How people affected by Chagas disease have struggled with their negligence: history, associative movement and World Chagas Disease Day.

It is well documented that Chagas disease (CD) can pose a public health problem to countries. As one of the World Health Organization Neglected Tropical Diseases undoubtedly calls for comprehensive healthcare, transcending a restricted biomedical approach. After more than a century since their discovery, in 1909, people affected by CD are still frequently marginalised and/or neglected. The aim of this article is to tell the story of their activism, highlighting key historical experiences and successful initiatives, from 1909 to 2019. The first association was created in 1987, in the city of Recife, Brazil. So far, thirty associations have been reported on five continents. They were created as independent non-profit civil society organisations and run democratically by affected people. Among the common associations' objectives, we notably find: increase the visibility of the affected; make their voice heard; build bridges between patients, health system professionals, public health officials, policy makers and the academic and scientific communities. The International Federation of Associations of People Affected by CD - FINDECHAGAS, created in 2010 with the input of the Americas, Europe and the Western Pacific, counts as one of the main responses to the globalisation of CD. Despite all the obstacles and difficulties encountered, the Federation has thrived, grown, and matured. As a result of this mobilisation along with the support of many national and international partners, in May 2019 the 72nd World Health Assembly decided to establish World Chagas Disease Day, on 14 April. The associative movement has increased the understanding of the challenges related to the disease and breaks the silence around Chagas disease, improving surveillance, and sustaining engagement towards the United Nations 2030 agenda.

Mapping the morbidity and mortality of Chagas disease in an endemic area in Brazil.

Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients' care.

Is a negative correlation between sTNFR1 and TNF in patients with chronic Chagas disease the key to clinical progression?

Soluble TNF receptors (sTNFR1 and sTNFR2) are natural endogenous inhibitors of TNF and are elevated in inflammatory, autoimmune, and chronic degenerative diseases. In Chagas disease, pleiotropic cytokine TNF is considered key in immunopathology. Thus, we aimed to evaluate the levels of TNF, sTNFR1, and sTNFR2 in the serum of patients with chronic Chagas disease. TNF and its soluble receptors were quantified using Cytometric Bead Array in the serum of 132 patients, of which 51 had the indeterminate form (IND), 39 the mild cardiac form (CARD 1), 42 the severe cardiac form (CARD 2), and 20 non-infected individuals (NI). The results indicate that the soluble receptors may regulate TNF in Chagas disease, as their leves were higher in T. cruzi-infected individuals when compared to non-infected individuals. We found a moderate negative correlation between sTNFR1 and TNF in individuals with the IND form, suggesting a relationship with non-progression to more severe forms, such as heart disease. sTNFR1 and sTNFR2 were increased in all clinical forms, but with a moderate positive correlation in more severe patients (r = 0.50 and p = 0.0005). TNF levels showed no statistical differences in the groups of patients. These findings suggest the importance of the endogenous balance of the levels of soluble TNF receptors in the protection and balance in patients with chronic Chagas disease, besides revealing the immunological complexity in chronic T. cruzi-infected individuals.

Estratégias terapêuticas utilizadas na consulta de enfermagem a pacientes com insuficiência cardíaca de etiologia chagásica / Therapeutic strategies used in the nursing appointmentofpatients with heart failure of chagasical etiology / Experiencias de profesionales de enfermería sobre el (ir)respeto a los derechos humanos en el cuidado de personas hospitalizadas

