Aneurisma de aorta abdominal. Prevalencia y factores de riesgo asociados en una población de pacientes ingresados en Medicina Interna / Abdominal aortic aneurysm. Prevalence and associated risk factors in a population of patients hospitalised in Internal Medicine

Objetivos: Determinar la prevalencia de aneurisma de aorta abdominal (AAA), no diagnosticado previamente, en pacientes ingresados en un Servicio de Medicina Interna, así como los factores de riesgo asociados. Pacientes y métodos: Estudio observacional, transversal, unicéntrico, aleatorizado de 241 pacientes ingresados en Medicina Interna, mayores de 50 años, sin diagnóstico previo de AAA. Se practicó una ecografía clínica. La variable dependiente fue la presencia o no de aneurisma. Las variables independientes fueron edad, sexo, factores de riesgo cardiovascular, enfermedad cardiovascular, función renal, índice tobillo-brazo (ITB), antecedente familiar de primer grado de AAA o de cardiopatía isquémica precoz. Se realizó un análisis bivariante y multivariante. Resultados: La prevalencia del AAA fue del 2,9% (IC 95%: 0,8-5). Los casos fueron confirmados mediante ecografía o TAC por el Servicio de Radiología. Todos fueron varones con antecedente de tabaquismo y con edad ≥ 65 años. En el análisis bivariante se asociaron ser varón (OR = 9,39), el tabaquismo (OR = 13,08), cardiopatía isquémica (OR = 5,6; IC 95%: 1,21-25,91; p < 0,05) e ITB inferior a 0,9 (OR = 12,50; IC 95% = 2,34-66,77; p < 0,05). En el análisis multivariante la variable asociada independientemente fue un ITB < 0,9 (OR: 10,758; IC 95%: 1,968-58,815; p = 0,006). Conclusiones: La prevalencia de AAA no diagnosticado en pacientes mayores de 50 años ingresados en Medicina Interna fue del 2,9%. Los datos llevarían a recomendar el cribado de AAA en esta población de pacientes varones, con antecedente de tabaquismo y con un ITB inferior a 0,9. La ecografía clínica posibilitaría este cribado de forma fiable

Objectives: To determine the prevalence of previously undiagnosed abdominal aortic aneurysm (AAA) in patients hospitalised in a department of internal medicine, as well as the associated risk factors. Patients and methods: An observational, cross-sectional, single-centre, randomised study was conducted on 241 patients hospitalised in Internal Medicine. The patients were older than 50 years, had no previous diagnosis of AAA and underwent clinical ultrasonography. The dependent variable was the presence or absence of an aneurysm. The independent variables were age, sex, cardiovascular risk factors, cardiovascular disease, renal function, ankle brachial index (ABI), family history (first degree) of AAA or of early ischaemic heart disease. A bivariate and multivariate analysis was conducted in the statistical analysis. Results: The prevalence of AAA was 2.9% (95% CI: 0.8-5). The cases were confirmed through ultrasonography or computed tomography by the Department of Radiology. All patients were men with a history of smoking and with an age≥65 years. The bivariate analysis found an association between being male (OR, 9.39), smoking (OR, 13.08), ischaemic heart disease (OR, 5.6; 95% CI: 1.21-25.91; P<.05) and ABI<0.9 (OR, 12.50; 95% CI: 2.34-66.77; P<.05). In the multivariate analysis, the independently associated variable was an ABI<0.9 (OR, 10.758; 95% CI: 1.968-58.815; P=.006). Conclusions: The prevalence of undiagnosed AAA in patients older than 50 years hospitalised in internal medicine was 2.9%. The data lead us to recommend AAA screening for this population of male patients with a history of smoking and an ABI<0.9. Clinical ultrasonography enables this screening in a reliable manner

Prevalence and intensity of infection, metacyclogenesis and nuclear phenotypes in Panstrongylus megistus (Burmeister, 1835) after ingestion of Trypanosoma cruzi (Chagas, 1909) II and subjection to heat shock / Prevalência e intensidade de infecção, metaciclogênese e fenótipos nucleares em Panstrongylus megistus (Burmeister, 1835) após ingestão de Trypanosoma cruzi (Chagas, 1909) II e choque de temperatura

This study aimed to contribute to our knowledge of the parasite-vector interaction associated with Trypanosoma cruzi (Chagas, 1909) infection in Panstrongylus megistus (Burmeister, 1835), an important vector of Chagas' disease in Brazil. The prevalence and intensity of T. cruzi infection, the incidence of metacyclogenesis and the frequency of nuclear phenotypes in Malpighian tubules were investigated in nymphs of P. megistus, reared at 28 °C and subjected to heat shock (40 °C, 1 hour) two days after infection with T. cruzi II (Y strain). Following the 45-day post-infection period, the frequency of epimastigotes was much higher than that of trypomastigotes in both heat-shocked and non-shocked insects, and the prevalence of infection was not altered by heat shock. Fewer epimastigotes and trypomastigotes were found in the infected insects subjected to the heat shock, indicating that the multiplication and metacyclogenesis of the parasites were affected by the stress. In infected specimens heat shock promoted an increased frequency of cell nuclei with heterochromatin decondensation, a cell survival response to stress, and did not affect insect survival. The effects of infection and heat shock, especially on the multiplication and metacyclogenesis of T. cruzi, and the observed resistance to heat shock developed by P. megistus nymphs are suggestive that they should be considered when adequate conditions for rearing these infected insects in the laboratory are pursued.

O presente estudo teve como objetivo contribuir para o conhecimento sobre a interação parasita-vetor associada à infecção por Trypanosoma cruzi (Chagas, 1909) em Panstrongylus megistus (Burmeister, 1835), importante vetor da doença de Chagas no Brasil. A prevalência e a intensidade da infecção por T. cruzi, a incidência de metaciclogênese e a frequência de fenótipos nucleares presentes em túbulos de Malpighi foram investigadas em ninfas de P. megistus criadas à temperatura de 28 °C e submetidas a choque térmico por 1 hora a 40 °C, dois dias após alimentação em camundongos infectados com T. cruzi II (linhagem Y). A análise realizada 45 dias pós-infecção revelou que tanto nos insetos submetidos ao choque térmico como nos respectivos controles a frequência de epimastigotos se apresentava muito maior do que a dos tripomastigotos; a prevalência da infecção não foi alterada pelo choque térmico. Menos epimastigotos e tripomastigotos foram encontrados nos insetos submetidos ao choque térmico, indicando que a multiplicação e a metaciclogênese dos parasitas possam ser afetadas com o estresse. Nos espécimes infectados, o choque térmico induziu aumento na frequência de núcleos com descompactação da heterocromatina, uma resposta de sobrevivência celular ao estresse, e não afetou a sobrevivência propriamente dita do inseto. Os efeitos da infecção e do choque térmico, especialmente sobre a multiplicação e a metaciclogênese de T. cruzi, e a resistência ao choque térmico desenvolvidos pelas ninfas de P. megistus são indicativos de que devam ser considerados quando se buscam condições adequadas de criação em laboratório de insetos infectados.