Influence of blood pressure profile on frailty phenotype in community-dwelling elders in Brazil - FIBRA study.

Frailty is a clinical condition associated with pathological aging and biological vulnerability. In the spectrum of events related to frailty, aging of the cardiocirculatory system and abnormalities in arterial blood pressure (BP) partly explain the changes in tissue perfusion and, potentially, the decrease in physiological reserves. This study investigated the relationship between BP levels, systemic arterial hypertension (SAH) and the frailty phenotype by analyzing frailty criteria in a cross-sectional model into the FIBRA network, a populational sample of community-dwelling elders in Southeastern Brazil. Study participants with ≥65 years were selected by probabilistic sampling of residents in the urban area of the municipality of Campinas (n=900). Considering frailty as a whole and the difference between genders, there was a greater proportion of frail or pre-frail individuals among women than men. Analysis of individual frailty criteria showed that weight loss and fatigue were more common among women (18.3% vs. 12.5%, p=0.034 and 22.5% vs. 11.9%, p<0.001, respectively). Comparison of individuals with or without SAH failed to reveal any differences related to frailty criteria. Nevertheless, averages of diastolic blood pressure (DBP) and mean arterial blood pressure values were lower among elderly individuals with reduced grip strength, physical activity and the frailty classification as a whole (OR 0.986, IC 0.975-0.997) (for every 1 mmHg reduction in MBP values, the likelihood of being frail increased 1.4%). Our findings corroborate the relationship between BP values and frailty in the elderly and contribute to an understanding of the pathophysiological mechanisms of the syndrome.

Aetiological treatment with itraconazole or ketoconazole in individuals with Trypanosoma cruzi/HIV co-infection.

Two Brazilian cases of Trypanosoma cruzi/HIV co-infection have recently been treated with azole derivatives. Benznidazole, the drug generally used for the treatment of Chagas disease, was initially used in one case but discontinued because of an adverse effect (retrobulbar neuritis) and replaced by itraconazole. The other case had oesophageal candidiasis, which was treated with ketoconazole, a drug that had already been shown to be effective in the treatment of Chagas disease. Since the medications were effective in reducing the T. cruzi parasitaemia in both patients, they probably helped prevent the severe morbidity sometimes associated with Chagas disease, although the HIV infections still proved fatal in both cases.

Working conditions of Chagas' disease patients in a large Brazilian city.

This study evaluated the working conditions of Chagas' disease patients in the city of Campinas, São Paulo, focusing on two-hundred-fifty patients with steady employment and treated at the University Hospital (HC-FCM/Unicamp): 98% were working-age and 77.6% were men. The origin of the patients reflected the migratory process occurring among this population. Most of the patients had limited professional skills, while 63.6% had not finished primary school and 21.6% were illiterate. However, 63.6% were regularly employed under duly processed work contracts. Their jobs were mainly in general services (21.6%) and heavy industry (21.2%). Some 55% of the patients reported a monthly income less than or equal to U$100.00, and 40.4% reported having been fired at least once during the last ten years, in 8.9% of the cases because of a diagnosis of Chagas' disease. Of the patients undergoing pre-hiring physical examinations (57.2%), 9.1% were refused, 92.3% of whom due to positive serology for T. cruzi. Finally, 78.4% reported not belonging to a labor union. The study demonstrated the precarious working conditions and discrimination experienced by workers with Chagas' disease.

Serum cytokines in chronic Chagas' disease.

We studied the serum levels of IL-2, IFN-gamma and TNF in different clinical forms of Chagas' disease and in patients clinically compensated and decompensated. Cytokines measured in 91 patients with the chronic form of the disease did not differ from those of 13 normal individuals, suggesting the absence of activation of the TH1 pattern of lymphocyte response. There were no statistical differences among the 17 patients in the indeterminate form of the disease, the patients presenting either early (n = 4) or well-developed signs of cardiomyopathy (n = 62), the digestive (n = 4) or the mixed (n = 4) forms of the disease. Serum TNF was undetectable and IFN-gamma levels did not differ between clinical forms and severities of Chagas' disease. However, we found IL-2 higher levels in the 25 non-controlled patients than in the 66 controlled individuals (p < 0.001). We suggest that IL-2 dosage may be useful as an indicator of the need for more aggressive procedures.

