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PREVALENCE OF COMORBIDITIES IN PATIENTS WITH CHAGASIC MEGAESOPHAGUS
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PAIVA, Arthur Marot de

; REIS, Gabriel Baeta Branquinho

; PERILLO, Pedro Henrique de Ávila

; SOUZA, Diogo Henrique Saliba

; OLIVEIRA, Enio Chaves de

; REZENDE FILHO, Joffre

Arquivos de Gastroenterologia

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sep 2023, Volume 60 N. 3 Pages 322 - 329

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Objective: This study aimed to evaluate the prevalence of some epidemiologically important comorbidities in patients with Chagas megaoesophagus in relation to the population without megaoesophagus, and whether this condition would be a protective or a risk factor for the conditions analysed. Methods: This observational descriptive study collected data from the medical records of patients with a previous diagnosis of megaoesophagus (timing: from 2005 to 2020). The patients were divided by age into a general (all ages) and an older group (aged 60 years or more). Associations were searched for four main areas/systems/involvements: cardiovascular, respiratory, endocrine and neurological. Results: The general group included 546 patients and the older group included 248 patients. As for the prevalence of comorbidities in the general group, the three most prevalent diseases were hypertension, with 44.3% (CI95%: 40.21-48.51%); dyslipidaemia, with 17.8% (CI95%: 14.79-21.19%); and heart failure, with 15.2% (CI95%: 12.43-18.45%). Similar to that in the general group, the most prevalent comorbidities in the group of older patients were hypertension, dyslipidaemia, and heart failure. Conclusion: Systemic arterial hypertension, dyslipidaemia, and heart failure were the most prevalent comorbidities in this population. The lower prevalence of diabetes mellitus and Alzheimer’s disease suggests the association of enteric nervous system denervation and requires further investigation.

RESUMO Objetivo: Este estudo teve como objetivo avaliar a prevalência de algumas comorbidades epidemiologicamente importantes em pacientes com megaesôfago chagásico em relação à população sem o megaesôfago e se essa condição seria um fator protetor ou de risco para as condições analisadas. Métodos: Este estudo descritivo observacional coletou dados de prontuários de pacientes com diagnóstico prévio de megaesôfago (período: de 2005 a 2020). Os pacientes foram divididos por idade em um grupo geral (todas as idades) e um grupo idoso (60 anos ou mais). Foram pesquisadas associações para quatro áreas/sistemas/envolvimentos principais: cardiovascular, respiratório, endócrino e neurológico. Resultados: O grupo geral incluiu 546 pacientes e o grupo idosos incluiu 248 pacientes. Quanto à prevalência de comorbidades no grupo geral, as três doenças mais prevalentes foram hipertensão, com 44,3% (IC95%: 40,21-48,51%); dislipidemia, com 17,8% (IC95%: 14,79-21,19%); e insuficiência cardíaca, com 15,2% (IC95%: 12,43-18,45%). Assim como no grupo geral, as comorbidades mais prevalentes no grupo de idosos foram hipertensão, dislipidemia e insuficiência cardíaca. Conclusão: Hipertensão arterial sistêmica, dislipidemia e insuficiência cardíaca foram as comorbidades mais prevalentes nessa população. A menor prevalência de diabetes mellitus e doença de Alzheimer sugere uma associação de denervação do sistema nervoso entérico e requer mais investigação.

https://doi.org/10.1590/s0004-2803.230302023-29

Prediction and prevention of preeclampsia Number 1 - January 2023
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Peixoto Filho, Fernando Maia

; Costa, Fabrício da Silva

; Kobayashi, Sergio

; Beitune, Patricia El

; Garrido, Adriana Gualda

; Carmo, Anselmo Verlangieri

; Rezende, Guilherme de Castro

; Werner Junior, Heron

; Amin Junior, Joffre

; Leão, Jorge Roberto Di Tommaso

; Nardozza, Luciano Marcondes Machado

; Machado, Luiz Eduardo

; Sarno, Manoel Alfredo Curvelo

; Ferreira Neto, Pedro Pires

; Becker Júnior, Eduardo

Revista Brasileira de Ginecologia e Obstetrícia

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2023, Volume 45 N. 1 Pages 49 - 54

Abstract: En | Text: En | PDF: En

https://doi.org/10.1055/s-0043-1763495

Immunotherapy in the treatment of chemoresistant gestational trophoblastic neoplasia - systematic review with a presentation of the first 4 Brazilian cases
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Braga, Antonio

; Balthar, Elaine

; Souza, Laís Cristhine Santos

; Samora, Michelle

; Rech, Matheus

; Madi, José Mauro

; Amim Junior, Joffre

; Rezende Filho, Jorge

; Elias, Kevin M.

