564649] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Linezolid has been used in the treatment of multidrug-resistant/extensively drug-resistant tuberculosis in adults with encouraging results, however experience in children is scarce. We describe our experience with the use of linezolid as part of a multidrug regimen in the treatment of 4 patients who had persistent positive cultures, despite prolonged combined therapy.
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Affiliation(s)
- Paula Kjöllerström
- Department of Paediatrics, Infectious Diseases, Hospital Dona Estefânia, Lisbon, Portugal.
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21
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Leal E, Brito MJ, Gouveia C, Varandas L, Ferreira GC. [Iatrogeny in paediatrics: reconsider attitudes]. ACTA MEDICA PORT 2011; 24:375-378. [PMID: 22011614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 08/25/2010] [Indexed: 05/31/2023]
Abstract
Iatrogeny is a pathologic condition caused in a patient in the different stages of a medical act. In the United States, it is the fourth cause of death but in Portugal, data are not yet available. Though different from medical error, it is still a taboo subject for health care providers. The authors report a case of relational, diagnostic and therapeutic iatrogeny with serious consequences for the patient. Doctors have a fundamental role in reducing morbidity and mortality due to iatrogenic causes; they have the duty to question and reconsider diagnosis and treatments, keeping an alert attitude and self-criticism in order to identify potential iatrogenic interventions or to correct it as soon as possible.
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Affiliation(s)
- Ema Leal
- Unidade de Infecciologia, Área de Pediatria Médica, Hospital de Dona Estefânia, Lisboa, Portugal
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22
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Albuquerque D, Manco L, Loua KM, Arez AP, Trovoada MDJ, Relvas L, Millimono TS, Rath SL, Lopes D, Nogueira F, Varandas L, Alvarez M, Ribeiro ML. SLC40A1 Q248H allele frequencies and associated SLC40A1 haplotypes in three West African population samples. Ann Hum Biol 2011; 38:378-81. [DOI: 10.3109/03014460.2010.541496] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Licínio Manco
- Department of Life Sciences, University of Coimbra, Portugal
- Department of Hematology, Centro Hospitalar de Coimbra-EPE, Portugal
| | - Kovana M. Loua
- Institut National de Santé Publique, Conakry, Republic de Guinée
| | - Ana Paula Arez
- Centro de Malária e outras Doenças Tropicais (CMDT-LA), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Portugal
| | | | - Luís Relvas
- Department of Hematology, Centro Hospitalar de Coimbra-EPE, Portugal
| | | | - Silvia L. Rath
- Institut National de Santé Publique, Conakry, Republic de Guinée
| | - Dinora Lopes
- Centro de Malária e outras Doenças Tropicais (CMDT-LA), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Portugal
| | - Fátima Nogueira
- Centro de Malária e outras Doenças Tropicais (CMDT-LA), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Portugal
| | - Luís Varandas
- Centro de Malária e outras Doenças Tropicais (CMDT-LA), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa, Portugal
| | - Manuela Alvarez
- Department of Life Sciences, University of Coimbra, Portugal
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Pinheiro AE, Ferreira R, Ferreira GC, Varandas L. [Anticonvulsant hypersensitivity syndrome in children]. ACTA MEDICA PORT 2010; 23:715-718. [PMID: 20688003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 12/22/2009] [Indexed: 05/29/2023]
Abstract
Anticonvulsant hypersensitivity syndrome, or DRESS (Drug Rash with Eosinophilia and Systemic Symptoms), is a rare multisystem disorder, potentially fatal, that occurs after exposure to antiepileptic drugs, mainly aromatic ones. Clinically, this condition is recognized by the classic triad of fever, rash and internal organ involvement that usually develops 1 to 12 weeks after initiation of therapy. We report a case of a child treated with sodium valproate for epilepsy that showed a febrile rash 4 weeks after being medicated with phenobarbital. Laboratory testing revealed leukocytosis with eosinophilia elevated C-reactive protein and liver enzymes. Phenobarbital was suspended, with slow full recovery. This syndrome may mimic infectious, immunologic and neoplastic conditions, which may delay the correct diagnosis, but must be excluded in the presence of characteristic clinical features and drug exposition.
