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[This corrects the article DOI: 10.1371/journal.pntd.0009809.].
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OBJECTIVE: Chagas disease (CD) globalization facilitated the co-infection with Human Immunodeficiency Virus (HIV) in endemic and non-endemic areas. Considering the underestimation of Trypanosoma cruzi (T. cruzi)-HIV co-infection and the risk of life-threatening Chagas Disease Reactivation (CDR), this study aimed to analyze the major co-infection clinical characteristics and its mortality rates. METHODS: This is a cross-sectional retrospective multicenter study of patients with CD confirmed by two serological or one parasitological tests, and HIV infection confirmed by immunoblot. CDR was diagnosed by direct microscopy with detection of trypomastigote forms in the blood or other biological fluids and/or amastigote forms in inflammatory lesions. RESULTS: Out of 241 patients with co-infection, 86.7% were from Brazil, 47.5% had <200 CD4+ T cells/µL and median viral load was 17,000 copies/µL. Sixty CDR cases were observed. Death was more frequent in patients with reactivation and was mainly caused by CDR. Other causes of death unrelated to CDR were the manifestation of opportunistic infections in those with Acquired Immunodeficiency Syndrome. The time between the co-infection diagnosis to death was shorter in patients with CDR. Lower CD4+ cells count at co-infection diagnosis was independently associated with reactivation. Similarly, lower CD4+ cells numbers at co-infection diagnosis and male sex were associated with higher lethality in CDR. Additionally, CD4+ cells were lower in meningoencephalitis than in myocarditis and milder forms. CONCLUSION: This study showed major features on T. cruzi-HIV co-infection and highlighted the prognostic role of CD4+ cells for reactivation and mortality. Since lethality was high in meningoencephalitis and all untreated patients died shortly after the diagnosis, early diagnosis, immediate antiparasitic treatment, patient follow-up and epidemiological surveillance are essentials in T. cruzi/HIV co-infection and CDR managements.
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Doença de Chagas/mortalidade , Coinfecção/mortalidade , Atenção à Saúde , Infecções por HIV/mortalidade , Terapia de Imunossupressão , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/mortalidade , Adulto , Brasil/epidemiologia , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos , Doença de Chagas/parasitologia , Coinfecção/parasitologia , Estudos Transversais , Gerenciamento de Dados , Feminino , Infecções por HIV/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Trypanosoma cruzi , Carga ViralRESUMO
This study evaluated the characteristics of 125 Chagas disease patients aged > 25 years or over who were attended at the Clinical Hospital of the State University of Campinas, State of São Paulo. Arterial pressure, age, gender, skin color, heart disease, body mass index, lipid profile, blood glucose level, alcohol and tobacco dependence, dyslipidemia, diabetes, anxiety disorders and obesity were investigated. It was found that the hypertensive Chagas disease patients were older than the non-hypertensive ones (p = 0.028). Among the hypertensive patients, there were more women (p = 0.015); higher blood glucose, LDL cholesterol and total cholesterol levels (p = 0.005, p = 0.024 and p = 0.017); more diabetics (p = 0.006); and more cardiac damage (p = 0.04) and left ventricular hypertrophy (p = 0.003). Only the age of patients with cardiac damage was shown to be higher (p = 0.003). The hypertensive Chagas disease patients presented clinical and laboratory characteristics that were similar to those of the general hypertensive population. This association may compound the harmful effects on the cardiovascular system.
