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[SciELO Preprints] - Guideline of the Brazilian Society of Cardiology on Diagnosis and Treatment of Patients with Chagas Disease Cardiomyopathy
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Marin-Neto, José Antonio Rassi Jr., Anis Moraes Oliveira, Gláucia M. Lemos Correia, Luís Claudio Novaes Ramos Jr., Alberto Hasslocher-Moreno, Alejandro Marcel Luquetti Ostermayer, Alejandro Sousa, Andréa Silvestre de Amato Vincenzo de Paola, Angelo Sobral de Sousa, Antonio Carlos Pinho Ribeiro, Antonio Luiz Correia Filho, Dalmo Moraes de Souza, Dilma do Socorro Cunha-Neto, Edecio J. A. Ramires, Felix Bacal, Fernando Pereira Nunes, Maria do Carmo Martinelli Filho, Martino Ibrahim Scanavacca, Maurício Magalhães Saraiva, Roberto Alves de Oliveira Júnior, Wilson M. Lorga-Filho, Adalberto de Jesus Benevides de Almeida Guimarães, Adriana Lopes Latado Braga, Adriana Sarmento de Oliveira, Adriana V. L. Sarabanda, Alvaro Yecê das Neves Pinto, Ana Assis Lopes do Carmo, André Schmidt, André Costa, Andréa Rodrigues da Ianni, Barbara Maria Markman Filho, Brivaldo Eduardo Rochitte, Carlos Thé Macedo, Carolina Mady, Charles Chevillard, Christophe Bittencourt das Virgens, Cláudio Marcelo Nery de Castro, Cleudson De Paoli de Carvalho Britto, Constança Felícia Pisani, Cristiano do Carmo Rassi, Daniela C. Sobral Filho, Dario Rodrigues Almeida, Dirceu A. Bocchi, Edimar T. Mesquita, Evandro de Souza Nogueira Sardinha Mendes, Fernanda Pereira, Francisca Tatiana Sperandio da Silva, Gilberto Marcelo de Lima Peixoto, Giselle Glotz de Lima, Gustavo H. Veloso, Henrique Turin Moreira, Henrique Bellotti Lopes, Hugo Masciarelli Francisco Pinto, Ibraim Pinto Dias, João Carlos Bemfica, João Marcos Silva-Nunes, João Paulo Soares Barreto-Filho, José Augusto Kerr Saraiva, José Francisco Lannes-Vieira, Joseli Menezes Oliveira, Joselina Luzia V. Armaganijan, Luciana Martins, Luiz Cláudio C. Sangenis, Luiz Henrique Barbosa, Marco Paulo Almeida-Santos, Marcos Antônio Simões, Marcos Vinicius Shikanai-Yasuda, Maria Aparecida Vieira Moreira, Maria da Consolação Higuchi, Maria de Lourdes Costa Monteiro, Maria Rita de Cássia Felix Mediano, Mauro Felippe Maia Lima, Mayara T. Oliveira, Maykon Moreira Dias Romano , Minna Nitz, Nadjar de Tarso Jorge Medeiros, Paulo Vieira Alves, Renato Alkmim Teixeira, Ricardo Coury Pedrosa, Roberto Aras, Roque Morais Torres, Rosália dos Santos Povoa, Rui Manoel Rassi, Sérgio Gabriel Salles Xavier, Sérgio Marinho Martins Alves , Silvia B. N. Tavares, Suelene Lima Palmeira, Swamy da Silva Junior, Telêmaco Luiz da Rocha Rodrigues, Thiago Madrini Junior, Vagner Maia da Costa , Veruska Dutra, Walderez

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Fecha de publicación: 2022-10-11

Resumen: En Pt

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.nbsp; Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities. nbsp; Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.nbsp; The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.nbsp; The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.nbsp; nbsp;nbsp; Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.

Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.nbsp;nbsp;nbsp; Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.nbsp;

https://doi.org/10.1590/SciELOPreprints.4820

Epidemiological-clinical profile and mortality in patients coinfected with Trypanosoma cruzi/HIV: experience from a Brazilian reference center
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Hasslocher-Moreno, Alejandro Marcel

; Sousa, Andréa Silvestre de

; Xavier, Sergio Salles

; Mendes, Fernanda de Souza Nogueira Sardinha

; Nunes, Estevão Portela

; Grinsztejn, Beatriz Gilda Jegerhorn

; Mediano, Mauro Felippe Felix

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volumen 55 elocation e0240-2022