Objetivo: O objetivo desse trabalho é descrever as estratégias terapêuticas utilizadas na consulta de enfermagem a pacientes com Insuficiência Cardíaca de etiologia Chagásica. Método: Trata-se de um estudo descritivo, com olhar qualitativo, desenhado a partir de métodos descritivos e observacionais sobre estratégias terapêuticas utilizadas na consulta de enfermagem a pacientes com Insuficiência Cardíaca de etiologia chagásica em um ambulatório referência do Estado de Pernambuco, Brasil. Resultados: através da anamnese e do exame físico, são utilizadas estratégias de intervenções relacionadas ao uso correto das medicações, dieta alimentar, atividade física e vacinação. Realizam-se orientações sobre a doença e hábitos saudáveis, a fim de fortalecer o autocuidado e melhorar a adesão terapêutica. Conclusão: sabe-se que o tratamento a esses pacientes deve ser similar ao de IC de outras etiologias, porém a etiologia chagásica exige uma coleta de dados minuciosa, para que o cuidado seja mais individualizado e integral, considerando o contexto complexo e negligenciado desta doença. (AU).

Objective: This study aims to describe the therapeutic strategies used in nursing appointments given to patients with heart failure of Chagas etiology. Method: This is a descriptive study, with a qualitative perspective, designed from descriptive and observational methods on therapeutic strategies used in the nursing appointments of patients with Heart Failure of Chagas etiology in a reference clinic in the State of Pernambuco, Brazil. Results: Through anamnesis and physical examination, intervention strategies related to the correct use of medications, diet, physical activity and vaccination are used. There are given orientations about the disease and healthy habits in order to strengthen self-care and improve therapeutic adherence. Conclusion: It is known that the treatment of these patients must be similar to the ones of Heart Failure of other etiologies, but the Chagasic etiology requires detailed data collection, so that care is more individualized and comprehensive, considering the complexity and neglected context of this disease. (AU).

El objetivo de este trabajo es describir las estrategias terapéuticas utilizadas en las consultas de enfermería de pacientes con insuficiencia cardíaca de etiología chagásica. Se trata de un estudio descriptivo, con perspectiva cualitativa, diseñado a partir de métodos descriptivos y observacionales sobre las estrategias terapéuticas utilizadas en las consultas de enfermería de pacientes con Insuficiencia Cardíaca de etiología chagásica en un servicio ambulatorio de referencia en el Estado de Pernambuco, Brasil. A través de la anamnesis y la exploración física se implementan estrategias de intervención relacionadas con el correcto uso de medicamentos, dieta, actividad física y vacunación. Se dan orientaciones sobre la enfermedad y los hábitos saludables con el fin de fortalecer el autocuidado y mejorar la adherencia terapéutica. Se sabe que el tratamiento de estos pacientes debe ser similar al de la IC de otras etiologías, pero la etiología chagásica requiere que se realice una recolección de datos detallada, para que la atención sea más individual e integral, considerando el contexto complejo y lo desatendida que está dicha enfermedad. (AU).

Mapping the morbidity and mortality of Chagas disease in an endemic area in Brazil

ABSTRACT Chagas disease is among the 21 neglected diseases according to the World Health Organization. This study aimed to investigate the morbidity and mortality distribution of Chagas disease for identifying areas with greater prevalences and deaths of the disease in Northeast Brazil. A population-based ecological study was performed from 2016 to 2018 using data on acute Chagas disease patients from the Disease Notification Information System, chronic cases from the Chagas Disease and the referral Heart Failure Outpatient Clinic in Pernambuco, and Chagas disease-related mortality from the Mortality Information System. The unit of analysis were Pernambuco State mesoregions. The indicators were spatialized into thematic maps on the occurrence and mortality of the disease per 100,000 inhabitants. No cases of acute disease were reported in the period analyzed. Data on 801 chronic Chagas disease patients were analyzed. The population showed an average age of 62 years, with female predominance. The most prevalent comorbidity was systemic arterial hypertension and cardiologic involvement without ventricular dysfunction. The average chronic disease occurrence rate was 3.2/ 100,000 people/ year. As for deaths in the mortality system; in total, 350 deaths were recorded, showing male predominance, age ≥ 60 years, and chronic disease with cardiac involvement as the main mortality cause. The annual average mortality proportion was 1.6/100,000 people. The chronic case distribution showed spatial heterogeneity, with the highest rates of chronic disease and deaths observed in two mesoregions, with the main cause of death being heart-related. This highlights the need for more specialized services in areas with higher burden of the disease to avoid delay in the patients' care.