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Doença de Chagas/complicações , Hipertensão/complicações , Fatores Etários , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/fisiopatologia , Doença de Chagas/fisiopatologia , Doença Crônica , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
Chagas disease (Cd) is the third most common parasitic disease that causes damage to human health. Even a century after its description by Carlos Chagas and advances in its control, it remains a neglected disease. To eradicate the parasite or reduce the parasitic load, specific treatment for Trypanosoma cruzi (T. cruzi) is advisable; benznidazole (BNZ) is the drug that is currently prescribed. The purpose of this study is to report the adverse events (AE) due to the use of BNZ as a specific treatment for Cd, with a particular focus on hepatic changes. This was an observational, cross-sectional cohort study that included patients who were treated with BNZ. The medical records of patients who joined the Grupo de Estudo em doença de Chagas [Chagas Disease Study Group]/UNICAMP/Brazil and were treated with BNZ were reviewed for epidemiological, clinical, laboratory and AE parameters for the drug. The 204 patients who were assessed had an average age of 40.6 years ± 13.5 years, and 104 of them were women (50.98%). Fourteen (6.86%) individuals were in the acute phase of Cd, and 190 (93.13%) were in its chronic phase. AEs occurred in 85 patients (41.66%), 35 (41.17%) of whom had AEs related to the liver, characterized by an elevation of AST liver enzymes, ALT, alkaline phosphatase and gamma-glutamyltransferase (γGT). Other AEs that were observed included the following: 48 cases of cutaneous changes (56.47%), 8 cases of epigastric pain (9.41%), 7 cases of blood alteration (8.23%), and 3 cases of peripheral neuropathy (3.52%). Treatment was interrupted in 32 patients (37.64%) due to AD. Adverse events related to the liver secondary to the use of BNZ for Cd-specific treatment were frequent in this study and were characterized by an elevation of liver enzymes. Therefore, it is suggested that these enzymes be monitored during treatment with benznidazole.
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Redes Comunitárias/história , Modelos Teóricos , Mitologia , Rede Social/história , História Antiga , HumanosRESUMO
INTRODUCTION: Chagas disease (CD) prevention and control rely on studies of its distribution, characteristics of individuals affected and mode of transmission. CD data in Brazil are scarce; a retrospective analysis of the clinical characteristics of 80 patients treated at the Clinical Hospital of UNICAMP, Campinas, Brazil, was performed. METHODS: Patient data records were analyzed. RESULTS: Thirty percent of the patients probably got infected through vector-borne transmission, 65% came from endemic areas, a predominance of cardiac and cardiodigestive forms was found among males, and the cardiac form prevailed (51%). CONCLUSIONS: The results update the view on the epidemiology of CD in Campinas, Brazil.
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Doença de Chagas , Registros Hospitalares/estatística & dados numéricos , Brasil/epidemiologia , Doença de Chagas/diagnóstico , Doença de Chagas/tratamento farmacológico , Doença de Chagas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos RetrospectivosRESUMO
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 .
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Doença de Chagas , Consenso , Brasil/epidemiologia , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Doença de Chagas/terapia , Doença de Chagas/transmissão , HumanosRESUMO
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.
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Doença de Chagas/diagnóstico , Doença de Chagas/terapia , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/terapia , Brasil/epidemiologia , Doença de Chagas/mortalidade , Doença de Chagas/transmissão , Doença Crônica , Consenso , Gerenciamento Clínico , Humanos , Doenças Negligenciadas/mortalidade , Doenças Negligenciadas/prevenção & controle , Saúde Pública , Medicina TropicalRESUMO
OBJECTIVE: To compare the effects of atorvastatin, fluvastatin, pravastatin, and simvastatin on endothelial function, aortic atherosclerosis, and the content of malondialdehyde (MDA) in native and oxidized LDL and in the arterial wall of hypercholesterolemic rabbits after adjusting the dosages of those statins to reduce total serum cholesterol levels to similar values. METHODS: Male rabbits were divided into the following 6 groups of 10 animals (n=10): 1) GH (control)--hypercholesterolemic animals; 2) GA--atorvastatin; 3) GF--fluvastatin; 4) GP--pravastatin; 5) GS--simvastatin; and 6) GN--normal. The animals were fed a standard food preparation enriched with 0.5% cholesterol and 2% coconut oil for 45 days. Fifteen days after beginning the experiment, atorvastatin, fluvastatin, pravastatin and simvastatin were administered for 15 days through gavage, and the dosages were adjusted to obtain similar cholesterol values in each group. At the end of the experiment, a blood sample was withdrawn for determining total cholesterol and separating the lipoproteins, and a segment of the thoracic aorta was removed to be used for studying endothelial function and lipid peroxidation, and for measuring aortic atherosclerosis in histological sections. RESULTS: The statins significantly reduced total serum cholesterol levels, LDL-cholesterol levels, and aortic atherosclerosis. The MDA content was also significantly reduced in native and oxidized LDL, as well as in the arterial wall. Endothelium-dependent relaxation was significantly greater in the treated group compared with that in the hypercholesterolemic group. CONCLUSION: The statins, at dosages adjusted, had a significant and similar effect in reducing lipid peroxidation in native and oxidized LDL-C and in arterial walls, in decreasing aortic atherosclerosis, and in reverting endothelial dysfunction.