Resumen: En | Texto: En | PDF: En

ABSTRACT Background: The recent urbanization of Chagas disease (CD) has contributed to a greater risk of coexistence with human immunodeficiency virus (HIV) and AIDS. Methods: This retrospective observational study included patients who were followed at INI-Fiocruz between July 1986 and October 2021. All patients underwent an assessment protocol that included sociodemographic profile, epidemiological history, and clinical evaluation. Descriptive data analyses included reports of the medians and frequencies of variables of interest. Differences in medians between groups were tested using the Mann-Whitney U test. Differences in frequency were tested using Fisher's exact test. Results: Among 2201 patients, 11 (0.5%) were identified with Trypanosoma cruzi/HIV coinfection. Of these, 63.6% were women with a median age of 51.0 years old. Two patients had the indeterminate form of CD, six had the cardiac form, two had the digestive form and one had the cardio-digestive form. Half of the patients were undergoing antiretroviral treatment at the time of coinfection diagnosis with a median CD4+ count of 350 cells/μL and a viral load of 1500 copies/μL. Four patients underwent a xenodiagnosis test at coinfection diagnosis, which all yielded positive results; two of them presented high parasitemia under the risk of reactivation. Prophylaxis for CD reactivation was administered to four patients; two with ketoconazole and two with benznidazole. Six patients died after a median follow-up of 22.5 months, with AIDS being the most common cause of death. Only one case of reactivation was observed. Conclusions: Early diagnosis and prompt treatment of CD reactivation dramatically reduced mortality. Identification of Trypanosoma cruzi/HIV co-infection is crucial to planning a close follow-up of coinfected patients.

https://doi.org/10.1590/0037-8682-0240-2022

La vida social de la innovación: una mirada pragmática a las prácticas de producción de conocimiento en el mundo de la consultoría
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Ariztia, Tomas

; Cotoras, Dusan

; Espinosa-Cristia, Juan

Journal of technology management & innovation

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2022, Volumen 17 Nº 1 Paginas 89 - 99

Resumen: En Es | Texto: En Es | PDF: En | PDF: Es

Abstract. The social life of innovation: A pragmatic approach to knowledge production practices in the consulting world This article unpacks the different practices and modes of knowledge that constitutes innovation consultancy. By relying on recent debates in economic sociology, it argues that innovation consulting work can be understood as the fabrication of types of situations that help to evoke non yet existing objects as a potential form of economic value. We call these situations as "innovation atmospheres". This theoretical argument is empirically deployed by presenting material from a six-month ethnographic case study consisting of attending innovation workshops developed for companies. We identify that different types of innovation atmospheres arise from the work involved in of mobilizing affects, devices, and metaphors to induce indeterminate situations. We describe how these atmospheres involve evaluating and prioritizing reality in specific ways. Finally, we conclude by discussing the similarities and differences between the constitutive operations of innovation consulting and other social practices oriented to produce the new, such as the art world.

Resumen Con base en debates recientes de la sociología económica, este articulo describe y problematiza las distintas prácticas y conocimientos que se movilizan en el mundo de la consultoría en innovación. Concretamente, se examina cómo la consultoría en innovación produce un tipo particular de situaciones para evocar objetos aún inexistentes como una forma potencial de valor. Denominamos estas situaciones “atmósferas de innovación”. Este argumento es desplegado empíricamente a través de un estudio de caso etnográfico de seis meses que consistió en asistir a talleres de innovación para empresas. Identificamos que los distintos tipos de atmósferas de innovación surgen del trabajo involucrado en la movilización de afectos, dispositivos y metáforas para inducir situaciones indeterminadas. Describimos como estas atmósferas implican evaluar y jerarquizar la realidad de formas específicas. Se concluye discutiendo las similitudes y diferencias entre las operaciones constitutivas de la consultoría en innovación y otras prácticas sociales orientadas a producir lo nuevo, tales como el mundo del arte.

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Indeterminate Form of Chagas Disease: Some Immunological Insights
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Matos, Daniel Mazza

; Viana, Carlos Eduardo Menezes

; Oliveira, Maria de Fátima

; Queiroz, José Ajax Nogueira

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volumen 55 elocation e0594-2021

Resumen: En | Texto: En | PDF: En

https://doi.org/10.1590/0037-8682-0594-2021

Frequency of exposure to arboviruses and characterization of Guillain Barré syndrome in a clinical cohort of patients treated at a tertiary referral center in Brasília, Federal District
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Matos, Luíza Morais de

; Borges, Ariely Teotonio

; Palmeira, Aline Barbosa

; Lima, Vinicius Moreira

; Maciel, Ernane Pires

; Fernandez, Rubens Nelson Morato

; Mendes, João Pedro Lima

; Romero, Gustavo Adolfo Sierra

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volumen 55 elocation e0306-2021