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Custódio D, Guimarães CS, Varandas L, Arbilla G. Pattern of volatile aldehydes and aromatic hydrocarbons in the largest urban rainforest in the Americas. Chemosphere 2010; 79:1064-1069. [PMID: 20403631 DOI: 10.1016/j.chemosphere.2010.03.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 03/19/2010] [Accepted: 03/19/2010] [Indexed: 05/29/2023]
Abstract
Atmospheric concentrations of aldehydes and monoaromatic hydrocarbons were determined in Tijuca Forest, the largest urban tropical forest in the Americas. The forest is a protected area, surrounded by the city of Rio de Janeiro. Data were also obtained in a commercial and a residential area for comparison. A total of 160 aldehyde samples and 60 BTEX (benzene, toluene, ethyl-benzene and xylenes) samples were collected from four locations between January and August of 2008. The aldehydes were collected using C18 resin cartridges coated with 2,4-dinitrophenylhydrazine and analyzed by high performance liquid chromatography (HPLC) with a diode array UV-Vis detector, while the BTEX samples were collected using tubes of coconut charcoal, which were then extracted with dichloromethane and analyzed by gas chromatography (GC). Within Tijuca Forest, formaldehyde and acetaldehyde levels were in the range of <detection limit - 5.09 ppbV and <detection limit - 4.08 ppbV, respectively. Formaldehyde concentrations strongly correlated with temperature and solar radiation. The different ratios for formaldehyde and acetaldehyde concentrations in the forest and in the urban sites clearly suggested that carbonyl levels within the forest might have an important contribution from biogenic sources. BTEX concentrations in the forest were very low, showing that the forest acted as a sink for many pollutants. Toluene/benzene ratios in the forest were also lower than in the city, which may be attributed to the faster photochemical oxidation of toluene. These observations were indicators of the low impact of the urban area on the studied forest.
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Affiliation(s)
- D Custódio
- Instituto de Química, Universidade Federal do Rio de Janeiro, CT, Cidade Universitária, Rio de Janeiro, RJ, Brazil
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Dent AJ, Cibin G, Ramos S, Smith AD, Scott SM, Varandas L, Pearson MR, Krumpa NA, Jones CP, Robbins PE. B18: A core XAS spectroscopy beamline for Diamond. ACTA ACUST UNITED AC 2009. [DOI: 10.1088/1742-6596/190/1/012039] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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26
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Figueiredo P, Benchimol C, Lopes D, Bernardino L, do Rosário VE, Varandas L, Nogueira F. Prevalence of pfmdr1, pfcrt, pfdhfr and pfdhps mutations associated with drug resistance, in Luanda, Angola. Malar J 2008; 7:236. [PMID: 19014684 PMCID: PMC2613152 DOI: 10.1186/1475-2875-7-236] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 11/17/2008] [Indexed: 11/13/2022] Open
Abstract
Background Malaria is the infectious disease causing the highest morbidity and mortality in Angola and due to widespread chloroquine (CQ) resistance, the country has recently changed its first-line treatment recommendations for uncomplicated malaria, from CQ to artemisinin combination therapies (ACT) in adults, and sulphadoxine/pyrimethamine (S/P) in pregnant women. Loss of SP sensitivity is, however, progressing rapidly in Africa and, in this study, were investigated a number of molecular markers associated to CQ and S/P. Methods Blood samples were collected from 245 children with uncomplicated malaria, admitted at the Pediatric Hospital Dr. David Bernardino (HPDB), Angola, and the occurrence of mutations in Plasmodium falciparum was investigated in the pfmdr1 (N86Y) and pfcrt (K76T) genes, associated with CQ resistance, as well as in pfdhfr (C59R) and pfdhps (K540E), conferring SP resistance. Results The frequencies of pfmdr1 mutations in codon 86 were 28.6% N, 61.3% Y and 10.1% mixed infections (NY). The frequency of pfcrt mutations in codon 76 were 93.9% K, 5.7% T and 0.4% mixed infections (KT). For pfdhfr the results were in codon 59, 60.6% C, 20.6% R and 18.8% mixed infections (CR). Concerning pfdhps, 6.3% of the isolates were bearers of the mutation 540E and 5.4% mixed infections (K540E). Conclusion The results of this epidemiologic study showed high presence of CQ resistance markers while for SP a much lower prevalence was detected for the markers under study.