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Anticolesterolemiantes/farmacologia , Doenças da Aorta/tratamento farmacológico , Arteriosclerose/tratamento farmacológico , Endotélio Vascular/efeitos dos fármacos , Hipercolesterolemia/tratamento farmacológico , Peroxidação de Lipídeos/efeitos dos fármacos , Animais , Doenças da Aorta/metabolismo , Doenças da Aorta/fisiopatologia , Arteriosclerose/metabolismo , Arteriosclerose/fisiopatologia , Atorvastatina , Colesterol/sangue , LDL-Colesterol/sangue , LDL-Colesterol/efeitos dos fármacos , Endotélio Vascular/metabolismo , Endotélio Vascular/fisiopatologia , Ácidos Graxos Monoinsaturados/farmacologia , Fluvastatina , Ácidos Heptanoicos/farmacologia , Hipercolesterolemia/metabolismo , Hipercolesterolemia/fisiopatologia , Indóis/farmacologia , Masculino , Malondialdeído/análise , Pravastatina/farmacologia , Pirróis/farmacologia , Coelhos , Sinvastatina/farmacologiaRESUMO
BACKGROUND: In pathological situations, such as acute myocardial infarction, disorders of motility of the proximal gut can trigger symptoms like nausea and vomiting. Acute myocardial infarction delays gastric emptying (GE) of liquid in rats. OBJECTIVE: Investigate the involvement of the vagus nerve, α 1-adrenoceptors, central nervous system GABAB receptors and also participation of paraventricular nucleus (PVN) of the hypothalamus in GE and gastric compliance (GC) in infarcted rats. METHODS: Wistar rats, N = 8-15 in each group, were divided as INF group and sham (SH) group and subdivided. The infarction was performed through ligation of the left anterior descending coronary artery. GC was estimated with pressure-volume curves. Vagotomy was performed by sectioning the dorsal and ventral branches. To verify the action of GABAB receptors, baclofen was injected via icv (intracerebroventricular). Intravenous prazosin was used to produce chemical sympathectomy. The lesion in the PVN of the hypothalamus was performed using a 1 mA/10 s electrical current and GE was determined by measuring the percentage of gastric retention (% GR) of a saline meal. RESULTS: No significant differences were observed regarding GC between groups; vagotomy significantly reduced % GR in INF group; icv treatment with baclofen significantly reduced %GR. GABAB receptors were not conclusively involved in delaying GE; intravenous treatment with prazosin significantly reduced GR% in INF group. PVN lesion abolished the effect of myocardial infarction on GE. CONCLUSION: Gastric emptying of liquids induced through acute myocardial infarction in rats showed the involvement of the vagus nerve, alpha1- adrenergic receptors and PVN.