How people affected by Chagas disease have struggled with their negligence: history, associative movement and World Chagas Disease Day

It is well documented that Chagas disease (CD) can pose a public health problem to countries. As one of the World Health Organization Neglected Tropical Diseases undoubtedly calls for comprehensive healthcare, transcending a restricted biomedical approach. After more than a century since their discovery, in 1909, people affected by CD are still frequently marginalised and/or neglected. The aim of this article is to tell the story of their activism, highlighting key historical experiences and successful initiatives, from 1909 to 2019. The first association was created in 1987, in the city of Recife, Brazil. So far, thirty associations have been reported on five continents. They were created as independent non-profit civil society organisations and run democratically by affected people. Among the common associations' objectives, we notably find: increase the visibility of the affected; make their voice heard; build bridges between patients, health system professionals, public health officials, policy makers and the academic and scientific communities. The International Federation of Associations of People Affected by CD - FINDECHAGAS, created in 2010 with the input of the Americas, Europe and the Western Pacific, counts as one of the main responses to the globalisation of CD. Despite all the obstacles and difficulties encountered, the Federation has thrived, grown, and matured. As a result of this mobilisation along with the support of many national and international partners, in May 2019 the 72nd World Health Assembly decided to establish World Chagas Disease Day, on 14 April. The associative movement has increased the understanding of the challenges related to the disease and breaks the silence around Chagas disease, improving surveillance, and sustaining engagement towards the United Nations 2030 agenda.

Influence of Angiotensin-converting Enzyme Insertion/Deletion Gene Polymorphism in Progression of Chagas Heart Disease.

INTRODUCTION: Chagas disease (CD) is a neglected disease caused by the parasite Trypanosoma cruzi. One-third of infected patients will develop the cardiac form, which may progress to heart failure (HF). However, the factors that determine disease progression remain unclear. Increased angiotensin II activity is a key player in the pathophysiology of HF. A functional polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with plasma enzyme activity. In CD, ACE inhibitors have beneficial effects supporting the use of this treatment in chagasic cardiomyopathy. METHODS: We evaluated the association of ACE I/D polymorphism with HF, performing a case-control study encompassing 343 patients with positive serology for CD staged as non-cardiomyopathy (stage A; 100), mild (stage B1; 144), and severe (stage C; 99) forms of Chagas heart disease. For ACE I/D genotyping by PCR, groups were compared using unconditional logistic regression analysis and adjusted for nongenetic covariates: age, sex, and trypanocidal treatment. RESULTS: A marginal, but not significant (p=0.06) higher prevalence of ACE I/D polymorphism was observed in patients in stage C compared with patients in stage A. Patients in stage C (CD with HF), were compared with patients in stages A and B1 combined into one group (CD without HF); DD genotype/D carriers were prevalent in the HF patients (OR = 2; CI = 1.013.96; p = 0.04). CONCLUSIONS: Our results of this cohort study, comprising a population from the Northeast region of Brazil, suggest that ACE I/D polymorphism is more prevalent in the cardiac form of Chagas disease with HF.

Influence of Angiotensin-converting Enzyme Insertion/Deletion Gene Polymorphism in Progression of Chagas Heart Disease

