Sarcopenia - visión clínica de una entidad poco conocida y mucho menos buscada

Se hace una revisión sobre sarcopenia, desde su definición, sus causas y consecuencias en personas de la tercera edad, haciéndose especial mención en obesidad y la importancia de su diagnóstico como un hecho clave en esta entidad. Los mecanismos fisiopatológicos, aspectos moleculares y abordaje clínico son los items más importantes junto con la conducta psicológica. Ejercicio como herramienta terapéutica eficaz en el tratamiento de la sarcopenia. La sarcopenia es potencialmente reversible con ejercicio de fuerza de alta intensidad, corta duración e intermitente.

A review of sarcopenie has been done from its definition, causes courses and consequences on people of the third age, having a special mention in obesity. The importance of this diagnosis is a key in this entity. The pathophysiological mechanisms, the molecular aspects and the clinical boarding are the most important items, beside the psychological conduct. Exercises are effective therapeutics tools in the treatment of sarcopenia. This pathology is potentially reversible with exercise of force and high intensity, they should be done in short duration but with intermittent actions.

Myocardial parasite persistence in chronic chagasic patients.

The persistence of Trypanosoma cruzi tissue forms was detected in the myocardium of seropositive individuals clinically diagnosed as chronic chagasic patients following endomyocardial biopsies (EMBs) processed by immunohistochemical (peroxidase-anti-peroxidase [PAP] staining) and molecular (polymerase chain reaction [PCR]) techniques. An indirect immunofluorescent technique revealed antigenic deposits in the cardiac tissue in 24 (88.9%) of 27 patients. Persistent T. cruzi amastigotes were detected by PAP staining in the myocardium of 22 (84.6%) of 26 patients. This finding was confirmed with a PCR assay specific for T. cruzi in 21 (91.3%) of 23 biopsy specimens from the same patients. Statistical analysis revealed substantial agreement between PCR and PAP techniques (k = 0.68) and the PCR and any serologic test (k = 0.77). The histopathologic study of EMB specimens from these patients revealed necrosis, inflammatory infiltrates, and fibrosis, and made it possible to detect heart abnormalities not detected by electrocardiogram and/or cineventriculogram. These indications of myocarditis were supported by the detection of T. cruzi amastigotes by the PAP technique or its genome by PCR. They suggest that although the number of parasites is low in patients with chronic Chagas' disease, their potential for heart damage may be comparable with those present during the acute phase. The urgent necessity for testing new drugs with long-term effects on T. cruzi is discussed in the context of the present results.

[Clinical, parasitological and histopathologic follow-up studies of acute Chagas patients treated with benznidazole]. / Seguimiento clínico, parasitológico e histopatológico de pacientes chagásicos agudos tratados con benznidazol.

With the purpose of studying their clinical and histopathologic evolution, 10 acute chagasic patients with myocarditis diagnosed by endomyocardial biopsy and positive sero-parasitologic methods were evaluated at 11 months (8-21 months) after treatment with oral benznidazole. Four of them were reevaluated 5 years post-treatment (58-68 months). Study protocol consisted of clinical, hemodynamic, echocardiographic, seroparasitologic and histopathologic evaluations. Results showed evidence of persisting myocarditis in 90% and 75% of patients evaluated at 11 months and 5 years respectively, along with asymptomatic, subclinical left ventricular systolic dysfunction being recognized in 75% of patients evaluated 5 years after treatment. All parasitologic studies became negative during follow-up, but serology remained positive for Trypanosoma cruzi antibodies in 80% and 75% of patients studied at 11 months and 5 years. In conclusion, myocardial damage was constantly found in our acute chagasic patients. Treatment with benznidazole eliminated symptoms and parasitemia, but it does not seem to alter favorably the histopathological evolution of the chagasic cardiac disease.

Cardiac involvement is a constant finding in acute Chagas' disease: a clinical, parasitological and histopathological study.

