Comparison of Health-Related Quality of Life in Outpatients with Chagas and Matched Non-Chagas Chronic Heart Failure in Colombia: A Cross-Sectional Analysis.

Chagas disease represents an important cause of heart failure (HF) and affects health-related quality of life (HRQoL). The study aimed to evaluate and compare the HRQoL of patients with chagasic HF and matched non-Chagas controls to identify factors associated with HRQoL. A cross-sectional study with pair-matched controls was conducted in Colombia. From October 2018 to December 2019, a total of 84 HF patients were screened for study subjects. Four were excluded, resulting in 80 patients for the analysis, among whom 40 patients with Chagas were enrolled as cases and 40 gender- and age-matched non-Chagas patients as controls. The Kansas City Cardiomyopathy Questionnaire (KCCQ) and the Minnesota Living with Heart Failure Questionnaire (MLWHFQ) were used to measure HRQoL. Demographic, clinical, and laboratory data were obtained from each subject. Health-related quality of life scores were significantly worse among the Chagas group than among the non-Chagas group in the KCCQ domains of physical functioning and symptoms and in the MLWHFQ scale. In the multivariate analysis, the variables associated with lower HRQoL scores were living alone, obesity, having less than 12 years of education, and an increase in left ventricular diameters in the systole and diastole. Health-related quality of life in patients with chronic HF is impaired across all domains. Chagas patients showed worse HRQoL scores than non-Chagas patients. Six variables, some potentially modifiable, were independently associated with worse HRQoL.

Prevalence of Chagas disease in Colombia: A systematic review and meta-analysis.

BACKGROUND: Despite the adoption of campaigns to interrupt the main vector and to detect Trypanosoma cruzi in blood banks, millions of people are still chronically infected; however, the prevalence data are limited, and the epidemiology of Chagas disease has not been systematically evaluated. This study aimed to estimate the prevalence of Chagas disease in Colombia. METHODS: A systematic literature review and meta-analysis was conducted to select all observational studies reporting the prevalence of Chagas disease in Colombia, based on serological diagnosis in participants of any age and published between January 2007 and November 2017. Pooled estimates and 95% confidence intervals (95% CIs) were calculated using random-effects models. In addition, the I2 statistic was calculated. RESULTS: The literature search yielded a total of 1,510 studies; sixteen articles with relevant prevalence data were included in the systematic review. Of these, only 12 articles were included for entry in the meta-analysis. The pooled prevalence of Chagas disease across studies was 2.0% (95% CI: 1.0-4.0). A high degree of heterogeneity was found among studies (I2 > 75%; p < 0.001). The publication bias was not statistically significant (Egger's test, p = 0.078). The highest pooled prevalences were found in the adult population (3.0%, 95% CI: 1.0-4.0), pregnant women (3.0%, 95% CI: 3.0-4.0) and the Orinoco region (7.0%, 95% CI: 2.2-12.6). CONCLUSIONS: The results indicate that the T. cruzi-infected population is aging, the adult population, pregnant women and that the Orinoco region (department of Casanare) have the highest prevalences. These results highlight the need to maintain screening and surveillance programs to identify people with chronic T. cruzi infections.

Endocarcinoma gástrico y embarazo reporte de dos casos y revisión de la literatura / Gastric carcinoma and pregnancy report of two clinical cases and review of the literature / Endocarcinoma gástrica e gravidez relatório de dois casos e revisão da literatura

RESUMEN La incidencia de cáncer durante la gestación es de 1: 1000 a 2000 embarazos, siendo los más frecuentes el de cérvix, mama, ovario, melanoma, tiroides, colon y hematológicos como linfoma y leucemia. A pesar de ser una entidad poco frecuente en el embarazo, se ha visto una tendencia a aumentar en los últimos años debido al incremento progresivo de la edad materna en el momento de la concepción. El carcinoma gástrico es una patología aún menos frecuente, siendo su incidencia durante la gestación de aproximadamente 0.016% a 0.026% en las series de casos de Japón, país con la mayor prevalencia de enfermedad. La cirugía es el tratamiento oncológico menos controversial durante la gestación. En los últimos años, ha cobrado importancia la quimioterapia adyuvante con antineoplásicos de tipo antimetabolito como el 5 fluoracilo (5 - FU), medicamento que ha demostrado mejoría de la supervivencia en pacientes gestantes con adenocarcinoma gástrico. Desafortunadamente, el 96.7% de los casos son diagnosticados en estadios avanzados, pues su presentación clínica suele confundirse con las manifestaciones propias de la primera mitad de la gestación como son las nauseas y el vomito. Presentamos dos casos clínicos, el de una gestante de 34 años con embarazo de 19 semanas y 3 días al momento del diagnóstico de un carcinoma gástrico Bormann III, llevada a laparotomía con intención curativa a las 21 semanas con hallazgo intraoperatorio de enfermedad metastásica avanzada y tumor ovárico izquierdo sugestivo de tumor de Krukenberg, a quien se le inicia a las 23 semanas quimioterapia paliativa con esquema FOLFIRI el cual recibió hasta la finalización de la gestación a las 33 semanas por restricción del crecimiento intrauterino y posteriormente durante el puerperio; y el de una gestante de 31 años con embarazo de 26 semanas y 6 días quien se ingresa para estudio de emesis persistente durante la gestación con confirmación diagnóstica de adenocarcinoma gástrico Bormann III asociado a Restricción del crecimiento intrauterino que fue llevada a cesárea a las 34 semanas y en el puerperio a gastrectomía total con vaciamiento ganglionar del area celiaca y reconstrucción en Y de Roux. El objetivo de realizar estos reportes surge de la carencia de guias de manejo respecto a dicha entidad durante la gestación debido a la poca frecuencia de presentación de la misma. Es frecuente encontrar discrepancias entre los conceptos en cuanto a conductas médicas se refiere. Disponemos de reportes y series de casos que orientan el manejo hacia un enfoque interdisciplinario dirigido a sopesar los riesgos y beneficios derivados de implementar o no un tratamiento durante la gestación siendo pocos los casos exitosos reportados en la literatura.

