Main causes of death in Dande, Angola: results from verbal autopsies of deaths occurring during 2009–2012

bACKGROUND - The Dande Health and Demographic Surveillance System (HDSS) located in Bengo province, Angola, covers nearly 65,500 residents living in approximately 19,800 households. This study aims to describe the main causes of deaths (CoD) occurred within the HDSS, from 2009 to 2012, and to explore associations between demographic or socioeconomic factors and broad mortality groups (Group I-Communicable diseases, maternal, perinatal and nutritional conditions; Group II-Non-communicable diseases; Group III-Injuries; IND-Indeterminate). Methods - Verbal Autopsies (VA) were performed after death identification during routine HDSS visits. Associations between broad groups of CoD and sex, age, education, socioeconomic position, place of residence and place of death, were explored using chi-square tests and fitting logistic regression models. Results - From a total of 1488 deaths registered, 1009 verbal autopsies were performed and 798 of these were assigned a CoD based on the 10th revision of the International Classification of Diseases (ICD-10). Mortality was led by CD (61.0%), followed by IND (18.3%), NCD (11.6%) and INJ (9.1%). Intestinal infectious diseases, malnutrition and acute respiratory infections were the main contributors to under-five mortality (44.2%). Malaria was the most common CoD among children under 15 years old (38.6%). Tuberculosis, traffic accidents and malaria led the CoD among adults aged 15–49 (13.5%, 10.5 % and 8.0% respectively). Among adults aged 50 or more, diseases of the circulatory system (23.2%) were the major CoD, followed by tuberculosis (8.2%) and malaria (7.7%). CD were more frequent CoD among less educated people (adjusted odds ratio, 95% confidence interval for none vs. 5 or more years of school: 1.68, 1.04–2.72). Conclusion - Infectious diseases were the leading CoD in this region. Verbal autopsies proved useful to identify the main CoD, being an important tool in settings where vital statistics are scarce and death registration systems have limitations.

Toxicidade a cianobactérias: impacte potencial na saúde pública em populações de Portugal e Brasil