Resumen: En | Texto: En | PDF: En

ABSTRACT Background: Guillian Barré syndrome (GBS) is an acute autoimmune polyradiculoneuropathy often associated with previous exposure to infectious agents. Methods: A clinical cohort of 41 patients with GBS admitted to the Base Hospital Institute of the Federal District between May 2017 and April 2019 was followed up for 1 year. Serological tests for arbovirus detection and amplification of nucleic acids using polymerase chain reaction for zika virus (ZIKV), dengue virus (DENV), and chikungunya virus (CHIKV) were performed. Results: The cohort consisted of 61% men with a median age of 40 years, and 83% had GBS-triggering events. A total of 54% had Grade 4 disability, 17% had Grade 3, 12% had Grade 2, 10% had Grade 5, and 7% had Grade 1. The classic form occurred in 83% of patients. Nerve conduction evaluations revealed acute demyelinating inflammatory polyneuropathy (51%), acute motor axonal neuropathy (17%), acute sensory-motor neuropathy (15%), and indeterminate forms (17%). Four patients were seropositive for DENV. There was no laboratory detection of ZIKV or CHIKV infection. Ninety percent of patients received human immunoglobulin. Intensive care unit admission occurred in 17.1% of the patients, and mechanical ventilation was used in 14.6%. One patient died of Bickerstaff’s encephalitis. Most patients showed an improvement in disability at 10 weeks of follow-up. Conclusions: GBS in the Federal District showed a variable clinical spectrum, and it was possible to detect recent exposure to DENV.

https://doi.org/10.1590/0037-8682-0306-2021

Letters to the Editor: Indeterminate form of Chagas Disease: some immunological insights
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Hasslocher-Moreno, Alejandro Marcel

; Xavier, Sergio Salles

; Saraiva, Roberto Magalhães

; Sousa, Andréa Silvestre de

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volumen 55 elocation e0713-2021

Resumen: En | Texto: En | PDF: En

https://doi.org/10.1590/0037-8682-0713-2021

Determinantes da Capacidade Funcional em Pacientes com Doença de Chagas
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Silva, Whesley Tanor

; Costa, Henrique Silveira

; Figueiredo, Pedro Henrique Scheidt

; Lima, Márcia Maria Oliveira

; Lima, Vanessa Pereira

; Costa, Fábio Silva Martins da

; Ávila, Matheus Ribeiro

; Mendonça, Vanessa Amaral

; Lacerda, Ana Cristina Rodrigues

; Nunes, Maria Carmo Pereira

; Rocha, Manoel Otávio Costa

Arquivos Brasileiros de Cardiologia

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Nov 2021, Volumen 117 Nº 5 Paginas 934 - 941

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: A doença de Chagas leva à redução da capacidade funcional. Entretanto, o estágio em que o comprometimento funcional é detectável permanece obscuro. Objetivos: O presente estudo teve como objetivo comparar a capacidade funcional de pacientes em diferentes estágios da doença de Chagas e de indivíduos saudáveis e verificar os determinantes do consumo de oxigênio de pico (VO2pico). Métodos: Em um estudo transversal, foram selecionados 160 indivíduos, 35 saudáveis e 125 com doença de Chagas. No grupo chagásico, 61 (49%) estavam na forma indeterminada da doença, 45 (36%) com cardiomiopatia chagásica (CC) e função cardíaca preservada e 19 (15%) com disfunção cardíaca e CC dilatada. Os dados foram analisados por meio de análise de regressão univariada e multivariada. A significância estatística foi fixada em 5%. Resultados: Pacientes na forma indeterminada da doença apresentaram capacidade funcional semelhante a indivíduos saudáveis (p> 0,05). Pacientes com ChC e função cardíaca preservada apresentaram VO2pico menor que os pacientes na forma indeterminada (p <0,05), mas apresentaram valores de VO2pico semelhantes ao ChC dilatado (p = 0,46). A idade, sexo masculino, classe funcional da NYHA, pressão arterial diastólica, razão entre a velocidade do fluxo transmitral diastólico precoce e a velocidade anular mitral diastólica precoce, a fração de ejeção do ventrículo esquerdo (FEVE) e o diâmetro diastólico final do ventrículo esquerdo foram associados à capacidade funcional. Porém, apenas idade, sexo masculino, FEVE e classe funcional da NYHA permaneceram associados ao VO2pico no modelo final (R2 ajustado = 0,60). Conclusão: Pacientes com CC apresentam menor capacidade funcional do que pacientes na forma indeterminada. FEVE, idade, sexo masculino e classe funcional da NYHA foram determinantes do VO2pico em pacientes com doença de Chagas.

