Prospective multicenter evaluation of real time PCR Kit prototype for early diagnosis of congenital Chagas disease.

BACKGROUND: Current algorithm for Congenital Chagas Disease (cCD) diagnosis is unsatisfactory due to low sensitivity of the parasitological methods. Moreover, loss to follow-up precludes final serodiagnosis after nine months of life in many cases. A duplex TaqMan qPCR kit for Trypanosoma cruzi DNA amplification was prospectively evaluated in umbilical cord (UCB) and peripheral venous blood (PVB) of infants born to CD mothers at endemic and non-endemic sites of Argentina. METHODS: We enrolled and followed-up 370 infants; qPCR was compared to gold-standard cCD diagnosis following studies of diagnostic accuracy guidelines. FINDINGS: Fourteen infants (3·78%) had cCD. The qPCR sensitivity and specificity were higher in PVB (72·73%, 99·15% respectively) than in UCB (66·67%, 96·3%). Positive and negative predictive values were 80 and 98·73% and 50 and 98·11% for PVB and UCB, respectively. The Areas under the Curve (AUC) of ROC analysis for qPCR and micromethod (MM) were 0·81 and 0·67 in UCB and 0·86 and 0·68 in PVB, respectively. Parasitic loads ranged from 37·5 to 23,709 parasite equivalents/mL. Discrete typing Unit Tc V was identified in five cCD patients and in six other cCD cases no distinction among Tc II, Tc V or Tc VI was achieved. INTERPRETATION: This first prospective field study demonstrated that qPCR was more sensitive than MM for early cCD detection and more accurate in PVB than in UCB. Its use, as an auxiliary diagnostic tool to MM will provide more accurate records on cCD incidence. FUNDING: FITS SALUD 001-CHAGAS (FONARSEC, MINCyT, Argentina) to the Public-Private Consortium (INGEBI-CONICET, INP-ANLIS MALBRAN and Wiener Laboratories); ERANET-LAC-HD 328 to AGS and PICT 2015-0074 (FONCYT, MinCyT) to AGS and FA.

Factores que contribuyen al abandono del uso de metodos anticonceptivos en las usuarias del programa de salud reproductiva de dos centros de salud de la ciudad de Resistencia: Provincia del Chaco / Factors that contribute to the abandon of the use of contraceptive in the users of the reproductive health progra of two health centers from the city of Resistance: Province of Chaco

Objetivo: Identificar los factores que contribuyeron al abandono de uso de métodos anticonceptivos de las usuarias del Programa de Salud Reproductiva, en los Centros de Salud del Barrio España y Villa Libertad de la ciudad de Resistencia. Provincia del Chaco durante los años 2002 y 2003, y a partir de ellos, establecer un perfil de riesgo que permita reconocer y acompañar los potenciales abandonos del uso de anticonceptivos enel Programa, para generar intervenciones que lo impidan y favorezca disminuir la mortalidad infantil y morbi mortalidad materna en la provincia. Material y Métodos: La población comprendió todas las mujeres ingresadas en el programa de salud reproductiva de dos centros de salud de Resistencia, Chaco, entre enero del 2002 y 2003, que reunían criterios de riesgo preconcepcional. Se realizó un análisis problacional, descriptivo, retrospectivo, cuantitativo, identificandose algunos factores sociodemog´raficos, de las historias reproductivas o inherentes al metodo anticonceptivo que podría condicionar en las ususarias del Programa de Salud Reproductiva la permanencia o el abandono de su uso.