Como recurso natural fundamental à vida, a água e os ecossistemas aquáticos devem ser alvo de avaliação contínua, no que se reporta à sua qualidade física, química e biológica. Segundo a Organização Mundial de Saúde cerca de 1,1 biliões de pessoas estão impossibilitadas em aceder a qualquer tipo de água potável e, as populações residentes nas proximidades de rios, lagoas, e reservatórios utilizam estas águas para as suas necessidades de consumo, aumentando o risco de transmissão de doenças. Enquanto constituintes da comunidade fitoplanctónica, as cianobactérias são microrganismos procariotas, fotossintéticos, que obtêm os nutrientes diretamente da coluna de água e, um aumento da concentração de nutrientes (principalmente azoto e fósforo), associado a condições ambientais favoráveis, pode desencadear um crescimento rápido originando fluorescências. Sob determinadas condições as cianobactérias podem produzir toxinas existindo registos que evidenciam que fluorescências toxicas são responsáveis pelo envenenamento agudo e morte de animais e humanos pelo que, a água utilizada para consumo humano deverá ser regularmente monitorizada para este elemento biológico. O objetivo deste estudo é relacionar a ocorrência de fluorescências de cianobactérias (> 2000 cel/ml) e toxicidade associada, com o impacte potencial na Saúde Pública avaliado através do consumo direto ou indireto da água. Em Portugal foram selecionados oito reservatórios situados na região Sul, pertencentes às bacias hidrográficas do Sado e Guadiana e estudados entre 2000 e 2008. No Brasil foram selecionados os reservatórios de Três Marias (Estado de Minas Gerais) e de Tucuruí (Estado do Pará) e estudados em 2005 e 2006 respetivamente. Os reservatórios foram caracterizados em termos físicos e químicos, tendo-se igualmente procedido à caracterização da comunidade fitoplanctónica através da identificação e quantificação dos principais grupos presentes em diferentes épocas do ano. Em termos fitoplanctónicos os reservatórios portugueses apresentaram maior diversidade,verificando-se contudo dominância das cianobactérias na comunidade. Associados a fluorescências, foram registados nestes reservatórios géneros produtores de hepato e neurotoxinas como Aphanizomenon sp, Microcystis aeruginosa e Oscillatoria sp. No Brasil, em situação de fluorescências, os géneros produtores de neuro e hepatotoxinas foram Microcystis (> 350.000 cels/ml) e Cylindrospermopsis. A presença destes géneros, poderá constituir um risco potencial para a saúde pública, pelo que é importante a implementação de medidas de mitigação em todos os reservatórios objeto de estudo, devendo essa atuação passar pelo controle do estado trófico no sentido de evitar o desenvolvimento de fluorescências. Assim sugere-se a implementação de um tratamento adequado para a produção de água de consumo e a organização de ações de sensibilização e aviso e informação às populações que utilizam os reservatórios em Portugal e no Brasil para diversos usos. - ABSTRACT - As a life fundamental natural resource, water and aquatic ecosystems must be continuously evaluated in their physical, chemical and biological quality. According World Health Organization, 1.1 billion people has no chance to access any kind of potable water. Populations living near rivers, lagoons or reservoirs use those waters to content their needs, increasing risks disease transmission. As members of phytoplankton community, cyanobacteria are prokaryotic, photosynthetic microorganisms and get its nutrients directly from water column. The increase of this nutrients (especially nitrogen and phosphorus) associated with favorable environment conditions, can support a sudden grow and instigate blooms. Under specific conditions cyanobacteria can produce toxins and several records have shown that toxic blooms are responsible by acute poisoning and death in animals and humans so, water for human consumption must be regularly surveyed for this biologic element. The aim of this study is to correlate Cyanobacteria blooms (>2.000cels/ml) and connected toxicity with public health impact, evaluated through water consumption. In Portugal, eight reservoirs located in the South region were selected and study between 2000 and 2008. In Brazil, Três Marias reservoir (Minas Gerais Provence) and Tucuruí (Pará Provence) were selected and study in 2005 and 2006. Reservoirs were characterized in physical and chemical aspects, as well as phytoplankton community, through identification and counting of main present groups along study period. In bloom circumstances, liver toxins and neurotoxins producers like Aphanizomenon sp, Microcystis aeruginosa and Oscillatoria sp. were founded in Portuguese reservoirs. In Brazil, cyanobacteria genera involved in toxic bloom were Microcystis (> 350.000 cels/ml) and Cylindrospermopsis. This genera presence represents a potential risk for public health, and show the requirement to implement mitigation measures in all study reservoirs. These measures can be represented by water eutrophication control to avoid blooms, by appropriate treatments of water to human consumption, and public warnings or information to dose people in Portugal and Brazil that use these reservoirs to several activities.

Occupational exposure to Aflatoxin B1 in Portuguese swine farms

Aflatoxins were first isolated about 40 years ago afier outbreaks of disease and death in turkeys and cancer in rainbow trout fed with rations formulated from peanut and cottonseed meals. These toxins are secondary metabolites produced under certain conditions of temperature, p14 and humidity predominantiy by Aspergilius flavus and Aspergilius parasiticus fungi species. Among 18 different types of aflatoxins identified, major members are aflatoxin B1, B2, G1 and G2. Aflatoxin B1 (AFB1) is normaily predominant in cultures as well as in food products. AFB1 was shown to be genotoxic and a potent hepatocarcinogen. This mycotoxin is metabolized by the mixed function oxidase system to a number of hydroxylated metabolites including the 8,9-epoxide. The latter is considered to be the ultimate carcinogen that reacts with cellular deoxyribonucleic acid (DNA) and proteins to form covalent adducts.

Implementation of proton therapy in the portuguese context of radiotherapy

Cancer is a national and international health care concern. It’s important to find strategies for early diagnosis as well as for the optimization of the various therapeutic options currently existing in Portugal. Cancer is the second leading cause of death in Portugal, the choice of this study, is due to the importance of radiotherapy approach in cancer treatment and because is the therapy used in 40% of oncology patients. Radiation therapy has evolve data technological level, that allows new treatment techniques that are more efficient and that also promotes greater professional satisfaction. The hadrons are charged particles, used in cancer therapy. These particles can bring a paradigm shift regarding the therapeutic approach in radiotherapy. The technique used is proton therapy, that reveal to be more accurate, efficacious and less toxic to surrounding tissue. Proton therapy may be a promising development in the field of oncology and how the treatment is given in radiotherapy. Although there is awareness of the benefits of proton therapy in oncology it’s also important to take in consideration the costs of these therapy, because they are considerably higher than conventional treatments of radiotherapy. Given the lack of a proton therapy service in Portugal, this study aims to be a documentary analysis of clinical records that will achieve the following objectives: to identify the number of cancer patients diagnosed in 2010 in Portugal and to calculate the estimated number of patients that could have been treated with proton therapy according to the Health Council of the Netherlands registration document.

