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Chagas disease is a tropical neglected disease that affects millions of people worldwide, still demanding a more effective and safer therapy, especially in its chronic phase which lacks a treatment that promotes substantial parasitological cure. The technical note of Romanha and collaborators published in 2010 aimed establish a guideline with the set of minimum criteria and decision gates for the development of new agents against Trypanosoma cruzi with the focus on developing new antichagasic drugs. In this sense, the present review aims to update this technical note, bringing the state of the art and new advances on this topic in recent years. worldwide therapy cure 201 drugs sense years 20 2

https://doi.org/10.1590/0074-02760240057

Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023 202 20 2
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Marin-Neto, José Antonio

; Rassi Jr, Anis

; Oliveira, Gláucia Maria Moraes

; Correia, Luís Claudio Lemos

; Ramos Júnior, Alberto Novaes

; Luquetti, Alejandro Ostermayer

; Hasslocher-Moreno, Alejandro Marcel

; Sousa, Andréa Silvestre de

; Paola, Angelo Amato Vincenzo de

; Sousa, Antônio Carlos Sobral

; Ribeiro, Antonio Luiz Pinho

; Correia Filho, Dalmo

; Souza, Dilma do Socorro Moraes de

; Cunha-Neto, Edecio

; Ramires, Felix Jose Alvarez

; Bacal, Fernando

; Nunes, Maria do Carmo Pereira

; Martinelli Filho, Martino

; Scanavacca, Maurício Ibrahim

; Saraiva, Roberto Magalhães

; Oliveira Júnior, Wilson Alves de

; Lorga-Filho, Adalberto Menezes

; Guimarães, Adriana de Jesus Benevides de Almeida

; Braga, Adriana Lopes Latado

; Oliveira, Adriana Sarmento de

; Sarabanda, Alvaro Valentim Lima

; Pinto, Ana Yecê das Neves

; Carmo, Andre Assis Lopes do

; Schmidt, Andre

; Costa, Andréa Rodrigues da

; Ianni, Barbara Maria

; Markman Filho, Brivaldo

; Rochitte, Carlos Eduardo

; Macêdo, Carolina Thé

; Mady, Charles

; Chevillard, Christophe

; Virgens, Cláudio Marcelo Bittencourt das

; Castro, Cleudson Nery de

; Britto, Constança Felicia De Paoli de Carvalho

; Pisani, Cristiano

; Rassi, Daniela do Carmo

; Sobral Filho, Dário Celestino

; Almeida, Dirceu Rodrigues de

; Bocchi, Edimar Alcides

; Mesquita, Evandro Tinoco

; Mendes, Fernanda de Souza Nogueira Sardinha

; Gondim, Francisca Tatiana Pereira

; Silva, Gilberto Marcelo Sperandio da

; Peixoto, Giselle de Lima

; Lima, Gustavo Glotz de

; Veloso, Henrique Horta

; Moreira, Henrique Turin

; Lopes, Hugo Bellotti

; Pinto, Ibraim Masciarelli Francisco

; Ferreira, João Marcos Bemfica Barbosa

; Nunes, João Paulo Silva

; Barreto-Filho, José Augusto Soares

; Saraiva, José Francisco Kerr

; Lannes-Vieira, Joseli

; Oliveira, Joselina Luzia Menezes

; Armaganijan, Luciana Vidal

; Martins, Luiz Cláudio

; Sangenis, Luiz Henrique Conde

; Barbosa, Marco Paulo Tomaz

; Almeida-Santos, Marcos Antonio

; Simões, Marcos Vinicius

; Yasuda, Maria Aparecida Shikanai

; Moreira, Maria da Consolação Vieira

; Higuchi, Maria de Lourdes

; Monteiro, Maria Rita de Cassia Costa

; Mediano, Mauro Felippe Felix

; Lima, Mayara Maia

; Oliveira, Maykon Tavares de

; Romano, Minna Moreira Dias

; Araujo, Nadjar Nitz Silva Lociks de

; Medeiros, Paulo de Tarso Jorge

; Alves, Renato Vieira

; Teixeira, Ricardo Alkmim

; Pedrosa, Roberto Coury

; Aras Junior, Roque

; Torres, Rosalia Morais

; Povoa, Rui Manoel dos Santos

; Rassi, Sergio Gabriel

; Alves, Silvia Marinho Martins

; Tavares, Suelene Brito do Nascimento