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Affiliation(s)
- Paula Figueiredo
- UEI Malária/Centro de Malária e Doenças Tropicais/IHMT/Universidade Nova de Lisboa, Lisbon, Portugal.
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27
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Manco L, Machado P, Lopes D, Nogueira F, Do Rosário VE, Alonso PL, Varandas L, Trovoada MDJ, Amorim A, Arez AP. Analysis of TPI gene promoter variation in three sub-Saharan Africa population samples. Am J Hum Biol 2008; 21:118-20. [PMID: 18792062 DOI: 10.1002/ajhb.20819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Population samples from Angola, Mozambique, and S. Tomé e Príncipe were screened for the TPI gene promoter variants -5A-->G, -8G-->A and -24T-->G. Three haplotypes were identified in the three populations: the haplotype -5A-8G-24T (average frequency 65.3%) and two less common haplotypes -5G-8G-24T (average frequency 24.7%) and -5G-8A-24T (average frequency 10.0%). A population sample from Central Portugal showed the haplotype -5A-8G-24T in 139 chromosomes and one subject heterozygous for haplotype -5G-8A-24G. The exact test of sample differentiation among three groups of malaria-infected individuals classified according to the severity of the disease showed no significant differences. We confirmed TPI gene diversity in sub-Saharan Africa, but we could not detect any association between TPI promoter variation and a malarial protective effect. Larger scale epidemiological studies are thus required to clarify this putative mechanism of natural host defense against this worldwide public health problem.
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Affiliation(s)
- Licínio Manco
- Departamento de Antropologia, Universidade de Coimbra, Coimbra, Portugal.
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28
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Pimentel S, Nogueira F, Benchimol C, Quinhentos V, Bom J, Varandas L, do Rosário V, Bernardino L. Detection of atovaquone-proguanil resistance conferring mutations in Plasmodium falciparum cytochrome b gene in Luanda, Angola. Malar J 2006; 5:30. [PMID: 16597338 PMCID: PMC1513587 DOI: 10.1186/1475-2875-5-30] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Accepted: 04/05/2006] [Indexed: 11/10/2022] Open
Abstract
Background The fixed dose combination atovaquone-proguanil is a recently introduced antimalarial for treatment and prophylaxis of Plasmodium falciparum malaria. It is highly effective with a good tolerability profile and a convenient prophylactic regimen. Nevertheless, cases of treatment failure have already been reported, which have been associated to mutations in the cytochrome b gene of the Plasmodium (pfcytb). The presence of atovaquone-proguanil in vivo resistance conferring mutations in pfcytb gene in Luanda, Angola, was investigated, in order to make recommendations on prescribing this antimalarial as prophylaxis for travellers. Methods Two hundred and forty nine blood samples from children hospitalized at Luanda Pediatric Hospital for malaria were studied. The PCR-RFLP methodology was used in order to identify pfcytb wild type codon 268 and two point mutations: T802A and A803C. Results All samples were identified as wild type for pfcytb gene at codon 268. In the studied population, no mutations associated to atovaquone-proguanil treatment failure were found. Prevalence of the studied mutations in the region was estimated to be less than 0.77% (99% significance level). Conclusion Atovaquone-proguanil can be recommended for use by travellers to Luanda with expected high efficacy. This represents an improvement compared to other currently used prophylatic antimalarials in this region. However, it is imperative to continue surveillance.
