Heart Transplantation for Chagas Cardiomyopathy

Abstract Heart transplantation (HT) is an established treatment for patients with advanced heart failure (HF). Chagas disease (CD), caused by the Trypanosoma cruzi (T.cruzi) is an important cause of HF in Latin America. Considering CD is a chronic infectious disease, the use of immunosuppressive therapy after HT can reactivate T. cruzi infection and compromise outcomes. Early diagnosis and treatment of this complication is extremely important, which requires knowledge, experience, and a high degree of suspicion by transplant physicians. Furthermore, with the international immigration of people, CD is no longer exclusive to Latin America, since a large number of immigrants with T. cruzi infection are living in non-endemic countries. This phenomenon represents not only a new global epidemiological problem, but also a challenge for transplant teams. This review aims to discuss the peculiarities of HT in the context of CD, with a focus on reactivation of the infection, clinical manifestations, etiological treatment of T. cruzi and differential diagnosis with allograft rejection, among HT recipients.

2 nd Brazilian Consensus on Chagas Disease, 2015.

Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research .

[Brazilian Consensus on Chagas Disease, 2015]. / II Consenso Brasileiro em Doença de Chagas, 2015.

Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

II Consenso Brasileiro em Doença de Chagas, 2015 / Brazilian Consensus on Chagas Disease, 2015

A doença de Chagas é uma condição crônica negligenciada com elevada carga de morbimortalidade e impacto dos pontos de vista psicológico, social e econômico. Representa um importante problema de saúde pública no Brasil, com diferentes cenários regionais. Este documento traduz a sistematização das evidências que compõe o Consenso Brasileiro de Doença de Chagas. O objetivo foi sistematizar estratégias de diagnóstico, tratamento, prevenção e controle da doença de Chagas no país, de modo a refletir as evidências científicas disponíveis. Sua construção fundamentou-se na articulação e contribuição estratégica de especialistas brasileiros com conhecimento, experiência e atualização sobre diferentes aspectos da doença. Representa o resultado da estreita colaboração entre a Sociedade Brasileira de Medicina Tropical e o Ministério da Saúde. Espera-se com este documento fortalecer o desenvolvimento de ações integradas para enfrentamento da doença no país com foco em epidemiologia, gestão, atenção integral (incluindo famílias e comunidades), comunicação, informação, educação e pesquisas.

Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

2 nd Brazilian consensus on Chagas Disease, 2015

Chagas disease is a neglected chronic condition with ahigh burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and controlof Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health...

Clotting factor XIII and desmopressin improve hemostasis in uncontrolled bleeding.

PURPOSE: To investigate hemostatic effects of supplementary factor XIII and desmopressin (DDAVP) in resuscitation of uncontrolled bleeding. METHODS: Fifty-four rabbits were randomized in nine groups: G1: Sham; G2: FXIII and normotensive resuscitation (NBP); G3: FXIII and permissive hypotension (PH) (MAP 60% baseline); G4: FXIII/DDAVP/NBP; G5: FXIII/DDAVP/PH; G6: NBP only; G7: FXIII no hemorrhage; G8: FXIII/DDAVP no hemorrhage; G9: PH only. Thromboelastometry and intra-abdominal blood loss were assessed. Scanning electron microscopy (EM) of the clots was performed. RESULTS: Compared to Sham, only G8 (FXIII/DDAVP w/o hemorrhage) showed clotting time (CT) significantly lower (p<0.05). NBP alone (G6) resulted in significantly prolonged CT compared to G2, G3 and G5 (p<0.05). Similarly, median alpha angle was significantly larger in G3,4,5, and 9 compared to G6 (p<0.05). Area under the curve was significantly greater in G5 than G2. Intra-abdominal blood loss was lower in G5 and G9 compared to G2 and G6. FXIII/DDAVP and PH resulted in more robust fibrin mesh by EM. CONCLUSIONS: Normotensive resuscitation provokes more bleeding and worsens coagulation compared to pH, that is partially reversed by factor XIII and desmopressin. FXIII and DDAVP can synergistically improve coagulation. Permissive hypotension reduces bleeding regardless of those agents.