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Esvaziamento Gástrico/fisiologia , Infarto do Miocárdio/fisiopatologia , Núcleo Hipotalâmico Paraventricular/fisiopatologia , Receptores Adrenérgicos alfa 1/fisiologia , Receptores de GABA-B/fisiologia , Nervo Vago/fisiopatologia , Antagonistas de Receptores Adrenérgicos alfa 1/farmacologia , Animais , Baclofeno/farmacologia , Agonistas dos Receptores de GABA-B/farmacologia , Gastroparesia/fisiopatologia , Masculino , Infarto do Miocárdio/complicações , Prazosina/farmacologia , Ratos Wistar , Fatores de Tempo , VagotomiaRESUMO
BACKGROUND: Pitavastatin is the newest statin available in Brazil and likely the one with fewer side effects. Thus, pitavastatin was evaluated in hypercholesterolemic rabbits in relation to its action on vascular reactivity. OBJECTIVE: To assess the lowest dose of pitavastatin necessary to reduce plasma lipids, cholesterol and tissue lipid peroxidation, as well as endothelial function in hypercholesterolemic rabbits. METHODS: Thirty rabbits divided into six groups (n = 5): G1 - standard chow diet; G2 - hypercholesterolemic diet for 30 days; G3 - hypercholesterolemic diet and after the 16th day, diet supplemented with pitavastatin (0.1 mg); G4 - hypercholesterolemic diet supplemented with pitavastatin (0.25 mg); G5 - hypercholesterolemic diet supplemented with pitavastatin (0.5 mg); G6 - hypercholesterolemic diet supplemented with pitavastatin (1.0 mg). After 30 days, total cholesterol, HDL, triglycerides, glucose, creatine kinase (CK), aspartate aminotransferase (AST), alanine aminotransferase (ALT) were measured and LDL was calculated. In-depth anesthesia was performed with sodium thiopental and aortic segments were removed to study endothelial function, cholesterol and tissue lipid peroxidation. The significance level for statistical tests was 5%. RESULTS: Total cholesterol and LDL were significantly elevated in relation to G1. HDL was significantly reduced in G4, G5 and G6 when compared to G2. Triglycerides, CK, AST, ALT, cholesterol and tissue lipid peroxidation showed no statistical difference between G2 and G3-G6. Significantly endothelial dysfunction reversion was observed in G5 and G6 when compared to G2. CONCLUSION: Pitavastatin starting at a 0.5 mg dose was effective in reverting endothelial dysfunction in hypercholesterolemic rabbits.
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Endotélio Vascular/efeitos dos fármacos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Hipercolesterolemia/tratamento farmacológico , Quinolinas/farmacologia , Experimentação Animal , Animais , Aorta Torácica/efeitos dos fármacos , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hipercolesterolemia/sangue , Peroxidação de Lipídeos/efeitos dos fármacos , Masculino , Quinolinas/administração & dosagem , Coelhos , Triglicerídeos/sangueRESUMO
Abstract INTRODUCTION: Chagas disease (CD) prevention and control rely on studies of its distribution, characteristics of individuals affected and mode of transmission. CD data in Brazil are scarce; a retrospective analysis of the clinical characteristics of 80 patients treated at the Clinical Hospital of UNICAMP, Campinas, Brazil, was performed. METHODS: Patient data records were analyzed. RESULTS: Thirty percent of the patients probably got infected through vector-borne transmission, 65% came from endemic areas, a predominance of cardiac and cardiodigestive forms was found among males, and the cardiac form prevailed (51%). CONCLUSIONS: The results update the view on the epidemiology of CD in Campinas, Brazil.
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Humanos , Masculino , Feminino , Registros Hospitalares/estatística & dados numéricos , Doença de Chagas/diagnóstico , Doença de Chagas/tratamento farmacológico , Doença de Chagas/epidemiologia , Brasil/epidemiologia , Prevalência , Estudos Retrospectivos , Pessoa de Meia-IdadeRESUMO
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.