; Horowitz, Neil S.

; Sun, Sue Yazaki

; Berkowitz, Ross S.

Clinics

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2023, Volume 78 elocation 100260

Abstract: En | Text: En | PDF: En

Abstract Objective To evaluate the efficacy of immunotherapy for GTN treatment after methotrexate-resistance or in cases of multiresistant disease, through a systematic review, as well as to present the first 4 Brazilian cases of immunotherapy for GTN treatment. Methods Three independent researchers searched five electronic databases (EMBASE, LILACS, Medline, CENTRAL and Web of Science), for relevant articles up to February/2023 (PROSPERO CRD42023401453). The quality assessment was performed using the Newcastle Ottawa scale for case series and case reports. The primary outcome of this study was the occurrence of complete remission. The presentation of the case reports was approved by the Institutional Review Board. Results Of the 4 cases presented, the first was a low-risk GTN with methotrexate resistance unsuccessfully treated with avelumab, which achieved remission with sequential multiagent chemotherapy. The remaining 3 cases were high-risk multiagent-resistant GTN that were successfully treated with pembrolizumab, among which there were two subsequent gestations, one of them with normal pregnancy and healthy conceptus. Regarding the systematic review, 12 studies were included, only one of them on avelumab, showing a 46.7% complete remission rate. The remaining 11 studies were on pembrolizumab, showing an 86.7% complete remission rate, regardless of tumor histology. Both immunotherapies showed good tolerability, with two healthy pregnancies being recorded: one after avelumb and another after pembrolizumab. Conclusion Immunotherapy showed effectiveness for GTN treatment and may be especially useful in cases of high-risk disease, where pembrolizumab achieves a high therapeutic response, regardless of the histological type, and despite prior chemoresistance to multiple lines of treatment.

https://doi.org/10.1016/j.clinsp.2023.100260

DIAGNOSIS AND MANAGEMENT OF CHRONIC IDIOPATHIC CONSTIPATION: A NARRATIVE REVIEW FROM A BRAZILIAN EXPERT TASK FORCE
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PASSOS, Maria do Carmo Friche

; ALVARIZ, Ricardo Cerqueira

; ANDRÉ, Eduardo Antonio

; BARBUTI, Ricardo Correa

; FILLMANN, Henrique Sarubbi

; MURAD-REGADAS, Sthela Maria

; REZENDE FILHO, Joffre

; PERROTTI, Marcos

; GUEDES, Luciana

Arquivos de Gastroenterologia

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mar 2022, Volume 59 N. 1 Pages 137 - 144

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Contexto A constipação idiopática crônica (CIC) é uma condição que afeta amplamente a população global, representa um grande custo econômico, causa substancial utilização de recursos em saúde e impacta o bem-estar do indivíduo. Objetivo Revisar os consensos de Sociedades de especialistas e diretrizes publicados sobre o diagnóstico e tratamento da CIC em adultos, buscando auxiliar o raciocínio e a tomada de decisão para a conduta médica frente ao paciente e oferecer um material prático de referência. Métodos Uma força tarefa médica brasileira realizou uma busca na literatura científica nas bases de dados eletrônicos Medline/PubMed, SciELO, Embase e Cochrane, tendo sido utilizados os seguintes descritores: chronic constipation, diagnosis, management of chronic constipation. Adicionalmente, foi realizada uma revisão de artigos sobre o mecanismo de ação, segurança e eficácia das opções terapêuticas disponíveis no Brasil. Resultados A abordagem diagnóstica e o entendimento da fisiopatologia presente na CIC são itens fundamentais para que seja indicada a terapêutica apropriada e seja compreendido o ecossistema de necessidades do paciente. Conclusão A CIC é uma condição comum em adultos, ocorrendo com maior frequência em idosos e mulheres. O manejo correto é definido pela anamnese e exame físico detalhados, juntamente com a terapêutica apropriada, independentemente de ser farmacológica ou não, conforme o melhor momento de indicação. Desta forma, o impacto na qualidade de vida também é otimizado.