Abstract Background: Chagas disease leads to reduced functional capacity. However, the stage at which functional impairment is detectable remains unclear. Objectives: The present study was addressed to compare the functional capacity of patients at different stages of Chagas disease and healthy individuals and to verify the determinants of peak oxygen uptake (VO2peak). Methods: In a cross-sectional study, 160 individuals were selected, 35 healthy and 125 with Chagas disease. In the Chagasic group, 61 (49%) were in the indeterminate form of the disease, 45 (36%) with Chagas cardiomyopathy (ChC) and preserved cardiac function and 19 (15%) with cardiac dysfunction and dilated ChC. The data were analyzed using univariate and multivariate regression analysis. Statistical significance was set at 5%. Results: Patients in the indeterminate form of disease showed similar functional capacity to healthy individuals (p>0.05). Patients with ChC and preserved cardiac function had lower VO2peak than patients in the indeterminate form (p<0.05), but showed similar VO2peak values than dilated ChC (p=0.46). The age, male sex, NYHA functional class, diastolic blood pressure, ratio of the early diastolic transmitral flow velocity to early diastolic mitral annular velocity, left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter were associated with functional capacity. However, only age, male sex, LVEF and NYHA functional class, remained associated with VO2peak in the final model (adjusted R2=0.60). Conclusion: Patients with ChC had lower functional capacity than patients in the indeterminate form. LVEF, age, male sex and NYHA functional class were determinants with VO2peak in patients with Chagas disease.

https://doi.org/10.36660/abc.20200462 3 descargas

Correlação entre Cardiomegalia pela Radiografia de Tórax e Diâmetro do Ventrículo Esquerdo pela Ecocardiografia em Pacientes com Doença de Chagas
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Ramos, Matheus Rassi Fernandes

; Moreira, Henrique Turin

; Volpe, Gustavo Jardim

; Romano, Minna

; Maciel, Benedito Carlos

; Schmidt, André

; Rassi Junior, Anis

; Marin Neto, Jose Antônio

Arquivos Brasileiros de Cardiologia

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Ene 2021, Volumen 116 Nº 1 Paginas 68 - 74

Resumen: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Fundamento Cardiomegalia pela radiografia de tórax (RXT) é preditor independente de morte em indivíduos com cardiomiopatia crônica da doença de Chagas (CCDC). Contudo, a correlação entre o aumento do índice cardiotorácico (ICT) na RXT e do diâmetro telediastólico do ventrículo esquerdo (DDVE) pela ecocardiografia (ECO) nessa população não está bem definida. Objetivos Analisar a relação entre cardiomegalia pela RXT e DDVE pela ECO em pacientes com doença de Chagas (DC) e sua aplicabilidade ao escore de Rassi. Métodos Estudo retrospectivo incluiu 63 pacientes ambulatoriais com DC avaliados por RXT e ECO. Cardiomegalia na RXT foi definida como ICT > 0,5. DDVE foi avaliado como variável contínua. Curva ROC foi utilizada para avaliar o potencial do DDVE para identificação de cardiomegalia pela RXT, com ponto de corte definido pela maior somatória de sensibilidade e especificidade. Resultados Idade mediana = 61 anos [intervalo interquartil: 48-68], 56% mulheres. CCDC foi identificada em 58 pacientes; 5 tinham a forma indeterminada da DC. Cardiomegalia foi detectada em 28 indivíduos. A área sob a curva ROC do DDVE para identificação de cardiomegalia foi de 0,806 (IC 95%: 0,692-0,919). O ponto de corte ótimo para DDVE foi de 60 mm (sensibilidade = 64%, especificidade = 89%). O uso do DDVE pela ECO em substituição ao ICT pela RXT alterou o escore de Rassi em 14 pacientes, e em 10 deles houve redução do risco presumido. Conclusão DDVE pela ECO é parâmetro adequado e com alta especificidade para distinguir entre presença e ausência de cardiomegalia na RXT na DC. (Arq Bras Cardiol. 2021; 116(1):68-74)

Abstract Background Cardiomegaly on chest X-ray is an independent predictor of death in individuals with chronic Chagas cardiomyopathy (CCC). However, the correlation between increased cardiothoracic ratio (CTR) on chest X-ray and left ventricular end-diastolic diameter (LVEDD) on echocardiography is not well established in this population. Objectives To assess the relationship between chest X-ray and LVEDD on echocardiography in patients with Chagas disease and its applicability to the Rassi score. Methods Retrospective study on 63 Chagas disease outpatients who underwent chest X-ray and echocardiography. Cardiomegaly on chest X-ray was defined as a CTR>0.5. LVEDD was analyzed as a continuous variable. ROC curve was used to evaluate the ability of LVEDD in detecting cardiomegaly by chest X-ray, with a cut-off point defined by the highest sum of sensitivity and specificity. Results Median age 61 years [interquartile range 48-68], 56% were women. CCC was detected in 58 patients, five patients had the indeterminate form of Chagas disease. Cardiomegaly was detected in 28 patients. The area under the ROC curve for LVEDD was 0.806 (95%CI: 0.692-0.919). The optimal cut-off for LVEDD was 60 mm (sensitivity = 64%, specificity = 89%). The use of LVEDD on echocardiography as a surrogate for CTR on chest X-ray changed the Rassi score values of 14 patients, with a reduction in the presumed risk in 10 of them. Conclusion LVEDD on echocardiography is an appropriate, highly specific parameter to distinguish between the presence and absence of cardiomegaly on chest X-ray in Chagas disease. (Arq Bras Cardiol. 2021; 116(1):68-74)

https://doi.org/10.36660/abc.20190673 985 descargas

Temporal changes in the clinical-epidemiological profile of patients with Chagas disease at a referral center in Brazil
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Hasslocher-Moreno, Alejandro Marcel