Abstract INTRODUCTION: Chagas disease (CD) is a neglected disease caused by the parasite Trypanosoma cruzi. One-third of infected patients will develop the cardiac form, which may progress to heart failure (HF). However, the factors that determine disease progression remain unclear. Increased angiotensin II activity is a key player in the pathophysiology of HF. A functional polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with plasma enzyme activity. In CD, ACE inhibitors have beneficial effects supporting the use of this treatment in chagasic cardiomyopathy. METHODS: We evaluated the association of ACE I/D polymorphism with HF, performing a case-control study encompassing 343 patients with positive serology for CD staged as non-cardiomyopathy (stage A; 100), mild (stage B1; 144), and severe (stage C; 99) forms of Chagas heart disease. For ACE I/D genotyping by PCR, groups were compared using unconditional logistic regression analysis and adjusted for nongenetic covariates: age, sex, and trypanocidal treatment. RESULTS: A marginal, but not significant (p=0.06) higher prevalence of ACE I/D polymorphism was observed in patients in stage C compared with patients in stage A. Patients in stage C (CD with HF), were compared with patients in stages A and B1 combined into one group (CD without HF); DD genotype/D carriers were prevalent in the HF patients (OR = 2; CI = 1.013.96; p = 0.04). CONCLUSIONS: Our results of this cohort study, comprising a population from the Northeast region of Brazil, suggest that ACE I/D polymorphism is more prevalent in the cardiac form of Chagas disease with HF.

Single nucleotide polymorphisms of cytokine-related genes and association with clinical outcome in a Chagas disease case-control study from Brazil.

BACKGROUND: The severity of chronic chagasic cardiomyopathy (CCC), the most frequent clinical outcome of Chagas disease (CD), has been associated with cytokine-enriched heart tissue inflammation, and high serum levels of transforming growth factor (TGFß), interferon-gamma (IFNγ), and tumour necrosis factor (TNF). Conversely, increased interleukin (IL)-10 serum concentrations have been associated with asymptomatic CD. Cytokines and cytokine-related gene polymorphisms may control cytokine expression and have been proposed to contribute to CCC outcomes. OBJECTIVES: We evaluated the association of 13 cytokine-related genes (TGFB: rs8179181, rs8105161, rs1800469; IL10: rs1800890, rs1800871, rs1800896; IFNG: rs2430561; TNF: rs1800629; BAT1: rs3853601; LTA: rs909253, rs2239704; TNFR1: rs767455; TNFR2: rs1061624) with risk and progression of CCC. FINDINGS: Four hundred and six seropositive patients from CD endemic areas in the state of Pernambuco, north-eastern Brazil, were classified as non-cardiopathic (A, 110) or cardiopathic (mild, B1, 163; severe, C, 133). We found no evidence of TGFB, IL10, TNF, or TNFR1/2 gene polymorphisms associated with CCC risk or progression. Only BAT1 rs3853601 -22G carriers (B1 vs. C: OR = 0.5; p-value = 0.03) and IFNG rs2430561 +874AT (A vs. C: OR = 0.7; p-value = 0.03; A vs. B1+C: OR = 0.8; p-value = 0.02) showed a significant association with protection from cardiopathy in a logistic regression analysis with adjustment for gender and ethnicity; however, the association disappeared after performing adjustment for multiple testing. A systematic review of TNF rs1800629 -308G>A publications included five studies for meta-analysis (534 CCC and 472 asymptomatic patients) and showed no consensus in pooled odds ratio (OR) estimates for A allele or A carriers (OR = 1.4 and 1.5; p-values = 0.14 and 0.15, respectively). In CD patients, TNF serum levels were increased, but not affected by the TNF rs1800629 -308A allele. MAIN CONCLUSIONS: Our data suggest no significant contribution of the analysed gene variants of cytokine-related molecules to development/severity of Chagas' heart disease, reinforcing the idea that parasite/host interplay is critical to CD outcomes.

Genetic Polymorphism at CCL5 Is Associated With Protection in Chagas' Heart Disease: Antagonistic Participation of CCR1+ and CCR5+ Cells in Chronic Chagasic Cardiomyopathy.