ABSTRACT Background Chronic idiopathic constipation (CIC) is a condition that widely affects the global population, represents relevant healthcare resource utilization and costs, and impacts the individual’s well-being. Objective To review the consensus of expert societies and published guidelines on the diagnosis and treatment of CIC in adults, seeking to assist reasoning and decision-making for medical management of patients with CIC and provide a practical reference material. Methods A Brazilian medical task force searched the scientific literature in the following electronic databases: MEDLINE/PubMed, SciELO, EMBASE and Cochrane, using the following descriptors: chronic constipation, diagnosis, management of chronic constipation. In addition, a review of articles on the mechanism of action, safety, and efficacy of therapeutic options available in Brazil was carried out. Results The diagnostic approach and the understanding of the pathophysiology present in CIC are essential items to indicate the appropriate therapy and to understand the ecosystem of the patient’s needs. Conclusion CIC is a common condition in adults, occurring more frequently in the elderly and in women. Proper management is defined by detailed medical history and physical examination, together with appropriate therapeutics, regardless pharmacological or not, and depending on the best moment of indication. This way, the impact on quality of life is also optimized.

https://doi.org/10.1590/s0004-2803.202200001-23

Good practices for ultrasound examinations in gynecology and obstetrics during the COVID-19 pandemic
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Peixoto Filho, Fernando Maia

; Garrido, Adriana Gualda

; Carmo, Anselmo Verlangieri

; Becker Júnior, Eduardo

; Rezende, Guilherme de Castro

; Werner Junior, Heron

; Amin Junior, Joffre

; Leão, Jorge Roberto Di Tommaso

; Nardozza, Luciano Marcondes Machado

; Machado, Luiz Eduardo

; Sarno, Manoel Alfredo Curvelo

; Beitune, Patricia El

; Ferreira Neto, Pedro Pires

; Kobayashi, Sergio

; Costa, Fabricio da Silva

Revista Brasileira de Ginecologia e Obstetrícia

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jan 2021, Volume 43 N. 1 Pages 74 - 79

Abstract: En | Text: En | PDF: En

https://doi.org/10.1055/s-0041-1723082 194 downloads

TRANSCUTANEOUS MULTICHANNEL ELECTROGASTROGRAPHY: NORMAL PARAMETERS IN A BRAZILIAN POPULATION
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CARVALHO, Nayara Salgado

; BAIMA, Diego Cardoso

; BARBUTI, Ricardo Correa

; CARVALHO, Paulo Jose Pereira Campos

; REZENDE FILHO, Joffre

; NAVARRO-RODRIGUEZ, Tomas

Arquivos de Gastroenterologia

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dec 2020, Volume 57 N. 4 Pages 428 - 433

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO CONTEXTO: Eletrogastrografia (EGG) é técnica não invasiva que avalia a atividade miolétrica gástrica utilizando eletrodos localizados na superfície abdominal. Alterações na atividade miolétrica gástrica podem estar associadas a distúrbios como gastroparesia, dispepsia funcional, náuseas e vômitos recorrentes. No Brasil, não há estudos até o momento que tenham avaliado a atividade miolétrica gástrica pela EGG multicanal transcutânea em indivíduos saudáveis. OBJETIVO: Estabelecer valores de normalidade da EGG multicanal transcutânea em indivíduos brasileiros saudáveis. MÉTODOS: Este foi um estudo prospectivo, incluindo 20 indivíduos saudáveis submetidos a EGG. O registro foi realizado em dois períodos: um período pré-prandial foi registrado por 30 minutos, e um período pós-prandial por 30 minutos após a ingesta de uma dieta de prova com consistência sólida e pastosa de 400 kcal (20 gramas de proteínas, 60 gramas de carboidratos e 9 gramas de gordura). RESULTADOS: Foram avaliados os parâmetros de frequência dominante (FD), distribuição da % de FD, coeficiente de instabilidade e “power ratio” (PR). Foram incluídos 20 indivíduos (11 mulheres e 9 homens) com idade média de 39,5 +/- 7,4 anos. A FD média (95%CI) variou de 2,4 a 3,1 cpm no período de basal (pré-prandial) e de 2,6 a 3,2 cpm no período pós-prandial. A % da FD na faixa de normogastria foi >70% em todos os indivíduos saudáveis. Identificamos que apenas um indivíduo não apresentou resposta positiva a refeição de prova, e os outros 19 indivíduos apresentaram PR>1. O coeficiente de instabilidade não mudou significativamente com a ingesta da refeição de prova. CONCLUSÃO: A EGG multicanal transcutânea pode ser aplicada em estudos futuros para a avaliar distúrbios da motilidade gástrica na população brasileira.