During the last 8 years 58 acute cases of Chagas' disease were studied. Patients from an endemic area of the state of Barinas, Venezuela, showed fever (98%) and circulating forms of T. cruzi (100%), and were treated with oral benznidazole. The recorded mortality was 8.6%. Acute myocarditis was constantly found either in myocardial biopsies or at necropsy, even in patients without any other sign of cardiac compromise (36%), which was detected by chest X-ray in 58%, by 2D echocardiography in 52%, by resting ECG in 41% and by clinical findings in 27.5% of the patients. Cardiomegaly was due to pericardial effusion rather than ventricular dilatation in most instances. Treatment eliminated parasitemia but negativized serology in only 20% of patients. It also appeared to have little influence on the ongoing myocarditic process, emphasizing the need for better therapeutic schedules, able to avoid or control the early appearance of immunologic mechanisms and microcirculatory damage involved in the future development of chronic chagasic myocarditis.

Results of electrophysiologic studies in patients with acute Chagasic myocarditis.

BACKGROUND: As the acute stage of Chagas' myocarditis is rarely detected, little is known about the electrophysiologic characteristics of that stage. HYPOTHESIS: This investigation was undertaken to conduct an electrophysiologic study of the properties of the heart during the acute phase of Chagasic myocarditis. METHODS: We studied eight patients who had positive xenodiagnosis, positive mice culture, and positive complement fixation test for Chagas' disease. RESULTS: Trypanosoma cruzi were identified in all of the patients' stained blood samples. Right ventricular endomyocardial biopsies were obtained, evidencing a distinct infiltrate of lymphocytes that confirmed the diagnosis of acute myocarditis. The cardiac dimensions and the ventricular systolic and diastolic function were preserved in all patients. The electrocardiogram evidenced conduction defects in two patients. The signal-averaged electrocardiogram displayed late potentials in three patients. In the electrophysiologic study, atrial fibrillation or flutter was induced in four patients. When compared with control patients, Chagasic patients were found to have greater values of atrial threshold, A-H interval, and atrioventricular (AV) nodal effective refractory period. The H-V interval was mildly prolonged in two patients, but the dynamic AV nodal conduction was preserved (1:1 conduction during right atrial stimulation at a cycle length of 400 ms) in all the Chagasic patients. The ventricular parameters were within normal limits, and no sustained ventricular arrhythmia could be induced. CONCLUSIONS: Patients with mild acute Chagasic myocarditis may suffer from electrical abnormalities and arrhythmias that are more evident at the supraventricular level and the AV junction.

Infestación por Ascaris: una posible explicación para los altos niveles de IgG anti-A observados en la población venezolana / Ascaris infestation: a possible explanation for the high levels of IgG anti-A found in Venezuela populations

Hemos investigado los niveles de IgG anti-A y los de IgG anti-Ascaris en grupos de nivel socioeconómico alto (NSEA) con un bajo grado de infestación por Ascaris (5,6%), de nivel socioeconómico bajo (NSEB) con un 47,6% por ciento de infestación y de indígenas del Amazonas con un nivel de infestación del 67,5 por ciento. Los títulos de IgG anti-A y anti-B se determinaron por hemaglutinación simple y por la técnica indirecta de Coombs, y los de IgG anti-Ascaris (en su forma adulta) por una técnica inmunoenzimática. Los títulos de IgG anti-A obtenidos por la prueba de Coombs, fueron significativamente mayores en el grupo indígena (media geométrica 1833) y en el de NSEB (659) en relación al grupo de NSEA (225). Aunque hubo una asociación positiva entre la frecuencia de infestación por Ascaris y los niveles de IgG anti-A, al comparar individualmente los títulos de IgG anti-A con los de IgG anti-Ascaris no se obtuvo correlación. Sin embargo, estos resultados no descartan la posibilidad de que componentes de otros estadios del parásito presenten reactividad cruzada con el antígeno A