ABSTRACT
INTRODUCTION: The purpose of this study was to determine digoxin serum concentrations in patients with Chagas' cardiomyopathy with chronic heart failure, because little is known concerning this laboratory test in patients with this condition. METHODS: This study focuses on 29 (29 percent) out of 101 patients with chronic heart failure secondary to Chagas' cardiomyopathy receiving digoxin therapy. Digoxin was measured by the immune-enzymatic method. RESULTS: New York Heart Association Functional Class III/IV was noted in 13 (45 percent) patients. The mean potassium serum level was 4.3± 0.5mEq/L, mean creatinine serum levels 1.4± 0.3dg/100ml, and left ventricular ejection fraction 34.7± 13.8 percent. The median digoxin serum level was 1.27 (0.55; 1.79)ng/ml. Sixteen (55 percent) patients had digoxin serum levels higher than 1.0ng/ml. Abnormal digoxin serum levels were verified in 13 (45 percent) patients. Digoxin serum levels correlated moderately with creatinine serum levels (r = 0.39; p< 0.03) and negatively with sodium serum levels (r= -0.38; p= 0.03). CONCLUSIONS: Digoxin serum concentration should be measured in patients with Chagas' cardiomyopathy with chronic heart failure receiving digoxin therapy due to the potential for digoxin toxicity.
INTRODUÇÃO: O propósito deste trabalho foi o de determinar a concentração sérica de digoxina em pacientes com insuficiência cardíaca crônica secundária à cardiomiopatia da doença de Chagas porque pouco se conhece sobre os níveis séricos desse fármaco em pacientes com tal condição clínica. MÉTODOS: Foram recrutados 29 (29 por cento) de 101 pacientes com insuficiência cardíaca crônica secundária à cardiomiopatia da doença de Chagas, os quais estavam sendo tratados com digoxina. Essa droga foi medida no soro desses pacientes pelo método imunoenzimático. RESULTADOS: Treze (45 por cento) pacientes estavam no grau III/ IV da Sociedade Nova-Iorquina de Cardiologia. Os níveis séricos de potássio médio foram 4,3± 0,5 mEq/L, a creatinina sérica média 1,4± 0,3dg/100ml, e a fração de ejeção do ventrículo esquerdo 34.7± 13. 8 por cento. Os níveis séricos médios de digoxina foram 1,27 (0,55; 1,79)ng/ml. Dezesseis (55 por cento) pacientes apresentaram níveis séricos de digoxina > 1,0ng/ml. Níveis séricos anormais de digoxina foram observados em 13 (45 por cento) pacientes. Os níveis séricos de digoxina correlacionaram moderadamente com os de creatinina (r= 0,39; p< 0,03) e negativamente com os de sodium (r= -0,38; p= 0,03). CONCLUSÕES: Os níveis séricos de digoxina devem ser medidos em pacientes com insuficiência cardíaca crônica secundária à cardiomiopatia da doença de Chagas por causa do potencial para ocorrer toxicidade pela digoxina.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Cardiotonic Agents/blood , Chagas Cardiomyopathy/blood , Digoxin/blood , Heart Failure/blood , Chronic Disease , Cross-Sectional Studies , Cardiotonic Agents/therapeutic use , Chagas Cardiomyopathy/complications , Chagas Cardiomyopathy/drug therapy , Creatinine/blood , Digoxin/therapeutic use , Heart Failure/drug therapy , Heart Failure/etiology , Immunoassay , Prevalence , Potassium/blood , Severity of Illness IndexABSTRACT
In this chapter it is emphasized the importance to guarantee safety and high quality blood transfusions. Besides, the following topics are analyzed: the importance of Trypcmosoma cruzi infection acquired by blood transfusions, the obligatory screening implemented in Chilean blood banks and serological diagnostic techniques used that for, the seroprevalence observed, the importance to confirm results and methods recommended in this purpose and, to notify the donor once the infection is confirmed. In addition a facsímil of a letter used to notify the positive donor is included as guidelines to make advice after, attaching a pro-forma of clinical-epidemiological registration to refer the donor to medical evaluation and treatment.
En este capítulo se establece la importancia de otorgar seguridad desde el punto de vista biológico y garantizar transfusiones de calidad y sin agentes infectantes detectables. Se analiza la importancia de la infección por Trypanosoma cruzi a través de transfusión sanguínea, el tamizaje obligatorio que se efectúa en Chile y las técnicas serológicas empleadas, la seroprevalencia encontrada en los bancos de sangre, la importancia de la confirmación y las técnicas empleadas y, la notificación al donante una vez confirmada la infección. Se acompaña de una carta tipo de notificación al donante positivo y una interesante guía para efectuar la consejería que debe seguir a la notificación, adjuntándose un formato de una ficha clínico-epidemiológica para su derivación a médico para estudio y tratamiento.
Subject(s)
Animals , Humans , Antibodies, Protozoan/blood , Blood Donors , Chagas Disease/diagnosis , Immunoglobulin G/blood , Mass Screening/methods , Trypanosoma cruzi/immunology , Chagas Disease/epidemiology , Chagas Disease/prevention & control , Chile/epidemiology , Enzyme-Linked Immunosorbent Assay , Fluorescent Antibody Technique, Indirect , Prevalence , Surveys and QuestionnairesABSTRACT
A summary of different kind of immune supressed hosts and the importance of Tryponosoma cruzi infection in this group of patients is presented. Then, most relevant aspects of immune compromised host-parasite interaction are analyzed such as the moment of acquiring the infection, immune compromise level, mechanisms of acquisition the infection and geographic region. Clinical features of primary infection and reactivation of infection in chronic Chagasic patients are described making especial emphasis in solid organ transplant and BMT. Chagas disease in AIDS patients is discussed including its treatment, follow up, monitoring the immune compromise level and prophylaxis.
Se revisa someramente los diferentes tipos de inmu-osupresión y la importancia de la infección por Trypa-nosoma cruzi en este tipo de pacientes. Se analizan los aspectos más relevantes de la relación hospedero inmunocomprometido-r. cruzi, tales como el momento de la infección, grado de inmunocompromiso, mecanismos de adquisición de la infección y área geográfica. Se presenta el cuadro clínico en el caso de primoinfección, como así también en la reactivación de la infección en pacientes chagásicos crónicos, haciéndose hincapié en el trasplante de órganos sólidos y precursores hematopoyéticos. Mención especial se hace de la enfermedad de Chagas en pacientes con SIDA, destacando el cuadro clínico y enfatizando en su tratamiento, seguimiento, monitorización del nivel de su compromiso inmunológico y profilaxis.