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Affiliation(s)
- Sónia Pimentel
- Centro de Malária e Outras Doenças Tropicais / IHMT / UNL, Lisbon, Portugal
| | - Fátima Nogueira
- Centro de Malária e Outras Doenças Tropicais / IHMT / UNL, Lisbon, Portugal
| | | | | | - Joana Bom
- Centro de Malária e Outras Doenças Tropicais / IHMT / UNL, Lisbon, Portugal
| | - Luís Varandas
- Centro de Malária e Outras Doenças Tropicais / IHMT / UNL, Lisbon, Portugal
- Unidade de Clínica das Doenças Tropicais / IHMT / UNL, Lisbon, Portugal
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Varandas L, Fraga C, Miranda A, Barreiro E. Design, Synthesis and Pharmacological Evaluation of New Nonsteroidal Antiinflammatory 1,3,4-Thiadiazole Derivatives. LETT DRUG DES DISCOV 2005. [DOI: 10.2174/1570180053398235] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Varandas L, Julien M, Gomes A, Rodrigues P, Van Lerberghe W, Malveiro F, Aguiar P, Kolsteren P, Van Der Stuyft P, Hilderbrand K, Labadarios D, Ferrinho P. A randomised, double-blind, placebo-controlled clinical trial of vitamin A in severe malaria in hospitalised Mozambican children. Ann Trop Paediatr 2001; 21:211-22. [PMID: 11579859 DOI: 10.1080/02724930120077781] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This paper reports a randomised, double-blind, placebo-controlled clinical trial of the effect of routine vitamin A supplementation given on admission to children with severe malaria with regard to survival, recovery during hospitalisation and outcome 6 weeks after discharge. Children aged between 6 and 72 months admitted to the paediatric wards of the Central Hospital of Maputo (CHM), Mozambique with a diagnosis of severe malaria were randomly assigned either to a control group (placebo) or an experimental group (vitamin A) and were followed up 6 weeks after discharge. There were 280 children in the experimental and 290 in the placebo group. Seven (2.5%) and 13 (4.5%) children died in the experimental and the placebo groups, respectively, a relative risk of death of 0.56 (95% CI 0.23-1.38, p = 0.201). During the 1st 5 hours of admission, the relative risk of death in the vitamin A-supplemented group was 2.54 (0.50-12.96); after 5 hours of admission it was 0.19 (95% CI 0.04-0.85; p = 0.015). In the supplemented group, 4/82 (4.9%) of the children developed neurological sequelae vs 2/78 (2.6%) in the placebo group (RR = 1.90; 95% CI 0.36-10.09; p = 0.682). Although the overall reduction in the risk of death observed for all children receiving vitamin A is not statistically significant, it might be clinically important. This finding cannot, however, be accepted as a firm conclusion and requires validation by future trials.
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Affiliation(s)
- L Varandas
- Health Systems Unit and Centre for Malaria and other Tropical Diseases, Institute of Hygiene and Tropical Medicine, New University of Lisbon, Portugal.
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Varandas L, Julien M, Van Lerberghe W, Goncalves L, Ferrinho P. Independent indicators of outcome in severe paediatric malaria: maternal education, acidotic breathing and convulsions on admission. Ann Trop Paediatr 2000; 20:265-71. [PMID: 11219163 DOI: 10.1080/1465328002003852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Severe malaria is an important cause of death in hospitalized children in Mozambique, but the risk factors for this remain unclear. The objectives of the study were to define simple clinical criteria to identify on admission the children most at risk of dying. We studied prospectively 559 children admitted with severe malaria to the Department of Paediatrics of the Central Hospital of Maputo, Mozambique between March 1995 and August 1996. The case fatality rate was 3.6%. In a multiple logistic regression model, mothers' education (RR = 9.6, 95% CI 1.2-76.0), acidotic breathing (RR = 4.3, 95% CI 1.3-13.8) and convulsions in the emergency room (RR = 8.1, 95% CI 2.6-25.1) were associated with outcome. Together they predicted 97% of outcomes but only 33.3% of deaths.