; Saraiva, Roberto Magalhaes

; Brasil, Pedro Emmanuel Alvarenga Americano do

; Sangenis, Luiz Henrique Conde

; Xavier, Sergio Salles

; Sousa, Andréa Silvestre de

; Sperandio-da-Silva, Gilberto Marcelo

; Mendes, Fernanda de Souza Nogueira Sardinha

; Costa, Andréa Rodrigues da

; Holanda, Marcelo Teixeira de

; Veloso, Henrique Horta

; Mazzoli-Rocha, Flavia

; Carneiro, Fernanda Martins

; Portela, Luciana Fernandes

; Mediano, Mauro Felippe Felix

Revista da Sociedade Brasileira de Medicina Tropical

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2021, Volumen 54 elocation e0040-2021

Resumen: En | Texto: En | PDF: En

Abstract INTRODUCTION We aimed to describe the sociodemographic, epidemiological, and clinical characteristics of patients with chronic Chagas disease (CD) at an infectious disease referral center. Changes in patient profiles over time were also evaluated. METHODS This retrospective study included patients with CD from November 1986-December 2019. All patients underwent an evaluation protocol that included sociodemographic profile; epidemiological history; anamnesis; and physical, cardiologic, and digestive examinations. Trend differences for each 5-year period from 1986 to 2019 were tested using a nonparametric trend test for continuous and generalized linear models with binomial distribution for categorical variables. RESULTS A total of 2,168 patients (52.2% women) were included, with a mean age of 47.8 years old. White patients with low levels of education predominated. The reported transmission mode was vectorial in 90.2% of cases. The majority came from areas with a high prevalence (52.2%) and morbidity (67.8%) of CD. The most common clinical presentation was the indeterminate form (44.9%). The number of patients referred gradually decreased and the age at admission increased during the study period, as did the patients’ levels of education. CONCLUSIONS The clinical profile of CD is characterized by a predominance of the indeterminate form of the disease. Regarding the patients who were followed up at the referral center, there was a progressive increase in the mean age and a concomitant decrease in the number of new patients. This reflects the successful control of vector and transfusion transmission in Brazil as well as the aging population of patients with CD.

https://doi.org/10.1590/0037-8682-0040-2021 158 descargas

10.

Indeterminate form of Chagas disease: historical, conceptual, clinical, and prognostic aspects
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Hasslocher-Moreno, Alejandro Marcel

; Xavier, Sergio Salles

; Saraiva, Roberto Magalhães

; Sousa, Andréa Silvestre de

Revista da Sociedade Brasileira de Medicina Tropical

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2021, Volumen 54 elocation e0254-2021

Resumen: En | Texto: En | PDF: En

Abstract Chagas disease (CD) remains a serious endemic disease in Latin America and a major public health problem. Because of globalization, the disease has spread to non-endemic areas in the northern hemisphere. In the chronic phase of the disease, most patients present with the indeterminate form (IF), characterized by positive serology for Trypanosoma cruzi, absence of clinical findings, and normal findings in electrocardiogram (ECG). IF was not recognized as a clinical entity until decades after the discovery of the disease, and only in the 1940-50s, it was categorized as a form of CD, and its conceptual definition was ratified in the 1980s. Children, adolescents, and young adults with the IF benefit from etiological treatment and tend to have less progression to heart disease in the long term than the untreated ones. IF patients have an essentially benign clinical condition, and their prognosis can be compared to that of healthy individuals with normal ECG findings. Currently, because of aging, patients with the IF have comorbidities that require attention in health services.

https://doi.org/10.1590/0037-8682-0254-2021 108 descargas

11.

Notes on some Late Cretaceous goniasterid starfish (Echinodermata, Asteroidea) from Belgium and Germany
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Jagt, John W. M.

; Jagt-Yazykova, Elena A.

; Bakel, Barry W. M. Van

; Fraaije, René H. B.

