Prevention of congenital chagas disease by trypanocide treatment in women of reproductive age: A meta-analysis of observational studies.

BACKGROUND: Maternal-foetal transmission of Chagas disease (CD) affects newborns worldwide. Although Benznidazole and Nifurtimox therapies are the standard treatments, their use during pregnancy is contra-indicated. The effectiveness of trypanocidal medications in preventing congenital Chagas Disease (cCD) in the offsprings of women diagnosed with CD was highly suggested by other studies. METHODS: We performed a systematic review and meta-analysis of studies evaluating the effectiveness of treatment for CD in women of childbearing age and reporting frequencies of cCD in their children. PubMed, Scopus, Web of Science, Cochrane Library, and LILACS databases were systematically searched. Statistical analysis was performed using Rstudio 4.2 using DerSimonian and Laird random-effects models. Heterogeneity was examined with the Cochran Q test and I2 statistics. A p-value of <0.05 was considered statistically significant. RESULTS: Six studies were included, comprising 744 children, of whom 286 (38.4%) were born from women previously treated with Benznidazole or Nifurtimox, trypanocidal agents. The primary outcome of the proportion of children who were seropositive for cCD, confirmed by serology, was signigicantly lower among women who were previously treated with no congenital transmission registered (OR 0.05; 95% Cl 0.01-0.27; p = 0.000432; I2 = 0%). In women previously treated with trypanocidal drugs, the pooled prevalence of cCD was 0.0% (95% Cl 0-0.91%; I2 = 0%), our meta-analysis confirms the excellent effectiveness of this treatment. The prevalence of adverse events in women previously treated with antitrypanocidal therapies was 14.01% (95% CI 1.87-26.14%; I2 = 80%), Benznidazole had a higher incidence of side effects than Nifurtimox (76% vs 24%). CONCLUSION: The use of trypanocidal therapy in women at reproductive age with CD is an effective strategy for the prevention of cCD, with a complete elimination of congenital transmission of Trypanosoma cruzi in treated vs untreated infected women.

Prognosis of chronic Chagas heart disease and other pending clinical challenges.

In this chapter, the main prognostic markers of Chagas heart disease are addressed, with an emphasis on the most recent findings and questions, establishing the basis for a broad discussion of recommendations and new approaches to managing Chagas cardiopathy. The main biological and genetic markers and the contribution of the electrocardiogram, echocardiogram and cardiac magnetic resonance are presented. We also discuss the most recent therapeutic proposals for heart failure, thromboembolism and arrhythmias, as well as current experience in heart transplantation in patients suffering from severe Chagas cardiomyopathy. The clinical and epidemiological challenges introduced by acute Chagas disease due to oral contamination are discussed. In addition, we highlight the importance of ageing and comorbidities in influencing the outcome of chronic Chagas heart disease. Finally, we discuss the importance of public policies, the vital role of funding agencies, universities, the scientific community and health professionals, and the application of new technologies in finding solutions for better management of Chagas heart disease.

Prognosis of chronic Chagas heart disease and other pending clinical challenges

In this chapter, the main prognostic markers of Chagas heart disease are addressed, with an emphasis on the most recent findings and questions, establishing the basis for a broad discussion of recommendations and new approaches to managing Chagas cardiopathy. The main biological and genetic markers and the contribution of the electrocardiogram, echocardiogram and cardiac magnetic resonance are presented. We also discuss the most recent therapeutic proposals for heart failure, thromboembolism and arrhythmias, as well as current experience in heart transplantation in patients suffering from severe Chagas cardiomyopathy. The clinical and epidemiological challenges introduced by acute Chagas disease due to oral contamination are discussed. In addition, we highlight the importance of ageing and comorbidities in influencing the outcome of chronic Chagas heart disease. Finally, we discuss the importance of public policies, the vital role of funding agencies, universities, the scientific community and health professionals, and the application of new technologies in finding solutions for better management of Chagas heart disease.

Análise dos fatores de risco cardiovascular em pacientes com doença de chagas aguda / Analysis of cardiovascular risk factors in patients with acute chagas disease

Na avaliação inicial dos pacientes com doença de Chagas não se pode ignorar a identificação dos fatores de risco cardiovascular, principalmente na fase aguda da doença. Oobjetivo foi analisar os fatores de risco cardiovascular em pacientes com doença de chagas aguda. Trata-se de um estudo retrospectivo, observacional, transversal, de fontes secundárias, em que foram revisados 160 prontuários de pacientes atendidos em dois hospitais públicos de ensino e pesquisa no período de 2009 a 2011. Dentre os 160pacientes, 89 (55,63%) eram homens, a média de idade foi de 41,59± 13,17anos. Osfatores de risco identificados como mais frequentes foram: dislipidemia 80,0%, hereditariedade 70,0%, hipertensão arterial 46,8%, IMC elevado 45,0%, diabetes 40,6%, tabagismo 45,0% e etilismo 62,5%. Oprincipal fator de risco para doença cardiovascular foi a dislipidemia, associada com a hipertensão arterial sistêmica, diabetes mellitus, obesidade e sedentarismo. Osautores concluem que os pacientes com doença de Chagas aguda compartilham os mesmos fatores de risco observados na população geral.

In the initial evaluation of patients with Chagas' disease can not ignore the identification of cardiovascular risk factors, especially in the acute phase of the disease. The objective was to analyze the cardiovascular risk factors in patients with acute Chagas disease. This is a retrospective, observational, cross-sectional study of secondary sources, which were reviewed 160 medical records of patients treated at two hospitals for teaching and research from 2009 to 2011. Among the 160patients, 89 (55.63%) were men, the average age was 41.59± 13.17years. The risk factors identified as most frequent were: dyslipidemia 80.0%, 70.0% heredity, high blood pressure 46.8%, high BMI 45.0%, 40.6% diabetes, smoking and alcohol consumption 45.0% 62 5%. The main risk factor for cardiovascular disease was the dyslipidemia associated with hypertension, diabetes mellitus, obesity and sedentary lifestyle. The authors conclude that patients with acute Chagas disease share the same risk factors observed in the general population.

Álcool e hipertensão. Aspectos epidemiológicos, fisiopatológicos e clínicos / Alcohol and hypertension. Epidemiological, pathophysiological and clinical aspects

Diversos estudos populacionais demonstram correlação positiva do álcool com a hipertensão arterial, porém as evidências observadas não são consistentes em relação aos riscos cardiovasculares que essa substância exerce em indivíduos hipertensos. O principal desafio é a quantificaçãodo nível de hipertensão em relação aos padrões de consumo do etanol, bem como a análise de resultados em populações com diferentes padrões de consumo. Nesse contexto, a proposta deste artigo é comentar sobre os efeitos agudos em longo prazo que o álcool exerce em populações hipertensas provindas de várias regiões, cujas características geográficas, epidemiológicas, socioeconômicas e culturais são diferentes.

Several population studies show a positive correlation between alcohol and hypertension, but theevidence observed is not consistent regardingthe cardiovascular risk that this substance brings to hypertensive subjects. The main challenge is toquantify hypertension levelin relation to the patterns of ethanol consumption as well as the analysis ofthe results in populations with different patterns of consumption. In this context, the aim of this article is to review the long-term acute effects that alcohol brings to hypertensive populations from several regions, whose geographic, epidemiological, cultural and socioeconomic characteristics are different.