Chronic cardiomyopathy is the main clinical manifestation of Chagas disease (CD), a disease caused by Trypanosoma cruzi infection. A hallmark of chronic chagasic cardiomyopathy (CCC) is a fibrogenic inflammation mainly composed of CD8+ and CD4+ T cells and macrophages. CC-chemokine ligands and receptors have been proposed to drive cell migration toward the heart tissue of CD patients. Single nucleotide polymorphisms (SNPs) in CC-chemokine ligand and receptor genes may determine protein expression. Herein, we evaluated the association of SNPs in the CC-chemokines CCL2 (rs1024611) and CCL5 (rs2107538, rs2280788) and the CCL5/RANTES receptors CCR1 (rs3181077, rs1491961, rs3136672) and CCR5 (rs1799987) with risk and progression toward CCC. We performed a cross-sectional association study of 406 seropositive patients from endemic areas for CD in the State of Pernambuco, Northeast Brazil. The patients were classified as non-cardiopathic (A, n = 110) or cardiopathic (mild, B1, n = 163; severe, C, n = 133). Serum levels of CCL5 and CCL2/MCP-1 were elevated in CD patients but were neither associated with risk/severity of CCC nor with SNP genotypes. After logistic regression analysis with adjustment for the covariates gender and ethnicity, CCL5 -403 (rs2107538) CT heterozygotes (OR = 0.5, P-value = 0.04) and T carriers (OR = 0.5, P-value = 0.01) were associated with protection against CCC. To gain insight into the participation of the CCL5-CCR5/CCR1 axis in CCC, mice were infected with the Colombian T. cruzi strain. Increased CCL5 concentrations were detected in cardiac tissue. In spleen, frequencies of CCR1+ CD8+ T cells and CD14+ macrophages were decreased, while frequencies of CCR5+ cells were increased. Importantly, CCR1+CD14+ macrophages were mainly IL-10+, while CCR5+ cells were mostly TNF+. CCR5-deficient infected mice presented reduced TNF concentrations and injury in heart tissue. Selective blockade of CCR1 (Met-RANTES therapy) in infected Ccr5-/- mice supported a protective role for CCR1 in CCC. Furthermore, parasite antigen stimulation of CD patient blood cells increased the frequency of CCR1+CD8+ T cells and CCL5 production. Collectively, our data support that a genetic variant of CCL5 and CCR1+ cells confer protection against Chagas heart disease, identifying the CCL5-CCR1 axis as a target for immunostimulation.

Single nucleotide polymorphisms of cytokine-related genes and association with clinical outcome in a Chagas disease case-control study from Brazil

BACKGROUND The severity of chronic chagasic cardiomyopathy (CCC), the most frequent clinical outcome of Chagas disease (CD), has been associated with cytokine-enriched heart tissue inflammation, and high serum levels of transforming growth factor (TGFβ), interferon-gamma (IFNγ), and tumour necrosis factor (TNF). Conversely, increased interleukin (IL)-10 serum concentrations have been associated with asymptomatic CD. Cytokines and cytokine-related gene polymorphisms may control cytokine expression and have been proposed to contribute to CCC outcomes. OBJECTIVES We evaluated the association of 13 cytokine-related genes (TGFB: rs8179181, rs8105161, rs1800469; IL10: rs1800890, rs1800871, rs1800896; IFNG: rs2430561; TNF: rs1800629; BAT1: rs3853601; LTA: rs909253, rs2239704; TNFR1: rs767455; TNFR2: rs1061624) with risk and progression of CCC. FINDINGS Four hundred and six seropositive patients from CD endemic areas in the state of Pernambuco, north-eastern Brazil, were classified as non-cardiopathic (A, 110) or cardiopathic (mild, B1, 163; severe, C, 133). We found no evidence of TGFB, IL10, TNF, or TNFR1/2 gene polymorphisms associated with CCC risk or progression. Only BAT1 rs3853601 −22G carriers (B1 vs. C: OR = 0.5; p-value = 0.03) and IFNG rs2430561 +874AT (A vs. C: OR = 0.7; p-value = 0.03; A vs. B1+C: OR = 0.8; p-value = 0.02) showed a significant association with protection from cardiopathy in a logistic regression analysis with adjustment for gender and ethnicity; however, the association disappeared after performing adjustment for multiple testing. A systematic review of TNF rs1800629 −308G>A publications included five studies for meta-analysis (534 CCC and 472 asymptomatic patients) and showed no consensus in pooled odds ratio (OR) estimates for A allele or A carriers (OR = 1.4 and 1.5; p-values = 0.14 and 0.15, respectively). In CD patients, TNF serum levels were increased, but not affected by the TNF rs1800629 −308A allele. MAIN CONCLUSIONS Our data suggest no significant contribution of the analysed gene variants of cytokine-related molecules to development/severity of Chagas' heart disease, reinforcing the idea that parasite/host interplay is critical to CD outcomes.