Boletín de la Sociedad Geológica Mexicana

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2021, Volumen 73 Nº 3 elocation 00016

Resumen: En Es | Texto: En Es | PDF: En | PDF: Es

Abstract Both partially articulated specimens and dissociated marginal ossicles form the basis for erection of two new species of Late Cretaceous goniasterids from the Mons and Liège-Limburg basins (Belgium) and the Hannover area (Germany). Chomataster breizh sp. nov., which recalls the type species, Chomataster acules Spencer, 1913, but differs in several respects, is based on a partial external mould of the marginal frame of disc and arms in flint (upper Campanian Spiennes Chalk Formation; Mons Basin), as well as on a more or less complete individual, preserving small, spherical spines and granules and encased in a flint nodule from the upper Maastrichtian Nekum Member (Maastricht Formation; Liège-Limburg Basin). In Ch. breizh sp. nov., supero- and inferomarginals bear close-set granule pits, of varying sizes, as well as bivalved alveolar scars of pedicellariae; median superomarginals and all inferomarginals lack large, crater-shaped spine pits - such are found only in the disc/arm transition and along the arms. Dissociated supero- and inferomarginal ossicles from the lower and upper Campanian of the Hannover area and the upper Campanian of northeast Belgium, previously recorded either as indeterminate astropectinids or as Nymphaster obtusus (Forbes, 1848) var. nov. and as Nymphaster sp., respectively, here are assigned to Nymphaster mudzborgh sp. nov. This species is characterised by a row of 3-5 large spine pits on the aboral and lateral surfaces of superomarginals; inferomarginals have an angular profile and a close cover of granule pits. Nymphaster tethysiensis Villier, 2001, from the upper Campanian of Landes (southwest France; Villier and Odin, 2001) appears best accommodated in Chomataster as well, because in the arm superomarginals alternate rather than meet over the mid-radial line.

Resumen Los especímenes parcialmente articulados, así como los huesecillos marginales disociados sientan la base para establecer dos nuevas especies Goniasteridae del Cretácico tardío, provenientes de las cuencas de Mons y Liège-Limburg en Bélgica y del área de Hannover en Alemania. La especie Chomataster breizh sp. nov., que recuerda a la Chomataster acules (Spencer, 1913) pero difiere en varios aspectos, se basa en un molde externo parcial de la estructura marginal del disco y los brazos en sílex (Spiennes, cuenca de Mons, Formación de Tiza del Campaniano superior); así como un ejemplar más o menos completo con gránulos y espinas pequeñas y esféricas, encerrado dentro de un nódulo de sílex, el cual corresponde al miembro Nekum del Mastrichtiano superior (cuenta Liège-Limburg de la Formación Mastrichtiana). Los marginales supero e ínfero de la especie Ch. breizh sp. nov., tienen cavidades granulares cercanas y de diferentes tamaños, así como cicatrices alveolares en ambas valvas de los pedicellariae; los supero-marginales medianos y todos los ínfero carecen de cavidades espinales grandes en forma de cráter, las cuales solo se encuentran en la transición del disco al brazo y a lo largo de los brazos. Los huesecillos disociados de los supero e ínfero marginales corresponden al Campaniano inferior y superior del área de Hannover, y del Campaniano superior del noreste de Bélgica; éstos estaban previamente registrados como astropectínidos indeterminados: Nymphaster obtusus (Forbes, 1848) var.nov., y como Nymphaster sp., respectivamente, aquí se asignan a Nymphaster mudzborgh sp. nov. Esta especie se caracteriza por tener una hilera entre 3-5 cavidades grandes en la columna vertebral de las superficies aboral y lateral de los supero-marginales; en cambio, los ínfero-marginales tienen un perfil angular y una cubierta cerrada de cavidades granulares. El espécimen Nymphaster tethysiensis (Villier, 2001) del Campaniano superior de Landes (suroeste de Francia; Villier y Odin, 2001) sugiere pertenecer al Chomataster porque también los supero-marginales del brazo se alternan, en vez de encontrarse sobre la línea radial media.

https://doi.org/10.18268/bsgm2021v73n3a030321 20 descargas

12.

Influência de fatores abióticos sob miogênese de peixes teleósteos
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Sánchez Roncancio MSc, Charles Oswaldo

; da Silva Souza Tcng, PhD, José Gilmar

; Arias Vigoya PhD, Ángel Andrés

CES Medicina Veterinaria y Zootecnia

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Dic 2020, Volumen 15 Nº 3 Paginas 41 - 50

Resumen: Es En Pt | Texto: Es En Pt | PDF: Es | PDF: En | PDF: Pt

Resumen Los peces teleósteos son organismos que generalmente tienen un límite de crecimiento indeterminado y están presentes en diferentes biomas con diferentes características ambientales. Los teleósteos poseen hasta el 80% de su composición corporal compuesta de tejido muscular, compuesto por fibras musculares y células satélite indiferenciadas, formando un tejido muscular complejo cuya forma es muy variada dependiendo de las especies que componen este grupo de animales. Un punto importante por considerar es que el crecimiento muscular de los peces está influenciado por las condiciones ambientales en que están inseridos. Esta influencia ocurre a nivel molecular, afectando la transcripción y la funcionalidad de diferentes transcripciones relacionadas con la miogénesis en diferentes etapas del desarrollo de los peces. Esta revisión tiene como objetivo discutir algunos de los puntos clave sobre la influencia de los factores ambientales en el desarrollo y el crecimiento muscular de los peces.