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Affiliation(s)
- L Varandas
- Centro de Malária e de Outras Doenças Tropicais and Health Systems Unit, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
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32
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Julien MR, Gomes A, Varandas L, Rodrigues P, Malveiro F, Aguiar P, Kolsteren P, Stuyft P, Hildebrand K, Labadarios D, Ferrinho P. A randomized, double-blind, placebo-controlled clinical trial of vitamin A in Mozambican children hospitalized with nonmeasles acute lower respiratory tract infections. Trop Med Int Health 1999; 4:794-800. [PMID: 10632986 DOI: 10.1046/j.1365-3156.1999.00493.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The objective of this study was to test the potential of routine vitamin A supplementation at admission to speed up recovery during hospitalization for acute lower respiratory tract infections (ALRI) and to decrease the levels of morbidity at 6 weeks after discharge. The study was conducted in the Central Hospital of Maputo (CHM), Mozambique, from 1995 to 1997. METHODS Children aged 6-72 months with ALRI admitted to the paediatric wards of the CHM were assigned to a supplementation group (n = 71, receiving 200000 IU of vitamin A) or a control group (n = 93, receiving a placebo). RESULTS The prevalence of vitamin A deficiency was very high and similar between the two groups. The median number of inpatient days for the supplementation group was 3, for the placebo group 4 days. On day 5 the rate of clinical discharge was 88.4% (n = 61/69) in the experimental intervention group and 73.9% (n = 65/88) in the placebo group (P = 0.023). CONCLUSION We found a statistically significant reduction in duration of admission among vitamin A-supplemented children with ALRI. This effect is in line with what is known about the role of vitamin A in human defence and immune mechanisms and with the serological evidence of the extent of vitamin A deficiency among the children in this trial.
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Affiliation(s)
- M R Julien
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique
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Lourenço A, Quelhas I, Varandas L, Machado I, Reis F, Sousa F, Sanfins V, Carvalho S, Pereira A, Gonçalo L, Almeida J, Nascimento R. [Echocardiographic evaluation of the aortic and pulmonary valve areas in the newborn infant. Normal patterns]. Rev Port Cardiol 1996; 15:225-9, 182. [PMID: 8634171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES To determine normal values of the aortic and pulmonary functional valve areas in healthy newborn children. MATERIAL AND METHODS We prospectively studied 32 newborns (17 boys) who were included in the following criteria: healthy parents, normal pregnancy, eutocic delivery, Apgar index 10 at 5 minutes weight between 2.500 and 4.000 kg, normal physical and echocardiographical examinations. The echocardiographical examination was executed during the first 48 hours of life. We used the continuity equation to calculate the aortic and pulmonary functional valve areas. As a reference we used the anatomic (pi r2) aortic and pulmonary valve areas, calculated in the bidimensional images from the distance measured between the two insertion points of the sigmoid valves. RESULTS We had echocardiographic images and Doppler registrations of excellent quality, in all the newborn children. The functional pulmonary valve area ranged between 0.30 and 0.50 cm2 (mean +/- SD = 0.41 +/- 0.06) and the anatomical one ranged between 0.29 and 0.49 cm2 (mean +/- SD = 0.49 +/- 0.05), without statistical significance and with a correlation index 0.92. The functional aortic valve area ranged between 0.20 and 0.40 cm2 (mean +/- SD = 0.31 +/- 0.05) and the anatomical ranged between 0.21 and 0.36 cm2 (mean +/- SD = 0.29 +/- 0.05), without statistical significance and with a correlation index 0.91. CONCLUSION There is a good correlation between the functional aortic and pulmonary valve areas, calculated from the continuity equation, and the anatomical ones. These values will be useful in characterizing the critical stenosis of the newborn child with decreased ventricular function, where the transvalvular gradient is inaccurate in the quantification of the obstruction.
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Affiliation(s)
- A Lourenço
- Laboratório de Ecocardiografia, Serviço de Cardiologia, Hospital da Senhora da Oliveria, Guimarães
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