ABSTRACT BACKGROUND: Electrogastrography (EGG) is a noninvasive technique for the assessment of gastric myoelectrical activity using electrodes placed on the abdominal surface. Changes in gastric myoelectrical activity may be associated with diseases such as gastroparesis, functional dyspepsia, nausea, and recurrent vomiting. In Brazil, no studies to date have assessed gastric myoelectrical activity using multichannel EGG in healthy individuals. OBJECTIVE: To establish normal values of transcutaneous multichannel EGG in healthy Brazilian individuals. METHODS: This was a prospective study including 20 healthy individuals who underwent EGG. Recording was performed during two periods: a preprandial recording was performed for 30 minutes, and a postprandial recording was performed for 30 minutes after a soft-solid meal of 400 kcal (20 grams of proteins, 60 grams of carbohydrates, and 9 grams of fat). RESULTS: We assessed dominant frequency (DF) parameters, %DF distribution, the instability coefficient, and the power ratio (PR). A total of 20 individuals (11 women and 9 men) with a mean age of 39.5±7.4 years were included. Mean DF (95%CI) ranged from 2.4 to 3.1 cpm in the resting phase and 2.6 to 3.2 cpm in the postprandial period. The %DF in normogastria range was >70% in all healthy individuals. We identified that only one individual did not present a positive response to the test meal, and the other 19 individuals showed a PR greater than 1. The instability coefficient did not change significantly with meal intake. CONCLUSION: Multichannel EGG may be applied in future studies to evaluate gastric motility disorders in the Brazilian population.

https://doi.org/10.1590/s0004-2803.202000000-78 627 downloads

2 nd Brazilian Consensus on Chagas Disease, 2015
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Dias, João Carlos Pinto

; Ramos Jr., Alberto Novaes

; Gontijo, Eliane Dias

; Luquetti, Alejandro

; Shikanai-Yasuda, Maria Aparecida

; Coura, José Rodrigues

; Torres, Rosália Morais

; Melo, José Renan da Cunha

; Almeida, Eros Antonio de

; Oliveira Jr., Wilson de

; Silveira, Antônio Carlos

; Rezende, Joffre Marcondes de

; Pinto, Fabiane Scalabrini

; Ferreira, Antonio Walter

; Rassi, Anis

; Fragata Filho, Abílio Augusto

; Sousa, Andréa Silvestre de

; Correia, Dalmo

; Jansen, Ana Maria

; Andrade, Glaucia Manzan Queiroz

; Britto, Constança Felícia De Paoli de Carvalho

; Pinto, Ana Yecê das Neves

; Rassi Jr., Anis

; Campos, Dayse Elisabeth

; Abad-Franch, Fernando

; Santos, Silvana Eloi

; Chiari, Egler

; Hasslocher-Moreno, Alejandro Marcel

; Moreira, Eliane Furtado

; Marques, Divina Seila de Oliveira

; Silva, Eliane Lages

; Marin-Neto, José Antonio

; Galvão, Lúcia Maria da Cunha

; Xavier, Sergio Salles

; Valente, Sebastião Aldo da Silva

; Carvalho, Noêmia Barbosa

; Cardoso, Alessandra Viana

; Silva, Rafaella Albuquerque e

; Costa, Veruska Maia da

; Vivaldini, Simone Monzani

; Oliveira, Suelene Mamede

; Valente, Vera da Costa

; Lima, Mayara Maia

; Alves, Renato Vieira

Revista da Sociedade Brasileira de Medicina Tropical

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dec 2016, Volume 49 Suppl. 1 Pages 3 - 60

Abstract: En | Text: En | PDF: En

Abstract Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research .

https://doi.org/10.1590/0037-8682-0505-2016 9267 downloads

Clinical and radiological correlations in patients with gestational trophoblastic disease
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Lima, Lana de Lourdes Aguiar