; Palmeira, Swamy Lima

; Silva Júnior, Telêmaco Luiz da

; Rodrigues, Thiago da Rocha

; Madrini Junior, Vagner

; Brant, Veruska Maia da Costa

; Dutra, Walderez Ornelas

; Dias, João Carlos Pinto

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 Nº 6 elocation e20230269

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

https://doi.org/10.36660/abc.20230269

Predictors of Trypanosoma cruzi PCR positivity in patients with chronic Chagas disease
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de Lima, Ana Carolina Bastos

; Mendes, Veronica Gonçalves

; Ferreira, Roberto Rodrigues

; Nisimura, Lindice Mitie

; Horita, Samuel Iwao Maia

; Veloso, Henrique H

; Costa, Andréa R

; da Silva, Gilberto Marcelo S

; Sangenis, Luiz Henrique C

; Holanda, Marcelo T

; Rimolo, Lorena

; Cunha, Ademir B

; Garzoni, Luciana Ribeiro

; Hasslocher-Moreno, Alejandro Marcel

; Mediano, Mauro Felippe F

; Moreira, Otacílio da Cruz

; Britto, Constança

; Saraiva, Roberto M

Memórias do Instituto Oswaldo Cruz

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2023, Volume 118 elocation e230115

Resumo: En | Texto: En | PDF: En

BACKGROUND A positive Trypanosoma cruzi polymerase chain reaction (PCR) is associated with a worse prognosis in patients with chronic Chagas disease (CD). OBJECTIVES To study the association of clinical, electrocardiographic, and echocardiographic characteristics and biomarker blood levels with positive T. cruzi PCR in chronic CD. METHODS This is a single-centre observational cross-sectional study. Positive T. cruzi PCR association with clinical, electrocardiographic, and echocardiographic characteristics, and biomarker blood levels were studied by logistic regression analysis. p values < 0.05 were considered significant. FINDINGS Among 333 patients with chronic CD (56.4% men; 62 ± 10 years), T. cruzi PCR was positive in 41.1%. Stepwise multivariate logistic regression showed an independent association between positive T. cruzi PCR and diabetes mellitus {odds ratio (OR) 0.53 [95% confidence interval (CI) 0.30-0.93]; p = 0.03}, right bundle branch block [OR 1.78 (95% CI 1.09-2.89); p = 0.02], and history of trypanocidal treatment [OR 0.13 (95% CI 0.04-0.38); p = 0.0002]. Among patients with a history of trypanocidal treatment (n = 39), only four (10%) patients had a positive T. cruzi PCR. MAIN CONCLUSIONS Among several studied parameters, only diabetes mellitus, right bundle branch block, and history of trypanocidal treatment showed an independent association with positive T. cruzi PCR. History of trypanocidal treatment was a strong protective factor against a positive T. cruzi PCR. (PCR . (CD) clinical electrocardiographic T singlecentre single centre crosssectional cross sectional analysis 005 0 05 0.0 significant 33 56.4% 564 56 4 (56.4 men 6 1 years, years , years) 411 41 41.1% odds OR (OR 053 53 0.5 95% 95 [95 (CI 0.300.93 030093 0.30 0.93 30 93 0.30-0.93] 0.03, 003 0.03 03 0.03} 178 78 1.7 (95 1.092.89 109289 1.09 2.89 09 2 89 1.09-2.89) 0.02, 002 0.02 02 0.02] 013 13 0.1 0.040.38 004038 0.04 0.38 04 38 0.04-0.38) 0.0002. 00002 0.0002 0002 0.0002] n 39, 39 39) 10% (10% parameters (CD 00 0. 3 56.4 5 (56. 41.1 9 [9 300 0.300.9 03009 030 0.3 093 0.9 0.30-0.93 17 7 1. (9 092 1.092.8 10928 109 1.0 289 2.8 8 1.09-2.89 01 040 0.040.3 00403 004 038 0.04-0.38 0000 0.000 000 (10 56. (56 41. [ 0.300. 0300 0.30-0.9 ( 1.092. 1092 28 2. 1.09-2.8 0.040. 0040 0.04-0.3 0.00 (1 (5 0.300 0.30-0. 1.092 1.09-2. 0.040 0.04-0. 0.30-0 1.09-2 0.04-0 0.30- 1.09- 0.04-