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INTRODUCTION: The co-infection Trypanosoma cruzi/HIV has been described as a clinical event of great relevance. The objective of this study was to describe clinical and epidemiological aspects published in literature. METHODS: It is a systematic review of a descriptive nature from the databases Medline, Lilacs, SciELO, Scopus, from 1980 to 2010. RESULTS: There were 83 articles (2.8 articles/year) with a total of 291 cases. The co-infection was described in 1980 and this situation has become the defining AIDS clinical event in Brazil. This is the country with the highest number of publication (51.8%) followed by Argentina (27.7%). The majority of cases are amongst adult men (65.3%) native or from endemic regions with serological diagnosis in the chronic stage (97.9%) and indeterminate form (50.8%). Both diseases follow the normal course, but in 41% the reactivation of the Chagas disease occurs. The most severe form is the meningoencephalitis, with 100% of mortality without specific and early treatment of the T. cruzi. The medication of choice was the benznidazole on doses and duration normally used for the acute phase. The high parasitemia detected by direct or indirect quantitative methods indicated reactivation and its elevation is the most important predictive factor. The lower survival rate was related to the reactivation of the Chagas disease and the natural complications of both diseases. The role of the antiretroviral treatment on the co-infection cannot yet be defined by the knowledge currently existent. CONCLUSIONS: Despite the relevance of this clinical event there are still gaps to be filled.
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Doença de Chagas/complicações , Coinfecção , Infecções por HIV/complicações , Doença Aguda , Adulto , Idoso , Terapia Antirretroviral de Alta Atividade , Doença de Chagas/tratamento farmacológico , Doença de Chagas/imunologia , Doença Crônica , Coinfecção/tratamento farmacológico , Coinfecção/imunologia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Nitroimidazóis/uso terapêutico , Parasitemia/tratamento farmacológico , Parasitemia/imunologia , Tripanossomicidas/uso terapêutico , Adulto JovemRESUMO
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.
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.
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Humanos , Masculino , Feminino , Doença de Chagas/diagnóstico , Doença de Chagas/prevenção & controle , Doença de Chagas/epidemiologia , Brasil , Conferência de Consenso , Doença de Chagas/terapia , Doença de Chagas/transmissãoRESUMO
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.
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JUSTIFICATIVA E OBJETIVO: Em função das medidas empregadas logrou-se interromper a transmissão da doença de Chagas. A partir daí surgiu um novo desafio, que é o de prestar assistência adequada aos indivíduos que envelhecem na condição de portadores crônicos dessa doença infecciosa, que se soma às outras enfermidades crônicas mais prevalentes na velhice, e que podem comprometer a funcionalidade do idoso. Esse estudo buscou estimar a funcionalidade desses indivíduos. MÉTODOS: Procedeu-se à avaliação da capacidade funcional, da função cognitiva e do estado de humor, junto a um grupo de 95 chagásicos, adultos e idosos, assistidos no Ambulatório do Grupo de Estudos em Doenças de Chagas (GEDoCh) do Hospital de Clínicas da Universidade Estadual de Campinas. A funcionalidade foi confrontada com variáveis sociodemográficas (faixa etária, gênero, escolaridade e renda) e clínicas (forma clínica da doença de Chagas, número de comorbidades e fármacos utilizados, saúde e incapacidade funcional autorreferidas). RESULTADOS: Verificou-se déficit cognitivo em 37,34% da amostra, sintomas depressivos em 26,31%, comprometimento das atividades instrumentais em 34,73%, e de atividades básicas de vida diária em 26,31%. Constatou-se associação de déficit de funcionalidade com percepção de incapacidade funcional (p=0,002)e maior número de comorbidades (p=0,038). CONCLUSÃO: Adultos e idosos chagásicos apresentam importante comprometimento da funcionalidade, em diferentes domínios. O autorrelato de incapacidade funcional e o maior número de doenças associadas podem representar indicadores relevantes desse tipo de comprometimento.