Clotting Factor XIII and desmopressin improve hemostasis in uncontrolled bleeding

PURPOSE: To investigate hemostatic effects of supplementary factor XIII and desmopressin (DDAVP) in resuscitation of uncontrolled bleeding. METHODS: Fifty-four rabbits were randomized in nine groups: G1: Sham; G2: FXIII and normotensive resuscitation (NBP); G3: FXIII and permissive hypotension (PH) (MAP 60% baseline); G4: FXIII/DDAVP/NBP; G5: FXIII/DDAVP/PH; G6: NBP only; G7: FXIII no hemorrhage; G8: FXIII/DDAVP no hemorrhage; G9: PH only. Thromboelastometry and intra-abdominal blood loss were assessed. Scanning electron microscopy (EM) of the clots was performed. RESULTS: Compared to Sham, only G8 (FXIII/DDAVP w/o hemorrhage) showed clotting time (CT) significantly lower (p<0.05). NBP alone (G6) resulted in significantly prolonged CT compared to G2, G3 and G5 (p<0.05). Similarly, median alpha angle was significantly larger in G3,4,5, and 9 compared to G6 (p<0.05). Area under the curve was significantly greater in G5 than G2. Intra-abdominal blood loss was lower in G5 and G9 compared to G2 and G6. FXIII/DDAVP and PH resulted in more robust fibrin mesh by EM. CONCLUSIONS: Normotensive resuscitation provokes more bleeding and worsens coagulation compared to pH, that is partially reversed by factor XIII and desmopressin. FXIII and DDAVP can synergistically improve coagulation. Permissive hypotension reduces bleeding regardless of those agents. .

Mast cells are crucial in the resistance against Toxoplasma gondii oral infection.

During oral infection, mucosal immunity assumes a predominant role. Here, we addressed the role of mast cells (MCs), which are mainly located in mucosa during oral infection with Toxoplasma gondii, using MC-deficient (W/W(v) ) mice. We show that in the absence of MCs the resistance of W/W(v) mice to oral infection was considerably reduced. W/W(v) mice uniformly succumbed within 15 days of infection after administration of cysts of the ME49 strain of T. gondii. The rapid lethality of T. gondii in W/W(v) mice correlated with a delayed Th1-cell response, since IFN-γ and IL-12 levels peaked in the later phase of the infection. In vitro, BM-derived MCs were able to recognize parasite lysate in a MyD88-dependent way, reaffirming the role of this TLR adapter in immune responses to T. gondii. The importance of MCs in vivo was confirmed when W/W(v) mice reconstituted with BM-derived MCs from control mice retrieved an early strong Th1-cell response and specially a significant IL-12 production. In conclusion, MCs play an important role for the development of a protective immune response during oral infection with T. gondii.

Portal cholangiopathy: case report / Colangiopatia portal: relato de caso

The present report describes the case of a child that after blunt abdominal trauma presented with portal thrombosis followed by progressive splenomegaly and jaundice. Ultrasonography and percutaneous cholangiography revealed biliary dilatation secondary to choledochal stenosis caused by dilated peribiliary veins, characterizing a case of portal biliopathy. The present case report is aimed at presenting an uncommon cause of this condition.

Relata-se o caso de uma criança que após trauma abdominal fechado apresentou trombose portal, seguida por esplenomegalia progressiva e icterícia. Os achados da ultrassonografia e da colangiografia percutânea mostraram dilatação de vias biliares secundária à constrição do colédoco por veias pericoledocianas dilatadas, configurando caso de colangiopatia portal. O objetivo deste relato é a apresentação de causa incomum desta condição.

Mastocitose sistêmica: relato de caso / Systemic mastocytosis: case report

A mastocitose sistêmica é um raro transtorno clonal dos mastócitos e de seus precursores. Embora de baixa incidência, a mastocitose sistêmica tem importância epidemiológica, pela morbimortalidade e pelo subdiagnóstico observados no nosso meio. Os sintomas da mastocitose sistêmica são advindos do acúmulo patogênico e da ativação dos mastócitos. Estudos recentes revelaram diferenças significativas entre a biologia celular e molecular dos mastócitos de indivíduos com mastocitose e de indivíduos normais. Esses achados podem ser usados tanto na formulação do critério diagnóstico quanto na elaboração de novas estratégias terapêuticas. É relatado caso de paciente do sexo masculino, 58 anos, com história de febre de origem indeterminada, astenia, adinamia, ascite e plaquetopenia internado no Hospital das Clínicas da UFMG com diagnóstico laboratorial de mastocitose sistêmica.