https://doi.org/10.1590/0074-02760230115

Inspiratory Muscle Strength in Chagas Cardiomyopathy: A Systematic Scoping Review Cardiomyopathy
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Mazzoli-Rocha, Flavia

; Diniz, Clara Pinto

; Rezende, Daniel Pereira Redes de

; Mendes, Fernanda de Souza Nogueira Sardinha

; Hasslocher-Moreno, Alejandro Marcel

; Sousa, Andréa Silvestre de

; Saraiva, Roberto Magalhães

; Borghi-Silva, Audrey

; Mediano, Mauro Felippe Felix

; Alexandre, Dângelo José de Andrade

Revista da Sociedade Brasileira de Medicina Tropical

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2023, Volume 56 elocation e0389-2023

Resumo: En | Texto: En | PDF: En

ABSTRACT The increase in inflammatory markers associated with persistent chronic fibrosing myocarditis, a characteristic of chronic Chagas disease, can result in a reduction in inspiratory muscle strength (IMS) in Chagas cardiomyopathy (CC). However, literature in this field is still scarce. This review aimed to map and summarize the evidence regarding IMS in patients with CC. The inclusion criteria included reports with adult participants with a CC diagnosis, with or without heart failure (HF). The core concept examined was the maximum inspiratory pressure evaluated in the untrained and trained groups in the pre-training period. The context was open, including but not limited to hospitals and health centers. Two authors independently identified eligible studies and extracted the data. Descriptive synthesis was used as the primary strategy for analyzing the results. Nine studies (five clinical trials, three cross-sectional, and one cohort) were included. The CC classification differed among the studies, with no mention of HF in five and no CC staging specification in six. IMS was assessed using a manovacuometer, and only six studies analyzed and interpreted the data concerning the predicted values. The CC population with HF appeared to have impaired IMS. All studies involved only Brazilian volunteers. In conclusion, randomized clinical trials evaluating IMS and the effects of inspiratory muscle training need to be conducted to better understand the prevalence and risk of inspiratory muscle weakness in the CC population, as well as the effects of training. Such studies should be conducted at different stages of CC in different populations and countries. myocarditis disease (IMS . (CC) However scarce diagnosis HF. (HF) pretraining pre period open centers results crosssectional, crosssectional cross sectional, sectional cross-sectional cohort manovacuometer values volunteers conclusion countries (CC (HF

https://doi.org/10.1590/0037-8682-0389-2023

Guidelines for Trypanosoma cruzi-HIV Co-infection and other Immunosuppressive Conditions: Diagnosis, Treatment, Monitoring, and Implementation from the International Network of Care and Studies - 2023 cruziHIV cruzi HIV Coinfection Co infection Conditions Diagnosis Treatment Monitoring 202 20 2
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Almeida, Eros Antonio de

; Mendes, Fernanda de Souza Nogueira Sardinha

; Ramos Júnior, Alberto Novaes

; Sousa, Andréa Silvestre de

; Pavan, Tycha Bianca Sabaini

; Mediano, Mauro Felippe Felix

; Ostermayer, Alejandro Luquetti

; Hasslocher-Moreno, Alejandro Marcel

; Britto, Constança Felicia De Paoli de Carvalho

; Novaes, Christina Gallafrio

; Correia, Dalmo

; Santos, Fred Luciano Neves

; Silva, Gilberto Marcelo Sperandio da

; Fernandez, Marisa Liliana

; Lima, Mayara Maia

; Carvalho, Noêmia Barbosa de

; Moreira, Otacílio da Cruz

; Albajar-Viñas, Pedro

; Leite, Ruth Moreira

; Palmeira, Swamy Lima

; Costa, Veruska Maia da

; Yasuda, Maria Aparecida Shikanai

Revista da Sociedade Brasileira de Medicina Tropical

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2023, Volume 56 elocation e0549-2023