; Parente, Raphael Câmara Medeiros

; Maestá, Izildinha

; Amim Junior, Joffre

; Rezende Filho, Jorge Fonte de

; Montenegro, Carlos Antonio Barbosa

; Braga, Antônio

Radiologia Brasileira

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aug 2016, Volume 49 N. 4 Pages 241 - 250

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Doença trofoblástica gestacional é anomalia da gravidez que engloba um grupo de doenças derivadas do trofoblasto, diferentes entre si na propensão para regressão, invasão, metástase e recidiva. No passado, era comum a paciente portadora de gravidez molar apresentar sintomas exuberantes: hemorragia copiosa, cistos tecaluteínicos, útero aumentado para a idade gestacional, pré-eclâmpsia precoce, hiperêmese e hipertireoidismo. Atualmente, com o diagnóstico precoce feito pela ultrassonografia, a maioria das pacientes é diagnosticada ainda na fase assintomática. Nos casos em que há progressão para neoplasia trofoblástica gestacional, o estadiamento feito com a dopplerfluxometria pélvica e a radiografia de tórax, eventualmente com a tomografia computadorizada e a ressonância magnética, é fundamental na avaliação da escolha do tratamento antineoplásico. Por ser uma doença incomum e grave, que acomete mulheres no menacme, mas cujo tratamento adequado determina elevadas taxas de cura, é fundamental que os radiologistas estejam familiarizados com essa entidade clínica, a fim de auxiliar no diagnóstico precoce e promover seu correto acompanhamento imaginológico.

Abstract Gestational trophoblastic disease is an abnormality of pregnancy that encompasses a group of diseases that differ from each other in their propensity for regression, invasion, metastasis, and recurrence. In the past, it was common for patients with molar pregnancy to present with marked symptoms: copious bleeding; theca lutein cysts; uterus larger than appropriate for gestational age; early preeclampsia; hyperemesis gravidarum; and hyperthyroidism. Currently, with early diagnosis made by ultrasound, most patients are diagnosed while the disease is still in the asymptomatic phase. In cases of progression to trophoblastic neoplasia, staging-typically with Doppler flow studies of the pelvis and chest X-ray, although occasionally with computed tomography or magnetic resonance imaging-is critical to the choice of an appropriate antineoplastic therapy regimen. Because it is an unusual and serious disease that affects women of reproductive age, as well as because its appropriate treatment results in high cure rates, it is crucial that radiologists be familiar with gestational trophoblastic disease, in order to facilitate its early diagnosis and to ensure appropriate follow-up imaging.

https://doi.org/10.1590/0100-3984.2015.0073 16517 downloads

Cesarean section by maternal request
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CÂMARA, RAPHAEL

; BURLÁ, MARCELO

; FERRARI, JOSÉ

; LIMA, LANA

; AMIM JUNIOR, JOFFRE

; BRAGA, ANTONIO

; REZENDE FILHO, JORGE

Revista do Colégio Brasileiro de Cirurgiões

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aug 2016, Volume 43 N. 4 Pages 301 - 310

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A cesariana a pedido materno é aquela realizada em uma gestante sem indicações médicas e sem contraindicação para tentativa do parto vaginal. Existe grande controvérsia sobre a realização da cesariana a pedido. Riscos potenciais da cesariana a pedido incluem complicações em gravidezes subsequentes, tais como: rotura uterina, placenta prévia e acretismo. Potenciais benefícios da cesariana a pedido englobam um menor risco de hemorragia pós-parto na primeira cesariana e menos complicações cirúrgicas quando comparada ao parto vaginal. A cesariana a pedido jamais deve ser realizada antes de 39 semanas.

ABSTRACT Cesarean section by maternal request is the one performed on a pregnant woman without medical indication and without contraindication to vaginal delivery. There is great controversy over requested cesarean section. Potential risks include complications in subsequent pregnancies, such as uterine rupture, placenta previa and accreta. Potential benefits of requested cesareans include a lower risk of postpartum hemorrhage in the first cesarean and fewer surgical complications compared with vaginal delivery. Cesarean section by request should never be performed before 39 weeks.

https://doi.org/10.1590/0100-69912016004002 26875 downloads

10.

