Letter to the Editor
Heart with Mozambique: A Portuguese contribution to the eradication of rheumatic heart disease
Coração com Moçambique: a contribuição Portuguesa para a erradicação da doença cardíaca reumática
Lido
1106
Vezesque se leu este artigo
256
Total PDF
850
Total HTML
Compartilhar estatísticas
array:22 [ "pii" => "S0870255124001185" "issn" => "08702551" "doi" => "10.1016/j.repc.2024.01.006" "estado" => "S300" "fechaPublicacion" => "2024-07-01" "aid" => "2330" "copyright" => "Sociedade Portuguesa de Cardiologia" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Rev Port Cardiol. 2024;43:435-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemAnterior" => array:18 [ "pii" => "S0870255124000076" "issn" => "08702551" "doi" => "10.1016/j.repc.2023.10.009" "estado" => "S300" "fechaPublicacion" => "2024-07-01" "aid" => "2297" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Port Cardiol. 2024;43:433-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>" "titulo" => "Not your typical cardiac mass – Renal cell carcinoma invading the right atrium" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "433" "paginaFinal" => "434" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Uma massa cardíaca atípica – carcinoma de células renais a invadir a aurícula direita" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1092 "Ancho" => 3258 "Tamanyo" => 304862 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Computed tomography showing a large heterogeneous mass in the inferior vena cava, extending into the right atrium (yellow arrows).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Catarina Isabel Ribeiro Carvalho, Marta Catarina Ribeiro Bernardo, Joana Trigo Ribeiro, Ana Isabel Santos Baptista, José Ilídio Azevedo Moreira" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Catarina Isabel" "apellidos" => "Ribeiro Carvalho" ] 1 => array:2 [ "nombre" => "Marta Catarina" "apellidos" => "Ribeiro Bernardo" ] 2 => array:2 [ "nombre" => "Joana" "apellidos" => "Trigo Ribeiro" ] 3 => array:2 [ "nombre" => "Ana Isabel" "apellidos" => "Santos Baptista" ] 4 => array:2 [ "nombre" => "José Ilídio" "apellidos" => "Azevedo Moreira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255124000076?idApp=UINPBA00004E" "url" => "/08702551/0000004300000007/v1_202407050544/S0870255124000076/v1_202407050544/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Heart with Mozambique: A Portuguese contribution to the eradication of rheumatic heart disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "435" "paginaFinal" => "436" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Inês Grácio de Almeida, Ana Esteves, Victor Gil" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Inês Grácio" "apellidos" => "de Almeida" "email" => array:1 [ 0 => "inesalmeida91@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ana" "apellidos" => "Esteves" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Victor" "apellidos" => "Gil" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar Lisboa Central EPE, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Serviço de Cardiologia, Hospital de São Bernardo, Centro Hospitalar de Setúbal EPE, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Faculdade de Medicina da Universidade Católica Portuguesa, Luz Cardiovascular Research Center, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Coração com Moçambique: a contribuição Portuguesa para a erradicação da doença cardíaca reumática" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Rheumatic heart disease (RHD) is a sequela of acute rheumatic fever. It was almost eradicated during the late 20th century in high-income countries due to improvements in socioeconomic conditions and the widespread use of benzathine penicillin G to treat streptococcal pharyngitis. However, there is still a significant burden of RHD in low- and middle-income regions, particularly Africa, South Asia, and the Pacific islands, associated with social determinants of poor health and with high mortality.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The current availability of echocardiography-based screening in areas in which the condition is endemic provides an easy and rapid way to diagnose RHD. The World Health Organization and the World Heart Federation (WHF) have shown an increasing interest in the burden of this disease, calling for a 25% reduction in cardiovascular mortality, including RHD, by 2025.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">‘Heart with Mozambique’ was created to address this issue. It is a project arising from collaboration between the Portuguese Society of Cardiology (SPC) and Eduardo Mondlane University in Maputo, Mozambique, organizations in two countries that share a common language and cultural heritage. This was an autonomous program following an initial challenge from the WHF project ‘Colors to Save Hearts’, which aims to fight RHD through improvements in medical training in the cardiovascular area and in the population's literacy.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The program began in May 2023 with an online course delivered by the Portuguese cardiologists involved in the mission. The objective was to provide Mozambican physicians with initial field training in transthoracic echocardiography and in clinical management of the main cardiovascular diseases.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Subsequently, 10 cardiologists were sent to Maputo to perform large-scale echocardiographic screening. The volunteers were seven adult cardiologists and three pediatric cardiologists. The mission was coordinated by Dr Victor Gil and organized by Dr Fernando Montenegro Sá, Dr Isabel Monteiro and Dr Kevin Domingues. The Camões Institute and the Portuguese Pharmaceutical Industry Association (APIFARMA) supported the mission, as did the SPC, which donated 10 portable ultrasound machines capable of high-quality cardiac screening. Three sites were selected for this purpose: the obstetrics department of Maputo's Central Hospital, a clinic in Eduardo Mondlane University, and the primary school of Matchik-tchik.