Systemic mastocytosis is a rare disturb of the mast cells and its progenitors. Even so the low incidence, the disease is epidemiologically important because of the high mortality and the misdiagnosed cases. The symptoms are due to systemic infiltration and activation of pathologic mast cells. Recent studies have documented the difference between the molecular and cellular biology of mast cells in patients with mastocytosis and those of healthy individuals. These findings are being used in formulating diagnostic criteria as well as dictating new treatment approaches to the disease. Is reported a clinic case of a male, 58 years old, with the history of fever of undetermined origin and malaise, ascitis and low platelets. The diagnosis criteria for systemic mastocytosis were established.

Hyperbaric oxygen therapy aggravates liver reperfusion injury in rats / Oxigenoterapia hiperbárica agrava lesão de reperfusão hepática em ratos

PURPOSE: To evaluate the effects of hyperbaric oxygen (HO) therapy in the protection against liver ischemia/reperfusion injury. METHODS: Thirty-two male Wistar rats were divided into four groups of eight animals each: group A - laparotomy and liver manipulation, group B - liver ischemia and reperfusion, group C - HO pretreatment for 60 min followed by liver ischemia and reperfusion, and group D - pretreatment with ambient air at 2.5 absolute atmospheres for 60 min followed by liver ischemia and reperfusion. Plasma was assayed for aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH). Intra-arterial blood pressure was monitored continuously. Myeloperoxidase activity in the liver and lung was assessed 30 min after reperfusion. RESULTS: Plasma AST, ALT and LDH increased after reperfusion in all animals. Plasma ALT values and myeloperoxidase activity in the liver parenchyma were higher in HO-pretreated animals than in groups A, B and D. HO had a negative hemodynamic effect during liver reperfusion. CONCLUSION: Liver preconditioning with hyperbaric oxygen therapy aggravated liver ischemia/reperfusion injury in rats as demonstrated by plasma ALT and liver myeloperoxidase activity.

OBJETIVO: Avaliar os efeitos da oxigenoterapia hiperbárica (OH) como método preventivo da lesão de isquemia e reperfusão (LIR) do fígado. MÉTODOS: Trinta e dois ratos machos Wistar foram distribuídos em quatro grupos de oito animais cada: A - laparotomia e manipulação hepática, B - isquemia e reperfusão hepática, C - pré-tratamento com OH por 60 minutos seguido de isquemia e reperfusão hepática e D - pré-tratamento com ar ambiente a 2,5 atmosferas absolutas por 60 minuto e isquemia e reperfusão hepática. Dosagens seriadas de AST, ALT e DHL foram realizadas. A pressão intra arterial foi monitorizada continuamente. O grau de infiltração leucocitária no fígado e pulmões foi inferido pela dosagem de mieloperoxidade tecidual. RESULTADOS: O nível sérico de AST, ALT e DHL aumentou em todos animais. Os animais expostos a OH apresentaram níveis de ALT e infiltração leucocitária hepática maior que os demais. A OH apresentou efeitos hemodinâmicos negativos durante a reperfusão hepática. CONCLUSÃO: O pré-condicionamento hepático por oxigenoteraia hiperbárica agrava a lesão de isquemia e reperfusão hepática em ratos.

Hyperbaric oxygen therapy aggravates liver reperfusion injury in rats.

PURPOSE: To evaluate the effects of hyperbaric oxygen (HO) therapy in the protection against liver ischemia/reperfusion injury. METHODS: Thirty-two male Wistar rats were divided into four groups of eight animals each: group A - laparotomy and liver manipulation, group B - liver ischemia and reperfusion, group C - HO pretreatment for 60 min followed by liver ischemia and reperfusion, and group D - pretreatment with ambient air at 2.5 absolute atmospheres for 60 min followed by liver ischemia and reperfusion. Plasma was assayed for aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate dehydrogenase (LDH). Intra-arterial blood pressure was monitored continuously. Myeloperoxidase activity in the liver and lung was assessed 30 min after reperfusion. RESULTS: Plasma AST, ALT and LDH increased after reperfusion in all animals. Plasma ALT values and myeloperoxidase activity in the liver parenchyma were higher in HO-pretreated animals than in groups A, B and D. HO had a negative hemodynamic effect during liver reperfusion. CONCLUSION: Liver preconditioning with hyperbaric oxygen therapy aggravated liver ischemia/reperfusion injury in rats as demonstrated by plasma ALT and liver myeloperoxidase activity.