II Consenso Brasileiro em Doença de Chagas, 2015
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Dias, João Carlos Pinto

; Ramos Jr., Alberto Novaes

; Gontijo, Eliane Dias

; Luquetti, Alejandro

; Shikanai-Yasuda, Maria Aparecida

; Coura, José Rodrigues

; Torres, Rosália Morais

; Melo, José Renan da Cunha

; Almeida, Eros Antonio de

; Oliveira Jr., Wilson de

; Silveira, Antônio Carlos

; Rezende, Joffre Marcondes de

; Pinto, Fabiane Scalabrini

; Ferreira, Antonio Walter

; Rassi, Anis

; Fragata Filho, Abílio Augusto

; Sousa, Andréa Silvestre de

; Correia Filho, Dalmo

; Jansen, Ana Maria

; Andrade, Glaucia Manzan Queiroz

; Britto, Constança Felícia De Paoli de Carvalho

; Pinto, Ana Yecê das Neves

; Rassi Jr., Anis

; Campos, Dayse Elisabeth

; Abad-Franch, Fernando

; Santos, Silvana Eloi

; Chiari, Egler

; Hasslocher-Moreno, Alejandro Marcel

; Moreira, Eliane Furtado

; Marques, Divina Seila de Oliveira

; Silva, Eliane Lages

; Marin-Neto, José Antonio

; Galvão, Lúcia Maria da Cunha

; Xavier, Sergio Salles

; Valente, Sebastião Aldo da Silva

; Carvalho, Noêmia Barbosa

; Cardoso, Alessandra Viana

; Silva, Rafaella Albuquerque e

; Costa, Veruska Maia da

; Vivaldini, Simone Monzani

; Oliveira, Suelene Mamede

; Valente, Vera da Costa

; Lima, Mayara Maia

; Alves, Renato Vieira

Epidemiologia e Serviços de Saúde

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jun 2016, Volume 25 N. spe Pages 7 - 86

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A doença de Chagas é uma condição crônica negligenciada com elevada carga de morbimortalidade e impacto dos pontos de vista psicológico, social e econômico. Representa um importante problema de saúde pública no Brasil, com diferentes cenários regionais. Este documento traduz a sistematização das evidências que compõe o Consenso Brasileiro de Doença de Chagas. O objetivo foi sistematizar estratégias de diagnóstico, tratamento, prevenção e controle da doença de Chagas no país, de modo a refletir as evidências científicas disponíveis. Sua construção fundamentou-se na articulação e contribuição estratégica de especialistas brasileiros com conhecimento, experiência e atualização sobre diferentes aspectos da doença. Representa o resultado da estreita colaboração entre a Sociedade Brasileira de Medicina Tropical e o Ministério da Saúde. Espera-se com este documento fortalecer o desenvolvimento de ações integradas para enfrentamento da doença no país com foco em epidemiologia, gestão, atenção integral (incluindo famílias e comunidades), comunicação, informação, educação e pesquisas.

ABSTRACT Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

https://doi.org/10.5123/s1679-49742016000500002 63592 downloads

11.

II Consenso Brasileiro em Doença de Chagas, 2015
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Dias, João Carlos Pinto

; Ramos Jr., Alberto Novaes

; Gontijo, Eliane Dias

; Luquetti, Alejandro

; Shikanai-Yasuda, Maria Aparecida

; Coura, José Rodrigues

; Torres, Rosália Morais

; Melo, José Renan da Cunha

; Almeida, Eros Antonio de

; Oliveira Jr., Wilson de

; Silveira, Antônio Carlos

; Rezende, Joffre Marcondes de

; Pinto, Fabiane Scalabrini

; Ferreira, Antonio Walter

; Rassi, Anis

; Fragata Filho, Abílio Augusto

; Sousa, Andréa Silvestre de

; Correia Filho, Dalmo

; Jansen, Ana Maria

; Andrade, Glaucia Manzan Queiroz

; Britto, Constança Felícia De Paoli de Carvalho

; Pinto, Ana Yecê das Neves

; Rassi Jr., Anis

; Campos, Dayse Elisabeth

; Abad-Franch, Fernando

; Santos, Silvana Eloi

; Chiari, Egler

; Hasslocher-Moreno, Alejandro Marcel

; Moreira, Eliane Furtado

; Marques, Divina Seila de Oliveira

; Silva, Eliane Lages

; Marin-Neto, José Antonio

; Galvão, Lúcia Maria da Cunha

; Xavier, Sergio Salles

; Valente, Sebastião Aldo da Silva

; Carvalho, Noêmia Barbosa

; Cardoso, Alessandra Viana

; Silva, Rafaella Albuquerque e

; Costa, Veruska Maia da

; Vivaldini, Simone Monzani

; Oliveira, Suelene Mamede

; Valente, Vera da Costa

; Lima, Mayara Maia

; Alves, Renato Vieira

Epidemiologia e Serviços de Saúde

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jun 2016, Volume 25 N. spe. Pages 7 - 86

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5123/S1679-49742016000500002 3725 downloads

12.