UV-Vis spectroscopic study preferential solvation and intermolecular interactions in methanol/1-propanol/acetonitrile by means of solvatochromic probes

Solvatochromic UV-Vis shifts of four indicators (4-nitroaniline, 4-nitroanisole, 4-nitrophenol and N,N-dimethy-1-4-nitro aniline) have been measured at 298.15 K in the ternary mixture methano1/1-propanol/acetonitrile (MeOH/1-PrOH/MeCN) in a total of 22 mole fractions, along with 18 additional mole fractions for each of the corresponding binary mixtures, MeOH/1-PrOH, 1-PrOH/MeCN and MeOH/MeCN. These values, combined with our previous experimental results for 2,6-dipheny1-4-(2,4,6-triphenylpyridinium-1-yl)phenolate (Reichardt's betaine dye) in the same mixtures, permitted the computation of the Kamlet-Taft solvent parameters, alpha, beta, and pi*. The rationalization of the spectroscopic behavior of each probe within each mixture's whole mole fraction range was achieved through the use of the Bosch and Roses preferential solvation model. The applied model allowed the identification of synergistic behaviors in MeCN/alcohol mixtures and thus to infer the existence of solvent complexes in solution. Also, the addition of small amounts of MeCN to the binary mixtures was seen to cause a significant variation in pi*, whereas the addition of alcohol to MeCN mixtures always lead to a sudden change in a and The behavior of these parameters in the ternary mixture was shown to be mainly determined by the contributions of the underlying binary mixtures. (C) 2014 Elsevier B.V. All rights reserved.

Bisphenol A at the reference level counteracts doxorubicin transcriptional effects on cancer related genes in HT29 cells

Human exposure to Bisphenol A (BPA) results mainly from ingestion of food and beverages. Information regarding BPA effects on colon cancer, one of the major causes of death in developed countries, is still scarce. Likewise, little is known about BPA drug interactions although its potential role in doxorubicin (DOX) chemoresistance has been suggested. This study aims to assess potential interactions between BPA and DOX on HT29 colon cancer cells. HT29 cell response was evaluated after exposure to BPA, DOX, or co-exposure to both chemicals. Transcriptional analysis of several cancer-associated genes (c-fos, AURKA, p21, bcl-xl and CLU) shows that BPA exposure induces slight up-regulation exclusively of bcl-xl without affecting cell viability. On the other hand, a sub-therapeutic DOX concentration (40nM) results in highly altered c-fos, bcl-xl, and CLU transcript levels, and this is not affected by co-exposure with BPA. Conversely, DOX at a therapeutic concentration (4μM) results in distinct and very severe transcriptional alterations of c-fos, AURKA, p21 and CLU that are counteracted by co-exposure with BPA resulting in transcript levels similar to those of control. Co-exposure with BPA slightly decreases apoptosis in relation to DOX 4μM alone without affecting DOX-induced loss of cell viability. These results suggest that BPA exposure can influence chemotherapy outcomes and therefore emphasize the necessity of a better understanding of BPA interactions with chemotherapeutic agents in the context of risk assessment.

Aetiology of diahrroea in children under five at the Bengo General Hospital, Angola

Diarrhoea is the second leading cause of death in children under five years being responsible for 760.000 deaths, corresponding to 9% of the total deaths in this age group. Africa is the region with more deaths due to diarrhoea (46%), followed by South Asia (38%). Three quarters of the total of deaths occurs within only 15 countries and Angola is in the 15th position with a record of 20,000 annual childhood deaths. Diarrhoeal disease can be caused by bacterial, viral and parasitic infectious agents and can be transmited through contaminated food or drinking water, or directly from person to person. Rotavirus and Escherichia coli were shown the most frequent pathogenic agents in developing countries. This study aims to identify the most frequent pathogenic agents of diarrhoea in children under five atttending the Bengo General Hospital (BGH)..