Reconstrução da parede torácica com metilmetacrilato: relato de caso / Chest wall reconstruction with methylmethacrylate: case report

Nos últimos 25 anos, numerosos autores descreveram técnicas de reconstrução da parede torácica. O metilmetacrilato é uma opção atrativa para reconstruções do suporte esquelético da parede torácica após ressecções extensas, por apresentar baixo custo e proporcionar bons e duradouros resultados estéticos e funcionais, além de estabilidade à reconstrução, evitando a movimentação descoordenada do tórax durante a respiração. O presente relato descreve a reconstrução da parede torácica com metilmetacrilato moldado, após exérese tumoral extensa ântero-lateral, com excelente resultado estético e funcional.

During the past 25 years, numerous authors have made remarkable contributions to the reconstruction of the thorax. The methylmethacrylate is an inexpensive and easy to apply option for reconstruction of chest wall skeletal support after extensive resections, and provides satisfactory and durable cosmetic and functional results, associated with stable results and prevention of uncoordinated chest wall motion. This report describes a chest wall reconstruction with molded methylmethacrylate after extensive resection of an anterolateral chest wall tumor, with excellent cosmetic and functional outcome.

Electrogastrography in patients with Chagas' disease.

Electrogastrograghy (EGG) was performed in 33 patients with Chagas' disease and in 15 healthy volunteers-control group. The EGG was performed in two different periods: in fasting and postprandial. The EGG was submitted to a continuous spectral analysis. The following parameters were evaluated: % dominant frequency in spectral bands: normogastria (2-4 cpm), bradygastria (1-2 cpm), tachygastria (4-10 cpm) and duod/resp (10-15 cpm). EGG was considered normal if normogastria > 65% in both EGG periods. The chagasic group showed % normogastria significantly lower (basal, P < 0.01), % bradygastria (basal, P = 0.01) and % tachygastria (basal and postprandial, P =.001) significantly higher than the control group. EGG was normal in 14/15 (93%) in control group x 16/33 (53%) in chagasic group (P < 0.05). It was concluded that: 1) the prevalence of gastric dysrhythmias was higher in chagasic patients than in comparison to a control group 2) gastric dysrhythmias may be considered one of the abnormalities presented in the chagasic gastropathy.

Doença de Castleman na pelve feminina: Relato de caso e revisäo de literatura / Pelvic Castleman disease: A case report and literature review

A doença de Castleman ou hiperplasia angiofolicular linfóide é uma condiçäo incomum, de etiologia desconhecida, que raramente se manifesta como massa pélvica isolada. Há poucos casos descritos na literatura. Relatamos a ocorrência de doença de Castleman, em pacientes de 35 anos, simulando um tumor anexial. Os aspectos relacionados ao diagnóstico, diagnóstico diferencial e tratamento säo revistos

Leiomioma uterino mixóide: relato de caso / Uterine myxoid leiomyoma: case report

Leiomiomas uterinos sÝo tumores derivados de músculo liso, de contorno circunscrito, aspecto fasciculado e de fácil diagnóstico, ultra-sonográfico e histopatológico. Os autores descrevem um caso de leiomioma uterino volumoso (peso 2.330 g) que apresentou extensa degeneraçÝo mixóide conferindo ao tumor aspecto gelatinoso. Houve dificuldade na exérese cirúrgica e no diagnóstico macroscópico diferencial com o leiomiossarcoma mixóide e o mixoma peritoneal

Curativos / Wound dressing

Os autores apresentam uma revisäo histórica do tratamento das feridas e dos curativos e descrevem os diversos tipos de materiais e de curativos utilizados no momento. Säo descritos as propriedades, finalidades, as técnicas e os avanços tecnológicos relevantes na área de curativos. Säo listadas as vantagens de cada tipo de curativo, bem como os procedimentos técnicos complementares para se obter bons resultados na confecçäo dos mesmos. Finalmente, faz-se referências à cultura de células epidérmicas como alternativa para os pacientes que necessitam reposiçäo de pele em áreas com grandes perdas.

Vagotomia, antrectomia e anastomose gastroduodenal ao nível da curvatura menor: justificaçäo fisiopatológica III / Vagotomy, antrectomy and gastroduodenal anastomosis at the level of lower curvature: physiopathological justification III

Faz-se uma justificaçäo fisiopatológica da operaçäo usada no momento da úlcera cloridropéptica. Analisam-se os tempos operatórios à luz da fisiologia gástrica. Na falta de um método mais eficiente, a operaçäo em estudo parece ser a que aproxima um estômago operado da condiçäo normal