La mejoría electrocardiográfica con el tratamiento de la enfermedad de Chagas crónica, es independiente de la persistencia de Trypanosoma cruzi / No association between persistence of the parasite and electrocardiographic evolution in treated patients with Chagas disease

Background: International studies show a low compliance with norms for the management of cardiovascular risk factors. Aim: To assess the prevalence of risk factors in patients admitted for a coronary or vascular event and to evaluate the proportion of patients that normalize these factors after one year of follow up. Material and Methods: Three hundred and fifty seven patients aged 64±13 years (264 males), admitted to a University Clinical Hospital for a coronary or vascular event were studied. They were educated about cardiovascular risk factors and followed by their treating physicians for a mean of 11.9±2 months. During this period, smoking habits, body mass index. blood pressure, serum lipid levels, blood glucose and the appearance of new cardiovascular events were registered. Results: One year survival was 96% (all 13 deaths were of cardiac origin). Eighty seven percent of patients were free of major cardiovascular events. At discharge from hospital and at the end of follow up 49% and 44% had a total cholesterol over 200 mg/dl respectively, 9,6% and 20,8% had systolic pressure over 140 mmHg. There was no diastolic hypertension in these patients, 27% and 31% had a body mass index over 25 kg/m2 and 2% smoked (versus 32% before the event). Conclusions: After one year of follow up, the prevalence of risk factors in patients that had suffered a cardiovascular event, continues to be high.

Cardiopatía chagásica en la primera región de Chile: estudio clínico, epidemiológico y parasitológico / Chagas cardiopathy in first region of Chile. Clincial, epidemiologic and parasitologic

705 inhabitants of rural towns in northern Chile were surveyed to study chagasic infection and cardiac involvement. Clinical evaluation, electrocardiogram, indirect hemagglutination test and senodiagnosis for reactores were employed. culture of positive xendoiagnsis was done to identify different zymodemes and schizodemes of T cruzi, T spinolai was not found in this area implying the absence of a wild cycle. Triotomines were not found over 3000 m high. Four cases of Z2b T. cruzi strains were found. Simultaneous infection by Z1 and Z2b strains was found in the same bug obtained from houses. Overall human infection rate was 10%, and 69% of then showed altered electrocardiograms. Therefore, a lower infection rate but greater evidence of cardiac involvement is found in northern Chile compared to other areas in the country

Cardiopatia chagasica y zimodemos de Trypanosoma cruzi en Chile / Chagas' cardiopathy and Trypanosoma cruzi zymodemes in Chile

Se hicieron cultivos de cepas de Trypanosoma cruzi aisladas en 97 pacientes chilenos, las cuales se centrifugaron para despues efectuar la lisis de los parasitos y obtener sus enzimas. Los extractos enzimaticos se sometieron a electroforesis y se utilizaron para identificar tres cepas designadas Z1, Z2a y Z2b. La cepa Z1, que se encontro en dos pacientes, era una cepa silvestre de T. cruzi transmitida por el insecto Triatoma spinolai; la cepa Z2a, que infecto a 16 pacientes era similar a la cepa brasilena (clon 3 Esmeraldo, Z2) y la cepa Z2b encontrada en 79 pacientes era semejante a la cepa Z2 de Bolivia (clon 1 SC43). No se hallaron diferencias estadisticamente significativas en la incidencia de alteraciones electrocardiograficas entre los pacientes infectados por las diferentes cepas, tal vez debido a que se considero un numero pequeno de enfermos. Sin embargo, la identificacion de la cepa Z1 indica que el hombre puede ser infectado por esta cepa silvestre transmitida por T. spinolai y que la infeccion puede producir cardiopatologias importantes. Por otro lado, la cepa aislada con mas frecuencia (Z2b) fue similar a la cepa boliviana Z2 de T. cruzi. Este hallazgo indica que es necesario llevar a cabo otros estudios estructurales del parasito para poder determinar si este u otros tipos de T. cruzi que se encuentran en Chile son cepas migratorias o autoctonas