Neoplasia trofoblástica gestacional após normalização espontânea da gonadotrofina coriônica humana em paciente com mola hidatiforme parcial
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Matos, Michelle

; Ferraz, Leda

; Lopes, Patrícia de Fátima

; Lozoya, Consuelo

; Amim Junior, Joffre

; Rezende-Filho, Jorge

; Braga, Antonio

Revista Brasileira de Ginecologia e Obstetrícia

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jul 2015, Volume 37 N. 7 Pages 339 - 343

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Neste relato, é apresentado um caso de neoplasia trofoblástica gestacional após normalização espontânea de gonadotrofina coriônica humana em paciente com mola hidatiforme parcial. Trata-se da segunda ocorrência publicada desse evento e a primeira em que há comprovação imuno-histoquímica. No bojo dessa apresentação, ademais de mostrar o tratamento para essa intercorrência da gravidez, discute-se a possibilidade de redução da duração do seguimento pós-molar, assim como estratégias para o precoce reconhecimento da neoplasia trofoblástica gestacional após a remissão espontânea da gravidez molar.

We report here a case of gestational trophoblastic neoplasia after spontaneous normalization of human chorionic gonadotropin in a patient with a partial hydatidiform mole. This is the second occurrence of this event to be reported and the first one with proven immunohistochemical evidence. Besides showing the treatment for this pregnancy complication, this case report discusses the possibility of reducing the duration of post-molar follow-up, as well as strategies for early recognition of gestational trophoblastic neoplasia after spontaneous remission of molar pregnancy.

https://doi.org/10.1590/S0100-720320150005318 5290 downloads

13.

THE DEPARTURE OF A BRAZILIAN MASTER OF GASTROENTEROLOGY
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REZENDE FILHO, Joffre

Arquivos de Gastroenterologia

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jun 2015, Volume 52 N. 2 Pages 81 - 82

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https://doi.org/10.1590/S0004-28032015000200001 1391 downloads

14.

Current epidemiological profile of Chagasic megaesophagus in Central Brazil
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Souza, Diogo Henrique Saliba de

; Vaz, Maria da Gloria Merheb

; Fonseca, Cristiano Rezio

; Luquetti, Alejandro

; Rezende Filho, Joffre

; Oliveira, Enio Chaves de

Revista da Sociedade Brasileira de Medicina Tropical

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jun 2013, Volume 46 N. 3 Pages 316 - 321

Abstract: En | Text: En | PDF: En

Introduction Chagasic megaesophagus (CM) is the most common digestive manifestation of Chagas disease in Brazil, and the State of Goiás is one of the most affected regions. In recent decades, the Hospital das Clínicas (HC)/Universidade Federal de Goiás (UFG) has been a reference center for the study and treatment of CM. The objective of this study was to characterize the current epidemiological profile of patients with CM observed at the HC of the UFG from 1998 to 2010. Methods In total, 939 patient records were analyzed, and age, gender, place of birth, serology, symptoms and radiological classification according to Rezende et al. were analyzed. Results The median patient age was 55 years. Male patients were more (54%) prevalent than female patients. The prevalence of younger patients (less than 31 years of age) was 4.2%, but 82.1% of the younger patients were from State of Bahia. Patients older than 40 years were the majority (85.5%). The radiological groups were distributed as follows: Group I (35.9%), Group II (32.9%), Group III (17%) and Group IV (14.2%). Conclusions Compared with previous studies by the same group in 1975, 1994 and 1995, the number of younger patients decreased, and the frequency curve has shifted to older patients.

https://doi.org/10.1590/0037-8682-0065-2013 2885 downloads

15.