BACKGROUND AND OBJECTIVES: The measures employed succeeded in interrupting the transmission of Chagas disease. From there emerged a new challenge, which is to provide appropriate assistance to individuals that are aging with this chronic infectious disease, whose effects added to the other chronic diseases more prevalent in old age, with the possibility of compromising their functionality. This study intended to estimate the functionality of these individuals. METHODOS: It was evaluated the functional ability, as well as the cognitive function and mood status of a group of 95 infected persons, adults and seniors, assisted in the Ambulatory of Chagas Disease Study Group from the State University Hospital of Campinas (SP). The functionality was confronted with socio-demographic (age, gender, education and income) and clinical variables (clinical form of Chagas disease, number of comorbidities and medicines used, self-referred health and functional incapacity). RESULTS: It was found cognitive deficit in 37.34% of the sample, depressive symptoms in 26.31%, commitment of instrumental activities in 34.73%, and of basic activities of daily life in 26.31%. It was noted association of deficit functionality with perception of functional disability (p=0.002) and higher number of comorbidities (p=0.038). CONCLUSION: Adults and seniors with Chagas disease present important impairment of functionality in different domains. The self-report of functional incapacity and the greatest number of associated diseases may represent relevant indicators of this kind of commitment.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Adulto , Idoso , Brasil , Doença de Chagas/complicações , Atividades Cotidianas , Comorbidade , Cognição/fisiologiaRESUMO
Objective The objective was to evaluate the perceived quality of life of adult and older adult patients with different clinical forms of Chagas disease. Methods This descriptive and cross-sectional research was conducted between 2005 and 2008. Data were collected from 202 patients. The World Health Organization Quality of Life-BREF was used to assess the quality of life domains. Statistical analyses included descriptive analysis, and univariate and multivariate logistic regression analyses. Results Of the 202 interviewed patients, 53.96% were female; 68.81% were aged £60 years, 66.83% presented the cardiac form, 11.39% presented the digestive form, and 21.78% had the indeterminate form. Patients with the cardiac and digestive forms were more likely to report lower quality of life in the physical, psychological, and social relationships domains than those with the indeterminate form. In the environment domain, women and those with more comorbidities had lower scores. Conclusion The social relationships domain received the highest scores, followed by the psychological and physical domains. The environment domain received the lowest scores. Comparing the scores of the World Health Organization Quality of Life-BREF domains by age group (adults and older adults) in relation to the clinical form, gender, and number of comorbidities, quality of life did not differ significantly in any of the study subgroups.
Objetivo Avaliar a percepção da qualidade de vida em pacientes adultos e idosos nas diferentes formas clínicas da doença de Chagas. Métodos Trata-se de estudo descritivo e transversal realizado entre 2005 e 2008. A amostra por conveniência foi composta de 202 pacientes. Utilizou-se o World Health Organization Quality of Life-BREF para avaliar os domínios da qualidade de vida. A análise estatística foi realizada por meio de análises descritiva e de regressão logística univariada e multivariada. Resultados Do total da amostra, 53,96% eram mulheres; 68,81% tinham idade 60 anos, 68,83% apresentavam a forma cardíaca; 11,39% a digestiva; e 21,78% a indeterminada. Portadores das formas cardíaca e digestiva evidenciaram maior chance de relatar baixa qualidade de vida nos domínios físico, psicológico e das relações sociais quando comparados aos pacientes com a forma indeterminada. No domínio do meio ambiente, as mulheres e os que tinham maior número de comorbidades apresentaram pontuação mais baixa. Conclusão O domínio das relações sociais foi o melhor avaliado, seguido pelos domínios psicológico e físico. Já o do meio ambiente foi o pior avaliado. Comparando os escores dos domínios do World Health Organization Quality of Life-BREF com a faixa etária (adultos e idosos) em relação à forma clínica, ao gênero e ao número de comorbidades, nenhuma diferença significativa foi encontrada em qualquer um dos subgrupos estudados.