Resumo: Pt | Texto: Pt | PDF: Pt

https://doi.org/10.1590/0037-8682-0549-2023

Exploring the Historical Background and Clinical Implications of Electrocardiogram in the Context of Chagas Disease Research
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Hasslocher-Moreno, Alejandro Marcel

; Saraiva, Roberto Magalhães

; Silva Júnior, Telêmaco Luiz da

; Xavier, Sergio Salles

; Sousa, Andréa Silvestre de

Revista da Sociedade Brasileira de Medicina Tropical

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2023, Volume 56 elocation e0506-2023

Resumo: En | Texto: En | PDF: En

ABSTRACT Chagas disease (CD) remains one of the most significant endemic diseases in Latin America. Approximately 30% of individuals with CD develop the cardiac form, the main determinant of morbidity and mortality, which is characterized by typical electrocardiogram (ECG) changes caused by chronic chagasic cardiopathy (CCC). This review accentuates to how crucial it is for research teams and reference centers that treat patients with CD to standardize ECG in CCC. This was a non-systematic review of the literature. ECG is the most widely used examination in the diagnosis and evaluation of CCC, and it is also employed in epidemiological surveys, risk stratification for cardiovascular events and death, and monitoring the clinical progression of the disease. Carlos Chagas and Eurico Villela published the first work addressing CCC in 1922. Other works followed, including the study by Evandro Chagas' which was the first to perform ECG in CD, culminating in Francisco Laranja's seminal work in 1956. Since the 1980s, standardizations and ECG reading codes for CD have been established. This standardization aimed to code complex arrhythmias and characteristic ventricular conduction disorders and standardize ECG readings for clinical and epidemiological studies in CD. Nearly all existing electrocardiographic abnormalities can be found in CD, with a predominance of abnormalities in the formation and conduction of cardiac stimuli. The complex and heterogeneous substrate of CD with varied electrocardiographic manifestations poses a significant challenge when comparing studies involving patients with CCC, emphasizing the need for ECG standardization in CD. (CD America 30 form mortality (ECG . (CCC) nonsystematic non systematic literature surveys death 1922 followed Laranjas Laranja s 1956 1980s established stimuli 3 (CCC 192 195 19 1

https://doi.org/10.1590/0037-8682-0506-2023

[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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Data de publicação: 2022-10-11

Resumo: 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

Chagas disease mortality during the coronavirus disease 2019 pandemic: A Brazilian referral center experience
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Hasslocher-Moreno, Alejandro Marcel

; Saraiva, Roberto Magalhães

; Silva, Gilberto Marcelo Sperandio da

; Xavier, Sergio Salles

; Sousa, Andréa Silvestre de

; Costa, Andrea Rodrigues da

; Mendes, Fernanda de Souza Nogueira Sardinha

; Mediano, Mauro Felippe Felix

Revista da Sociedade Brasileira de Medicina Tropical

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2022, Volume 55 elocation e0562-2021

Resumo: En | Texto: En | PDF: En

ABSTRACT Background We investigated the mortality rates of patients with Chagas disease (CD) during the coronavirus disease 2019 (COVID-19) pandemic and assessed the association between this mortality and CD clinical presentation and comorbidities. Methods: This was an observational retrospective study with clinical data retrieved from medical records. Results: Comorbidities were more prevalent among patients who died from COVID-19 than those who died from other causes. The proportion of patients according to CD clinical presentation was similar between the two groups. Conclusions: The prevalence of comorbidities seems to be related to a poorer prognosis in CD and COVID-19.

https://doi.org/10.1590/0037-8682-0562-2021

10.

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, Volume 55 elocation e0240-2022

Resumo: 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

11.

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, Volume 55 elocation e0713-2021

Resumo: En | Texto: En | PDF: En

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

12.

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, Volume 54 elocation e0040-2021

Resumo: 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 downloads

13.