Abstract Teleost fish are organisms that generally show an indeterminate growth limit and are present in different biomes with different environmental conditions. Approximately up to 80% of the body composition of fish is formed by muscle tissue. Muscle tissue is composed of muscle fibers and undifferentiated satellite cells, forming a complex tissue that shows a widely varied shape depending on the species which form this group of animals. An important point to be considered is that the muscle growth of the fish is influenced by the environmental conditions in which they are inserted. This influence occurs at the molecular level, affecting the transcription and functionality of different transcripts related to myogenesis at different stages of fish development. This review aims to discuss some of the key aspects about the influence of environmental factors on the development and muscle growth of teleost fish.

Resumo Os peixes teleósteos são organismos que, geralmente, apresentam limite de crescimento indeterminado e estão presentes em diferentes biomas com diversas características ambientais. Os teleósteos possuem até 80% de sua composição corporal formado por tecido muscular, composto por fibras musculares e células satélites indiferenciadas, formando um tecido muscular complexo cuja forma é muito variada em função das espécies que compõem este grupo de animais. Um ponto importante a ser considerado é que o crescimento muscular dos peixes é influenciado pelas condições ambientais em que estão inseridos. Esta influência ocorre à nível molecular afetando a transcrição e funcionalidade de diferentes transcritos relacionados à miogênese em diferentes fases do desenvolvimento dos peixes. Esta revisão tem o objetivo de discutir alguns dos pontos chave sobre a influência dos fatores ambientais sobre o desenvolvimento e crescimento muscular dos peixes.

https://doi.org/10.21615/cesmvz.15.3.3 28 descargas

13.

Clinical and epidemiological profile of patients in the chronic phase of Chagas disease treated at a reference center in Southeastern Brazil
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Zanella, Luiz Gonzaga Francisco de Assis Barros D'Elia

; Galiano, Isabela Walder

; Martins, Cintia Perinetti Alves

; Tokumo, Maurício Ossamu

; Suzuki, Rodrigo Buzinara

; Chagas, Eduardo Federighi Baisi

; Martins, Luciamáre Perinetti Alves

Revista de la Facultad de Medicina

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Sep 2020, Volumen 68 Nº 3 Paginas 391 - 398

Resumen: Es En | Texto: Es En | PDF: Es | PDF: En

Resumen Introducción. Luego de la implementación de medidas de control de la transmisión vectorial por Triatoma infestans en Brasil, hubo una reducción en el número de nuevos casos de la enfermedad de Chagas (EC). Actualmente, en el continente americano la incidencia anual de EC es de 28 000 casos, pero cabe señalar que aún existe una gran cantidad de adultos mayores que padecen los síntomas y signos de la fase crónica de esta enfermedad. Objetivo. Caracterizar el perfil clínico y epidemiológico de pacientes chagásicos en fase crónica atendidos en un centro de referencia ubicado en el estado de São Paulo, Brasil. Materiales y métodos. Estudio transversal y descriptivo. Se analizaron las historias clínicas de 62 pacientes chagásicos crónicos atendidos en el Hospital das Clínicas de Marília. Resultados. No hubo diferencias significativas con respecto a sexo, edad y tiempo de diagnóstico. Los problemas cardiacos fueron el signo clínico más reportado. Se observó una diferencia significativa en el caso de la forma indeterminada de la enfermedad, siendo más predominante en los hombres. Por otra parte, el estadio B1 fue más frecuente en las mujeres, mientras que el estadio B2 fue predominante en los hombres. Conclusión. El diagnóstico tardío de la EC puede aumentar la probabilidad de presentar complicaciones digestivas. Sin embargo, las manifestaciones clásicas de esta enfermedad y sus comorbilidades pueden ser controladas siempre que se cuente con atención médica integral (multidisciplinar), ya que de esta forma se retrasa su evolución y, en consecuencia, se mejora la calidad de vida de estos pacientes.