[Clinical relationship between Chagas' disease and primary arterial hypertension at an outpatient referral service]. / Interação clínica entre moléstia de Chagas e hipertensão arterial primária em um serviço de referência ambulatorial.

PURPOSE: To evaluate the clinical relationship between Chagas' disease and primary arterial hypertension. METHODS: The study involved 878 chronic chagasic outpatients followed by the Chagas' Disease Study Group of the University Hospital (Unicamp), over a 15-year period. Initially, the age, gender, race, clinical form of Chagas' disease and the presence of hypertension were noted for each patient. Subsequently, the data for matched hypertensive and normotensive chagasic patients were compared. RESULTS: Of the chagasic patients 37% were hypertensive, of those, 65% had some form of heart disease compared to 49% in the normotensive group. Of those patients with Chagas' disease and arterial hypertension, 41% were blacks and 35% were caucasians. Fifty percent of the hypertensive chagasic patients were over 45 years old compared to only 29% of the non-hypertensive patients. CONCLUSION: Most of the hypertensive chagasic patients were 45 or more years old and showed some degree of heart failure compared to the normotensive group.

IL-12 enhances proliferation of peripheral blood mononuclear cells from Chagas' disease patients to Trypanosoma cruzi antigen.

Chagas' disease is caused by infection with Trypanosoma cruzi. Patients in the chronic phase of infection were grouped as belonging to the asymptomatic (or indeterminate), cardiac and cardiac plus digestive forms. Previous studies have described abnormal immune responsiveness by peripheral blood mononuclear cells (PBMC) from chronic chagasic patients. We report significant parasite antigen (T-Ag)-stimulated PBMC proliferative responses to be present in all three groups of patients. Treatment of T-Ag-stimulated cultures with rIL-12 significantly amplifies proliferative responses in all patients' groups, with similar rates of increment. IL-12 enhances T-Ag-specific lymphoproliferation without increasing proliferation of unstimulated PBMC from normal individuals or from patients. Comparatively, treatment with rIL-2 enhances both T-Ag-specific and unstimulated proliferation by PBMC from patients and normals. Thus, IL-12 acts on pre-activated cells while IL-2 also stimulates resting cells. No synergism was obtained by the combined use of IL-12 and IL-2. Therefore IL-12 can act as a more selective amplifier of T. cruzi reactive cells than IL-2. IL-12, by enhancing parasite-antigen specific immunity, could be of potential therapeutic use to control reactivated T. cruzi infections concomitant to AIDS or other situations of immunosuppression.

Chronotropic and blood pressure response to oral glucose load in Chagas' disease.

Cardiac chronotropic and pressor responses after an oral load of glucose were assessed in sixteen Chagasic subjects and 28 controls by means of blood pressure and pulse rate measurements. Cardiovascular response was correlated with serum insulin and glucose levels. The experiment identified a subgroup of Chagasic subjects (n = 8) with a hypoinsulinemic behavior presenting less chronotropic and pressor responses than controls. This may indicate a lower insulin activity and/or an early Autonomic Nervous System dysfunction in this subgroup.

Heterogenous insulin response to an oral glucose load by patients with the indeterminate clinical form of Chagas' disease.

This study was designed to investigate the behavior of serum glucose and insulin in response to an oral glucose load in chagasic patients with the indeterminate clinical form of the disease. Sixteen chagasic patients and 28 healthy control subjects were studied after an overnight fast and during 2 h after ingestion of 100 g glucose. There were no significant differences in serum glucose levels before and 2 h after the glucose load between chagasic and control subjects. However, in 8 chagasic patients, the total area under the insulin curve was significantly lower (2976 +/- 448 microU ml-1 120 min-1) than in the control (10123 +/- 995 microU ml-1 120 min-1) and in the remaining chagasic patients (9220 +/- 826 microU ml-1 120 min-1). These results suggest that the hypoinsulinemia of this subgroup of chagasic patients may be secondary to reduced insulin secretion and/or to increased peripheral insulin sensitivity probably related to autonomic dysfunction.