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, Volume 54 elocation e0254-2021

Resumo: 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 downloads

14.

Adverse drug events and the associated factors in patients with chronic Chagas disease
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Lopes, Luiza Braz da Cunha

; Pereira, Raquel Rodrigues

; Andrade, Patricia Mello

; Carneiro, Fernanda Martins

; Mediano, Mauro Felippe Felix

; Kilgore, Sophia Isabel Linnemann

; Hasslocher-Moreno, Alejandro Marcel

; Sousa, Andréa Silvestre de

; Oliveira, Manoel Marques Evangelista

; Saraiva, Roberto Magalhães

; Holanda, Marcelo Teixeira de

; Silva, Gilberto Marcelo Sperandio da

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volume 53 elocation e20190443

Resumo: En | Texto: En | PDF: En

Abstract INTRODUCTION: Herein, we aimed to identify the factors associated with adverse drug events (ADEs) in chronic Chagas disease (CD) patients. METHODS: We analyzed 320 medical notes from 295 patients. The Naranjo algorithm was applied to determine the cause of ADEs. Mixed effects logistic regression was performed to evaluate the factors associated with ADEs. RESULTS: ADEs were described in 102 medical notes (31.9%). Captopril was most frequently associated with ADEs. Age (RR 0.96; 95%CI 0.94-0.99) and cardiac C/D stages (RR 3.24; 95%CI 1.30-4.58) were the most important clinical factors associated with ADEs. CONCLUSIONS: Close follow-up is warranted for CD patients.

https://doi.org/10.1590/0037-8682-0443-2019 452 downloads

15.

Agreement between upper endoscopy and esophagography in the diagnosis of megaesophagus in Chagas disease
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Barros, Fernando de

; Soares, João Carlos de Almeida

; Barros, Fernando Prado de

; Sangenis, Luiz Henrique Conde

; Silva, Gilberto Marcelo Sperandio da

; Fonseca, Ana Beatriz Monteiro

; Hasslocher-Moreno, Alejandro Marcel

; Sousa, Andrea Silvestre de

; Saraiva, Roberto Magalhães

; Mediano, Mauro Felippe Felix

Revista da Sociedade Brasileira de Medicina Tropical

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2019, Volume 52 elocation e20180258

Resumo: En | Texto: En | PDF: En

Abstract INTRODUCTION The diagnosis and classification of megaesophagus can be challenging in patients with Chagas disease. The present study aimed to evaluate the agreement between upper endoscopies and esophagographies for the diagnosis and classification of megaesophagus in Chagas disease. METHODS: A cross-sectional study of 50 patients with Chagas disease with upper digestive symptoms was undertaken. Esophagography and upper endoscopy exams were performed to compare diagnoses. Statistical analysis included sensitivity and specificity used to evaluate the diagnostic accuracy of upper endoscopies, and measures of agreement: linearly weighted Kappa (κw) and Cohen`s classical Kappa (κ) coefficients with 95% confidence intervals (95% CI). RESULTS: Twenty-three patients (46%) were diagnosed with megaesophagus by esophagography. The upper endoscopy sensitivity and specificity for megaesophagus diagnosis were 100% and 33.3%, respectively. Regarding megaesophagus classifications, there was a substantial agreement between the two exams (κw = 0.622; 95% CI: 0.498 to 0.746). Within megaesophagus groups, agreement for group I was slight (κ = 0.096; 95% CI: 0.000 to 0.403); for group II, substantial (κ = 0.703; 95% CI: 0.456 to 0.950); and for groups III and IV, inconclusive (κ = 0.457; 95% CI: 0.000 to 0.967; κ = 0.540; 95% CI: 0.035 to 1.000, respectively). CONCLUSIONS Upper endoscopy has a high sensitivity, but a low specificity to diagnose megaesophagus. Agreement between the two exams varies depending on the megaesophagus grade. Thus, upper endoscopy can be used in the diagnostic workup of a possible Chagas disease megaesophagus, but all identified cases should undergo esophagography.

https://doi.org/10.1590/0037-8682-0258-2018 1495 downloads

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