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Over a period of two weeks in July 2023, a total of 2219 transthoracic echocardiography (TTE) scans were performed, of which 213 were in the hospital on full-term pregnant and postpartum women. Of these, 42 (20%) showed anomalous findings, mainly left ventricular hypertrophy (LVH) in 50%, as well as mild mitral regurgitation (MR) in 17% and mild pericardial effusion in 9.5%. We also encountered more serious situations with repercussions for the acute treatment of pregnant or postpartum women, such as severe rheumatic mitral stenosis and large pericardial effusions.</p><p id="par0035" class="elsevierStylePara elsevierViewall">At the primary school, 1787 children aged 5–15 years were observed. Besides TTE, they also underwent an oral swab for pharyngeal streptococcus screening. Of these TTE scans, 279 (15.6%) presented with mild anomalies, mainly mitral or tricuspid regurgitation. These findings may indicate an early stage of RHD which will merit further follow-up at a specialist clinic.</p><p id="par0040" class="elsevierStylePara elsevierViewall">At the clinic, 219 TTE scans were performed, of which 123 (56%) presented with abnormal findings. The most common was LVH in 68%; followed by mild MR in 29%, rheumatic valve disease in 7%, left ventricular dysfunction in 5% and severe pericardial effusion in 1.6%. At the same time, there was an investment in the theoretical and practical training of 24 health care providers (five specialists in family and community medicine, 18 residents and one general medical doctor) to perform and guide the application of TTE.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Now that the field experience is over, we can consider that our mission was a success. A considerable number of individuals were assessed and important data were obtained. A significant percentage of the observed echocardiographic findings were abnormal, confirming the expected high prevalence of cardiovascular and valvular disease in this population, showing the scope for a larger investment in the medical knowledge of the population and their access to health care. An important contribution to improving medical training was made, particularly in TTE, aiming for specialized and timely provision of medical care to this population. One of the major limitations we encountered was the limited training time available, especially considering the technique in question, which is highly dependent on continuous practice, and the at times basic learning needs, leaving us with the feeling that a structured program repeated over time could have a greater impact in this population.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Finally, we hope that this work can continue in the coming years, to improve the diagnosis of cardiovascular disease, aiming to reduce its complications and mortality, and to strengthen ties between Portuguese and Mozambican physicians.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Participants</span><p id="par0055" class="elsevierStylePara elsevierViewall">Dr Ana Esteves, Cardiology Department, São Bernardo Hospital, Arrábida Local Health Unit; Dr Ana Neto, Cardiology Department, Padre Américo Hospital; Tâmega and Sousa Local Health Unit; Dr Catarina Brandão, Pediatric Cardiology Department, Santa Marta Hospital, São José Local Health Unit; Dr Cláudio Guerreiro, Cardiology Department, Eduardo Santos Silva Hospital, Gaia/Espinho Local Health Unit; Dr Inês Grácio de Almeida, Cardiology Department, Santa Marta Hospital, São José Local Health Unit; Dr Luís Almeida Morais, Cardiology Department, Santa Marta Hospital, São José Local Health Unit; Dr Mariana Lemos, Pediatric Cardiology Department, Santa Cruz Hospital, Lisboa Ocidental Local Health Unit; Dr Marisa Silva, Cardiology Departement, Eduardo Santos Silva Hospital, Gaia/Espinho Local Health Unit; Dr Sara Fernandes, Cardiology Departement, Santo António Hospital, Santo António Local Health Unit; Dr Sílvia Alvares, Pediatric Cardiology Department, Albino Aroso North Mother and Child Center, Santo António Local Health Unit.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Participants" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "Reference" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Reference" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:1 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Regional, and National Burden of Rheumatic Heart Disease, 1990–2015" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. David" 1 => "M.D.M.P.H. Watkins" 2 => "O. Catherine" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "N Engl J Med" "fecha" => "2017" "volumen" => "377" "paginaInicial" => "713" "paginaFinal" => "722" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000004300000007/v1_202407050544/S0870255124001185/v1_202407050544/en/main.assets" "Apartado" => array:4 [ "identificador" => "93494" "tipo" => "SECCION" "pt" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "pt" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000004300000007/v1_202407050544/S0870255124001185/v1_202407050544/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255124001185?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 7 | 6 | 13 |
| 2024 Outubro | 62 | 30 | 92 |
| 2024 Setembro | 67 | 40 | 107 |
| 2024 Agosto | 487 | 41 | 528 |
| 2024 Julho | 161 | 84 | 245 |
| 2024 Junho | 45 | 15 | 60 |
| 2024 Maio | 21 | 40 | 61 |