Heterogenous insulin response to an oral glucose load by patients with the indeterminate clinical form of Chagas' disease

This study was designed to investigate the behavior of serum glucose and insulin in response to an oral glucose load in chagasic patients with the indeterminate clinical form of the disease. Sixteen chagasic patients and 28 healthy control subjects were studied after an overnight fast and during 2 h after ingestion of 100 g glucose. There were no significant differences in serum glucose levels before and 2 h after the glucose load between chagasic and control subjects. However, in 8 chagasic patients, the total area under the insulin curve was significantly lower (2976 +/- 448 microU ml-1 120 min-1) than in the control (10123 +/- 995 microU ml-1 120 min-1) and in the remaining chagasic patients (9220 +/- 826 microU ml-1 120 min-1). These results suggest that the hypoinsulinemia of this subgroup of chagasic patients may be secondary to reduced insulin secretion and/or to increased peripheral insulin sensitivity probably related to autonomic dysfunction

[Chagas disease and primary arterial hypertension]. / Doença de Chagas e hipertensão arterial primária.

PURPOSE: To evaluate the pressoric behaviour in chagasic patients in different stages of myocardial damage and to correlate Chagas' disease with arterial hypertension. METHODS: The arterial blood pressure of 644 chagasic patients surveyed in the HC-UNICAMP, with arterial hypertension or not, associated with the stage of myocardial dysfunction was evaluated. This group was compared with 370 hypertensive patients without Chagas' disease. Both were divided by sex and age. The results were evaluated by covariance analysis and the significance was pointed at p < 0.05. RESULTS: The chagasic group presented a high prevalence of arterial hypertension with 16.8% in the clinical phase I, 27.8% in the phase II and 34% in the III. Both hypertensive and nonhypertensive chagasic patients had a significant drop in clinical phase I after the age of 30 years. The chagasic patients classified in phase II presented a high prevalence between 30-50 years, not associated with the pressoric behaviour and/or sex. The symptomatic myocardial dysfunction (phase III) was uncommon below 40 years old in chagasic group with hypertension or not, but presented a highest prevalence in male hypertensive chagasic patients above 50 years old. CONCLUSION: The study demonstrated a more usual association of Chagas' disease and hypertension in patients with symptomatic myocardial dysfunction, above 50 years old. This find evidenciates the somatory and progressive effect of both diseases. It is possible that the pathogenic mechanisms of Chagas' disease contributed to the increment of the arterial blood pressure.

[The experimental infection of Cebus apella sp. monkeys with Trypanosoma cruzi. Its clinical, electrocardiographic and anatomicopathological assessment]. / Infecção experimental de macacos Cebus apella sp. pelo Trypanosoma cruzi. Avaliaçao clínica, eletrocardiográfica e anatomopatológica.

Thirty-two monkeys were captured and adapted to laboratory conditions captives isolated. They were submitted to multiple xenodiagnosis which were negative. Twelve were infected intraperitoneally with different strains of T. cruzi (1.10(5) to 5.10(6)). Twenty were the control group. Between on to six years both the control group and the infected monkeys, were submitted to xenodiagnosis, serological testing clinical examination and electrocardiography. The clinical examination and the electrocardiogram were always normal. The monkey were autopsied and histological examination detected in the infected group four monkeys with evidence of disease: one with parasites in the tissue and three with chronic myocarditis. Parasitaemia was in 66.66% of the monkeys in the acute phase and the serology was positive in 91.66% in the chronic phase. The authors concluded that Cebus monkeys were not susceptible to the development of the disease but they could be utilized to maintain of such strains and studies of serological research in long-terms infections.

Tratamento da hipertensão arterial leve e moderada com baixas doses de captopril / Treatment of mild and moderate arterial hypertension with low doses of captopril

Quinze pacientes portadores da hipertensao arterial sem complicacoes, apos um periodo de 2 semanas de placebo, foram tratados com captopril (25-75 mg), isolado ou associado a diuretico tiazidico, por 8 semanas A pressao arterial media do periodo placebo era de 125,1 mmHg, caindo para 109,9 mmHg, apos as 8 semanas de captropril e diuretico. Esta diferenca foi estatisticamente significante p < 0,01. Doze destes pacientes usaram diuretico isoladamente durante 4 semanas, notando-se elevacao da pressao arterial media para 116,8 mmHg.Esta diferenca foi estatisticamente significante (p < 0,05). O estudo permitiu concluir que o captopril, isolado ou associado a diuretico, mostrou-se eficaz no tratamento da hipertensao arterial, pois normalizou a pressao arterial em 10 dos 15 pacientes estudados. Como uso isolado de diuretico, notou-se elevacao da pressao arterial em 9 dos 12 pacientes estudados