ABSTRACT Incidence of cancer during pregnancy is 1 in 1000. The most frequent carcinomas are the cervix, breast, ovaries, melanoma, thyroid, colon and hematological such as lymphoma and leukemia. Although cancer is not frequently associated with pregnancy, there has been a tendency to increase in recent years due to the progressive increase in maternal age at conception. Gastric carcinoma during pregnancy is a rare pathology, with an incidence of 0.016% to 0.026% in the series of cases from Japan, one of the countries with the greatest prevalence of this disease. Surgery is the least controversial type of oncologic treatment during pregnancy. In the last years, the adjuvant chemotherapy with antimetabolite drugs like the 5-fluoracile has gained relevance because it has demonstrated to improve survival in pregnant patients with gastric carcinoma. Unfortunately, the 96.7% of cases are diagnosed in advanced states because its symptoms can be misinterpreted as pregnancy induced nausea and vomiting characteristic of first half of pregnancy. We present two Clinical cases. The case of a 34 years old pregnant woman with 19 weeks and 3 days of gestation at the time of diagnosis of a gastric carcinoma in Bormann III stage, she was laparotomized with curative intentions at 21 weeks of gestation with intraoperative findings consistent with advanced metastatic disease and left-sided ovarian tumor suggestive of Krukenberg tumor. At 23 weeks palliative chemotherapy with FOLFIRI was initiated and it was continued until the end of gestation at 33 weeks and later in the puerperium; and the case of a 31 years old pregnant woman with 26 weeks and 6 days of gestation, she was admitted for the study of persistent vomiting during pregnancy with diagnostic confirmation of gastric adenocarcinoma Bormann III associated with intrauterine growth restriction, she was carried cesarean at 34 weeks. In the postpartum she was carried total gastrectomy with lymph node dissection of the celiac area and Roux-Y reconstruction. The objective of this report arises from the absence of clinical randomized studies about the management of this entity during pregnancy in consequence of the few cases available in the literature. This has been a cause of discrepancies between medical staff regarding therapeutics. There are some available literature series and case reports that guide management to a multidisciplinary approach in pursuit of more benefits and less risk in the context of the pregnant patient, with little cases reported as successful.

RESUMO A incidência de câncer durante a gravidez é de 1 em 1000. Os carcinomas mais freqüentes são o colo do útero, mama, ovários, melanoma, tireóide, cólon e hematológicos, como linfoma e leucemia. Embora o câncer não seja freqüentemente associado à gravidez, houve tendência de aumento nos últimos anos devido ao aumento progressivo da idade materna na concepção. O carcinoma gástrico durante a gravidez é uma patologia rara, com incidência de 0,016% a 0,026% na série de casos do Japão, um dos países com maior prevalência desta doença. A cirurgia é o tipo menos controverso de tratamento oncológico durante a gravidez. Nos últimos anos, a quimioterapia adjuvante com fármacos antimetabolitos como a 5-fluoracile ganhou relevância porque demonstrou melhorar a sobrevida em gestantes com carcinoma gástrico. Infelizmente, os 96,7% dos casos são diagnosticados em estados avançados porque seus sintomas podem ser mal interpretados, pois a náusea e os vômitos induzidos pela gravidez são característicos da primeira metade da gravidez. A presentamos dois casos clínicos. O caso de uma mulher grávida de 34 anos com 19 semanas e 3 dias de gestação no momento do diagnóstico de carcinoma gástrico no estádio Bormann III, foi laparotomizada com intenções curativas às 21 semanas de gestação com achados intraoperatórios consistentes com doença metastática avançada e tumor de ovário esquerdo sugestivo de tumor de Krukenberg. Às 23 semanas, iniciou-se a quimioterapia paliativa com FOLFIRI e continuou até o final da gestação às 33 semanas e mais tarde no puerpério; e o caso de uma mulher grávida de 31 anos com 26 semanas e 6 dias de gestação, foi admitida para o estudo de vômitos persistentes durante a gravidez com confirmação diagnóstica de adenocarcinoma gástrico Bormann III associado à restrição de crescimento intra-uterino, foi realizada cesariana às 34 semanas. No pós-parto foi transportada gastrectomia total com dissecção dos linfonodos da área celíaca e reconstrução Roux-Y. O objetivo deste relatório decorre da ausência de estudos clínicos randomizados sobre o manejo dessa entidade durante a gravidez em conseqüência dos poucos casos disponíveis na literatura. Esta foi uma causa de discrepâncias entre a equipe médica em relação à terapêutica. Existem algumas séries de literatura disponíveis e relatos de casos que orientam o gerenciamento para uma abordagem multidisciplinar em busca de mais benefícios e menos risco no contexto da paciente grávida, com pequenos casos relatados como bem sucedidos.