Abstract Introduction: After implementing measures to control vector transmission by Triatoma infestans in Brazil, the number of new cases of Chagas disease (CD) decreased. Currently, the American continent has an annual incidence of 28 000 cases, but a large number of older adults are still affected by the chronic phase of this disease. Objective: To characterize the clinical and epidemiological profile of patients in the chronic phase of CD treated at a reference center located in the state of São Paulo, Brazil. Materials and methods: A cross-sectional, descriptive study was conducted based on the analysis of the medical records of 62 patients in the chronic phase of CD and treated at the Hospital das Clínicas de Marília. Results: No significant differences were found regarding sex, age and time of diagnosis. Cardiac problems were the most reported clinical sign. A significant difference was observed in the case of the indeterminate form of the disease, which was more predominant in males. In addition, functional classification B1 of CD was more common in women, while B2 predominated in men. Conclusion: A late diagnosis of CD may increase the chances of presenting digestive complications. However, the classic manifestations of the disease and its comorbidities can be successfully managed as long as comprehensive (multidisciplinary) medical care is provided, since this would help delay the course of the disease and, consequently, improve the patients' quality of life.

https://doi.org/10.15446/revfacmed.v68n3.76191 218 descargas

14.

Use of tissue doppler imaging for the early detection of myocardial dysfunction in patients with the indeterminate form of Chagas disease
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Cianciulli, Tomás Francisco

; Saccheri, María Cristina

; Papantoniou, Alonso

; Méndez, Ricardo José

; Gagliardi, Juan Alberto

; Prado, Nilda Graciela

; Riarte, Adelina Rosa

; Morita, Luis Alberto

; Clérici, Javier Eduardo

; Lax, Jorge Alberto

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volumen 53 elocation e20190457

Resumen: En | Texto: En | PDF: En

Abstract INTRODUCTION: Chagas disease is one of the most common diseases in Latin America and heart involvement is the main cause of death. This study aimed to determine differences in tissue Doppler imaging (TDI) parameters in the assessment left and right ventricular function in patients with the indeterminate form of Chagas disease compared to those in healthy controls. METHODS: We compared 194 patients with the indeterminate form of Chagas disease to 72 age-matched healthy individuals. We considered p-values <0.05 to be statistically significant. RESULTS: TDI analysis of the right ventricular (RV) showed lengthened isovolumic relaxation time (IRT) and higher RV index of myocardial performance (RIMP) and left ventricle (LV) index of myocardial performance (LIMP) in the Chagas group than in the control group, indicating RV and LV systolic and diastolic myocardial damage. TDI analysis of the myocardial velocities of the interventricular septum and the lateral wall of the LV also showed a systolic and diastolic myocardial damage. CONCLUSIONS: The study results demonstrated early LV systolic and diastolic myocardial damage in the RV and LV in patients with the indeterminate form of Chagas disease by TDI. These early findings of RV and LV dysfunction may help identify patients who will progress to heart failure during the disease course. TDI should be included in initial patient evaluations because it allows adequate follow-up and treatment.

https://doi.org/10.1590/0037-8682-0457-2019 952 descargas

15.

Clinical and epidemiological aspects of chronic Chagas disease from Southern Brazil
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Lidani, Kárita Cláudia Freitas

; Sandri, Thaisa Lucas

; Castillo-Neyra, Ricardo

; Andrade, Fabiana Antunes

; Guimarães, Cesar Maistro

; Marques, Eduardo Nunes

; Beltrame, Marcia Holsbach

; Gilman, Robert Hugh

; Messias-Reason, Iara de

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volumen 53 elocation e20200225

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Abstract INTRODUCTION: Patients with Chagas disease (CD), caused by Trypanosoma cruzi, present a higher risk of developing other chronic diseases, which may contribute to CD severity. Since CD is underreported in the southern state of Paraná, Brazil, we aimed to characterize clinical and epidemiological aspects of individuals chronically infected with T. cruzi in Southern Brazil. METHODS: A community hospital-based study was performed, recording clinical/demographic characteristics of 237 patients with CD from Southern Brazil. To estimate the association between different forms of CD and sociodemographic and clinical variables, multiple logistic regression models were built using the Akaike information criterion. RESULTS: Mean age was 57.5 years and 59% were females. Most patients’ (60%) place of origin/birth was within Paraná and they were admitted to the CD outpatient clinic after presenting with cardiac/digestive symptoms (64%). The predominant form of CD was cardiac (53%), followed by indeterminate (36%), and digestive (11%). The main electrocardiographic changes were in the right bundle branch block (39%) and left anterior fascicular block (32%). The average number of comorbidities per patient was 3.9±2.3; systemic arterial hypertension was most common (64%), followed by dyslipidemia (34%) and diabetes (19%); overlapping comorbidities were counted separately. Male sex was associated with symptomatic cardiac CD (OR=2.92; 95%CI: 1.05-8.12; p=0.040). CONCLUSIONS: This study provided greater understanding of the distribution and clinical profile of CD patients in Southern Brazil, indicating a high prevalence of comorbidities among these patients who are a vulnerable group due to advanced age and substantial risk of morbidity.

https://doi.org/10.1590/0037-8682-0225-2020 548 descargas

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