Screening of diseases transmissible by blood in recipients prior to transfusion at a university hospital in the northeast of Brazil / Triagem de doenças transmissíveis por sangue em receptores de um hospital universitário no nordeste do Brasil, antes da transfusão

The Brazilian Ministry of Health has made tests for HIV1 and HIV2, HTLV I and HTLV II, HCV, HBV, T. cruzi, T. pallidum and Plasmodium in endemic areas, mandatory for all blood collection bags used in the country. However, blood-borne infectious diseases are not investigated in blood recipients before transfusion. For this study, a serological evaluation of recipients before transfusion was carried out. Prior to transfusion, serum samples from 159 blood recipients were analyzed using the same tests used in the serological screening of blood donors. The blood recipients were divided into three groups: Group 1 (G1), patients who had never received blood, Group 2 (G2), patients who had received multiple transfusions and Group 3 (G3) one-off recipients. SPSS v.8 was used for statistical analysis. Values of p<0.05 were taken to be significant. The results showed that 62 blood recipients tested positively for one or more blood-borne infectious diseases. In addition, several recipients were unaware of their serological status before the transfusion. The identification of blood-borne infectious diseases in recipients before transfusion could avoid the State being held responsible by recipients who were unaware that they were carriers of such diseases and only found out about their contamination after transfusion.

O Ministério da Saúde brasileiro determina a realização de testes sorológicos para HIV 1 e 2, HTLV I e II, HCV, HBV, T. cruzi, T. pallidum e Plasmodium nas áreas endêmicas, em todas as bolsas de coleta de sangue utilizadas no País. Entretanto, as doenças infecciosas transmissíveis através do sangue não são inves­tigadas nos receptores de sangue (RS) antes da transfusão. Neste estudo, realizamos uma avaliação sorológica dos RS anterior à transfusão. Amostras de soro de 159 RS foram analisadas aplicando-se os mesmos testes utilizados na triagem soro­lógica dos doadores de sangue. Os RS foram divididos em três grupos: Grupo 1 (G1), pacientes que nunca receberam sangue, Grupo 2 (G2), pacientes politransfundidos e Grupo 3 (G3) receptores eventuais. Para a análise estatística utilizou-se o pro­grama SPSS v.8. Valores de p<0,05 foram considerados signi­ficantes. Os resultados mostraram que 62 RS apresentaram positividade para uma ou mais doenças infecciosas trans­missíveis pelo sangue. Além disso, vários RS desconheciam seu estado sorológico anterior à transfusão. A identificação de doenças infecciosas transmissíveis pelo sangue em RS anterior à transfusão poderia evitar a responsabilidade do Estado pelos RS que desconheciam ser portadores de tais doenças e apenas tiveram conhecimento de sua contaminação após a transfusão.