Occurrence of dolichocolon without megacolon in chronic Chagas disease patients
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Castro, Cleudson

; Hernandez, Esperanza Bernal

; Rezende, Joffre

; Prata, Aluizio

Revista da Sociedade Brasileira de Medicina Tropical

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jun 2012, Volume 45 N. 3 Pages 353 - 356

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: Desde 1970, suspeita-se que o alongamento do retossigmoide pode ocorrer como manifestação isolada da colopatia chagásica. MÉTODOS: Para testar esta hipótese, 210 pacientes soropositivos e 63 soronegativos fizeram enema opaco e as radiografias nas posições ântero-posterior e póstero-anterior foram lidas sem conhecimento dos dados clínicos e sorológicos. O comprimento do cólon distal foi medido com curvímetro, percorrendo-se o eixo central da imagem, do ânus à crista ilíaca. RESULTADOS: O diagnóstico de dolicocólon foi estabelecido em 31 (14,8%) pacientes soropositivos e 3 (4,8%) soronegativos. O comprimento médio nos pacientes soropositivos foi de 57,2 (±12,2)cm, enquanto nos soronegativos foi de 52,1 (±8,8)cm (p=0,000), isto é, os chagásicos apresentaram o cólon distal em média 5,1cm maior. Os indivíduos do sexo feminino soropositivos exibiram comprimento médio de 58,8 (±12,3)cm, e os soronegativos de 53,2 (±9,1)cm, (p=0,002). Nos pacientes do sexo masculino soropositivos, o comprimento médio foi de 55 (±11,6)cm, enquanto nos soronegativos foi de 49,9 (±7,8)cm (p=0,02). Nos 191 pacientes, sem megacólon e suspeitos de megacólon, o comprimento médio foi de 56,3 (±11,6)cm nos soropostivos e 52 (±8,8)cm nos soronegativos (p=0,003). Dos indivíduos com cólon distal >70cm, os 31 chagásicos tiveram comprimento médio de 77,9 (±7,1)cm, enquanto nos três não chagásicos foi de 71,3 (±1,1)cm, (p=0,000). Nos 179 com cólon distal <70cm, os soropositivos tiveram em média 53,6 (±8,8)cm, e os soronegativos 51,2 (±7,8)cm, (p=0,059). Dentre os com sorologia positiva, as mulheres apresentaram cólon distal maior que os homens (p=0,02), enquanto naqueles com sorologia negativa o comprimento médio foi igual (p=0,16). CONCLUSÕES: Nas áreas endêmicas do Brasil Central, o dolicocólon solitário é um sinal radiológico da doença de Chagas.

INTRODUCTION: Since 1970, lengthening of the rectosigmoid has been suspected to be a solitary manifestation of Chagas colopathy. METHODS: To test this hypothesis, opaque enema was administered on 210 seropositive and 63 seronegative patients, and radiographs in the anteroposterior and posteroanterior positions were examined blind to the serological and clinical findings. The distal colon was measured using a flexible ruler along the central axis of the image from the anus to the iliac crest. RESULTS: Dolichocolon was diagnosed in 31 (14.8%) seropositive and 3 (4.8%) seronegative patients. The mean length was 57.2 (±12.2)cm in seropositive patients and 52.1 (±8.8)cm in the seronegative patients (p = 0.000), that is, the distal colon in Chagas patients was, on average, 5.1cm longer. Seropositive female patients presented a mean length of 58.8 (±12.3)cm, and seronegative female patients presented 53.2 (±9.1)cm (p = 0.002). Seropositive male patients had a mean length of 55 (±11.6)cm, and seronegative male patients had 49.9 (±7.8)cm (p = 0.02). Among 191 patients without megacolon and suspected megacolon, the mean length was 56.3 (±11.6)cm in seropositive individuals and 52 (±8.8)cm in seronegative patients (p = 0.003). Among individuals with distal colon >70cm, there were 31 Chagas patients with mean length of 77.9 (±7.1)cm and three seronegative with 71.3 (±1.1)cm (p = 0.000). Among 179 with distal colon <70cm, seropositive individuals had a mean length of 53.6 (±8.8)cm, and seronegative patients had 51.2 (±7.8)cm (p = 0.059). Serological positive women had longer distal colon than men (p = 0.02), whereas the mean length were the same among seronegative individuals (p = 0.16). CONCLUSIONS: In endemic areas of Brazil Central, solitary dolichocolon is a radiological Chagas disease signal.

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