Avaliação dos perfis sorológico e sócio-demográfico dos receptores de sangue do Hospital Universitário Oswaldo Cruz da Universidade de Pernambuco-UPE / Evaluation of the profiles sorologic and partner-demographic of the receivers of blood of the Hospitals, University Oswaldo Cruz of the University of Pernambuco-UPE

(...) O objetivo do trabalho foi avaliar os perfis sorológico e sóciodemográfico dos receptores de sangue (RS) internados no Hospital Universitário Oswaldo Cruz (HUOC) da Universidade de Pernambuco-UPE. O estudo foi realizado nos RS (n=172) no período de fevereiro a maio de 2003, quando os pacientes foram submetidos ao instrumento de coleta de dados. O trabalho foi aprovado pela Comissão de Ética do Centro de Pesquisas Aggeu Magalhães-CPqAM. A sorologia foi realizada na Fundação Hemope, e as amostras foram submetidas aos mesmos testes utilizados para triagem dos doadores de sangue (T. pallidum, T. cruzi, HIV, HCV, HBV e HTLV I/II). Os RS que apresentaram reação positiva foram divididos em três grupos: grupo 1 (G1), nunca receberam sangue; grupo 2 (G2), politransfundidos; e grupo 3 (G3), receptores eventuais de sangue. O perfil sócio-demografifico de 172 receptores de sangue do HUOC mostrou que a idade média foi de 32,2 anos, 46,5 por cento do sexo masculino e 53,5 por cento feminino, 43 por cento casados, 37 por cento solteiros, 20,0 por cento outros. Quanto ao grau de escolaridade, 65,3 por cento tinham ensino fundamental. Apenas 22,6 por cento residiam na cidade do Recife e 49,1 por cento eram oriundos de outros municípios e estados do Brasil, e 57,2 por cento não estavam exercendo atividade trabalhista. O estudo sorológico pré-transfusional, realizado em 159 RS, mostrou que 62 desses indivíduos apresentaram reatividade para uma ou mais das doenças transmissíveis por sangue - 10 (13,3 por cento) foram positivos para T. pallidum, 4 (5,3 por cento ) para T. cruzi, 23 (30,7 por cento para HIV, 7 (9,3 por cento) para HCV e 31 (41,4 por cento) para HBV. Nenhuma reação foi observada para HTLV I/II. A positividade para os grupos foi: 38 (62,3 por cento) do G1, 2 (3,3 por cento) do G2 e 21 (34,4 por cento) do grupo G3. Vários RS (n=33) não tinham conhecimento do seu estado sorológico prévio à transfusão: 19 (57,6 por cento) do G1, 2 (100 por cento) do G2, e 12 (63,2 por cento) do G3. Estes fatos apontam para a necessidade da criação de mecanismos capazes de detectar nos receptores, antes da transfusão, a presença de agentes patógenos transmissíveis por sangue. Isso minimizaria o risco de co-morbidade e respaldaria o Estado e os serviços de hemoterapia quanto à presença desses agentes nos receptores, anteriores a transfusão

Importância da avaliação sorológica pré-transfusional em receptores de sangue / The importance of pre-transfusional serological screening in blood transfusion recipients

A triagem sorológica em doadores de sangue, não possibilita segurança de 100 por cento quanto à possibilidade de transmissão de agentes infecto-contagiosos. O Ministério da Saúde determina a realização de testes para sífilis, hepatite B e C, HIV, doença de Chagas, HTLV I/II e malária nas áreas endêmicas, em todas as unidades de sangue coletadas no Brasil. A amostra do doador deve ficar armazenada por um período mínimo de seis meses. Com relação aos receptores de sangue, o Ministério determina a realização de testes imuno-hematológicos pré-transfusionais tais como classificação ABO/Rh, pesquisa de anticorpos irregulares e testes de compatibilidade. Nesse caso, a amostra do receptor deve ficar armazenada por um período de dez dias. Considerando que algumas patologias testadas, quando não detectadas no doador, podem ser transmitidas e cursar durante décadas sem apresentar sintomas, um estudo de provas entre receptores e seus respectivos doadores fica comprometido. Um recente estudo no Brasil, envolvendo receptores sem passado transfusional, eventual e politransfundidos mostrou uma importante prevalência de patologias que podem ser transmitidas pelo sangue. O estudo revelou também que uma elevada percentagem dos receptores que apresentaram reatividade não tinha conhecimento prévio à transfusão do seu estado sorológico. A segurança transfusional e a importância da aplicação de testes sorológicos em receptores de sangue antes da transfusão são pontos discutidos na presente revisão.

Avaliação do perfil sócio-demográfico dos receptores de sangue do Hospital Oswaldo Cruz da Universidade de Pernambuco / Evaluation of the social demographic profile from the Hospital Universitário Oswaldo Cruz (HUOC) - Brazil

O objetivo do presente trabalho foi avaliar o perfil sócio-demográfico dos receptores de sangue (RS) internados no Hospital Universitário Oswaldo Cruz (HUOC) da Universidade de Pernambuco-UPE. O estudo foi realizado nos RS (n=172) no período de fevereiro a maio de 2003, quando os pacientes foram submetidos ao instrumento de coleta de dados. O trabalho foi aprovado pela comissão de Ética do Centro de Pesquisa Aggeu Magalhães-CpqAM. O perfil sócio-demográfico do RS mostrou que a idade média foi de 32,2 anos, 46,5por cento do sexo masculino e 53,5por cento do sexo feminino, 43,0por cento casados, 37,0por cento solteiros, 20,0 por cento outros. Quanto ao grau de escolaridade, 65,3por cento tinham ensino fundamental. Apenas 22,6por cento resideiam na cidade do Recife e 49,1 eram oriundos de outros municípios e estados do Brasil, e 57,2por cento não estam exercendo atividade trabalhista. A baixa escolaridade encontrada no RS (65,3por cento com apenas o primeiro grau) e a ausência de atividade laborativa (57,2por cento) pode dificultar o entendimento da necessidade de reposição de estoques de sngue. Os dados obtidos no presente trabalho poderão ser utilizados para auxiliar no planejamento estrategico na política de captação de doadores de sangue de reposição para o HUOC

Bypass ou piggback no transplante ortotópico de fígado: há sempre necessidade? / Bypass or piggyback in orthotopic liver transplantation: Is it always mandatory?

Para minimizar os efeitos hemodinâmicos da oclusão das veias cava e porta na fase anepática do transplante ortotópico de fígado, emprega-se rotineiramente o bypass porto-cava-axilar ou a técnica da preservação da veia cava retro-hepática, conhecida como piggyback. Ocorre que ambas as alternativas também apresentam seus icnconvenientes. Uma série consecutiva de 14 pacientes foi submetida ao transplante hepático, doze dos quais pela forma convencional simplificada, sem bypass ou piggyback. A esperada instabilidade hemodinâmica na fase anepática foi contornada em todos os casos. A diurese não sofreu redução significativa e o número de unidades de concentrado de hemácias administrado no transoperatório foi relativamente baixo (X=6,5 + ou - 4,2). O nível sérico médio de creatinina pré-operatório (X=0,84) não se elevou significamente após o procedimento ("t" = 1,32, p<0,05). Todos os pacientes obtiveram alta hospitalar em boas condições. Os autores concluem que, no transplante ortotópico de fígado da presente série, a utilização de bypass ou piggyback pôde ser contornado na maioria dos casos

Aspectos psicológicos, observados em doadores, relacionados à comunicaçäo da infecçäo pelo HTLV-1 / Psychological aspects in donors related to communication of HTLV-1 infection

A comunicaçäo de diagnóstico muitas vezes pode provocar reaçöes de medo, insegurança, ansiedade e tensäo, até outras reaçöes imprevisíveis. Um aspecto importante a ser considerado é a maneira como se faz essa comunicaçäo, podendo isso suscitar fantasias errôneas e demasiado apressadas como o verificado da associaçäo do HTLV-1 com o HIV. Assim este trabalho compreende duas partes: Na primeira, descreve-se as reaçöes de ansiedade decorrentes da informaçäo, bem como a ansiedade apresentada como traço de personalidade do indivíduo. Na segunda parte, apresentamos outros aspectos que de modo geral podem interferir na qualidade de vida e no comportamento dessas pessoas.