Prevalencia de enfermedad de Chagas en estudiantes de medicina de 16 países latinoamericanos de la Escuela Salvador Allende, Cuba / Prevalence of Chagas disease in medical students from 16 Latin American countries attending Escuela Salvador Allende, Cuba

Introducción: Una de las enfermedades infecciosas que tiene repercusión en Latinoamérica es la enfermedad de Chagas. Objetivo: Identificar los estudiantes con serología positiva para la enfermedad de Chagas y describir las características en los mismos con enfoque epidemiológico. Método: Se realizó una investigación observacional, descriptiva y prospectiva. Se determinó la prevalencia en los estudiantes latinoamericanos de medicina que residen en la Escuela Salvador Allende en el periodo comprendido entre octubre de 2009 a enero de 2010, mediante serología, otros estudios y examen clínico. Se recogieron las variables de las historias clínicas y de entrevista personal. Resultados: Afectados 50 de la delegación boliviana. La prevalencia fue de 6,6 por ciento de esta delegación. No tenían síntomas clínicos. Las alteraciones detectadas fueron la hipertrofia ventricular izquierda, los trastornos de conducción y del ritmo por electrocardiograma. Predominó el sexo masculino y la procedencia rural. Se encontró variabilidad en los resultados de laboratorio, siendo positivos en su país y negativos en Cuba y viceversa. Solo el 56 por ciento cumplió el tratamiento. Las reacciones adversas fueron mínimas. Conclusión: Constituye un problema sanitario y demanda un mejor diagnóstico, control y seguimiento.

Introduction: One of the infectious illnesses that have repercussion in Latin America are the Chagas illness. Objective: with the objective of identifying the students with positive serology for the illness of Chagas and describe the characteristics in the same thing with focussing epidemiological carried out to him the present study. Method: It become fulfilled a observational investigation, descriptive and prospectival. It decided the prevalencial in the Latin American students of medicine that resides in the school Salvador Allende in the period understanded between October of the 2009 to January of the 2010 by means of serology, other clinical studieses and examination. They took shelter the variables of the clinical records and of personal interview.. Results: Affected 50 of the Bolivian delegation. The prevalence went of 6.6 percent of this delegation. Have clinical symptoms. The detected alterations went the ventricular hypertrophy left and the disorders of transportation and of the rhythm for electrocardiogram. It predominated the masculine sex and the rural origin. It found variability in the results of laboratory, being positive in their country and negative in Cuba and vice versa. Single 56 percent fulfilled the treatment. The adverse reactions went minims. Conclusion: It constitutes a sanitary problem and demands a better diagnosis, control and follow-up.

A lesão apical em pacientes cardiopatas chagásicos crônicos. Estudo clínico e ecocardiográfico / The apical lesion in chronic chagasic myocardiopathy. A clinical and echocardiographic study

JUSTIFICATIVA E OBJETIVOS: A lesão apical (LA) é sede de tromboses e marcadora de mau prognóstico na doença de Chagas. O ecocardiograma bidimensional é um exame útil na avaliação de alterações morfofuncionais em cardiopatas chagásicos crônicos (CCC). O objetivo deste estudo foi avaliar a frequência da LA em CCC, diagnosticada por meio do ecocardiograma bidimensional com Doppler, e estudar clinicamente estes pacientes. MÉTODO: Realizou-se um estudo retrospectivo de prontuários de CCC submetidos ao ecocardiograma bidimensional com Doppler. Os pacientes foram divididos em dois grupos, na dependência da presença (Grupo A) ou ausência (Grupo B) da LA. Foram estudadas variáveis clínicas e ecocardiográficas, que foram submetidas à análise estatística.RESULTADOS: Foram incluídos 100 pacientes; 21 no grupo A [13-(61,9%) do sexo masculino; idade média de 61,10 anos] e 79 no B [46-(58,23 %) do sexo feminino; idade média de 57,01 anos]. Dos 50 pacientes miopatas, 70 batmopatas e 60 dromopatas observados, a LA esteve presente respectivamente em 17 (34,0%), 13 (18,6%) e 11 (18,3%). As três formas clínicas simultaneamente foram observadas em 26 pacientes, desses, sete (26,9%) apresentavam LA. A hipertensão arterial foi a comorbidade mais frequente, encontrada em 61 pacientes (61%), 11 (52,38%) eram do grupo A. No grupo B, 82,5% (52 pacientes) tinham fração de ejeção maior ou igual a 55, enquanto no grupo A, 26,3% (5 pacientes) a tinham abaixo de 55. Três casos de trombose foram diagnosticados ao Ecocardiograma; em dois o trombo se localizava na própria LA.(...)

BACKGROUND AND OBJECTIVES: The apical lesion (AL) is the seat of thrombosis and amarker of poor prognosis in Chagas disease. Bi-dimensional echocardiogram is a helpful tool in the evaluation of morphofunctional changes in chronic chagasic cardiopathy (CCC). The objective of this study was to evaluate the frequency of AL in CCC, diagnosed by bi-dimensional Doppler echocardiography and study these patients clinically. METHOD: A retrospective study of CCC medical records was conducted. The patients were submitted to a bi-dimensional Doppler echocardiogram and then divided into two groups, depending on the presence (Group A) or absence (Group B) of AL. We studied clinical and echocardiographic variables that were subjected to statistical analysis.RESULTS: 100 patients were included, 21 in group A [13 - (61.9%) males, average age 61.10 years old] and 79 in B [46 - (58.23%) females, average age 57.01 years old]. In this study we found 50 patients with myopathy, 70 with arrhythmias and 60 patients had intracardiac conduction disturbances. Among these patients, AL was present respectively in 17 (34.0%), 13 (18.6%) and 11 (18.3%). These three clinical forms were observed simultaneously in 26 patients and seven of them (26.9%) had AL. High blood pressure was the most common comorbidity which was found in 61 patients (61%); 11 (52.38%) of these patients had AL. In group B, 82.5% (52 patients) had an ejection fraction measured by echocardiography greater than or equal to 55; while in group A, 26.3% (5 patients) had an ejection fraction less than 55. Three cases of thrombosis were diagnosed by echocardiography; the thrombus was located in AL itself in two of these cases.(...)

Anticuerpos contra Trypanosoma cruzi en pacientes con miocardiopatía dilatada en Tuxtla Gutiérrez, Chiapas / Antibodies against Trypanosoma cruzi in patients with dilated cardiomyopathy in Tuxtla Gutierrez, Chiapas

La enfermedad de Chagas es causada por el protozoario flagelado Trypanosoma cruzi. Encuestas seroepidemiológicas realizadas en Chiapas informan individuos seropositivos en comunidades rurales, y cabe la posibilidad de que la forma crónica de la enfermedad ocurra en el estado. La expresión clínica dominante en la enfermedad de Chagas crónica es cardíaca. Material y métodos: Con el objeto de conocer la frecuencia de cardiopatía chagásica crónica (CCC) se hizo una encuesta serológica a pacientes con miocardiopatía dilatada (MD) internados entre octubre de 2002 a octubre de 2003, en el Servicio de Cardiología del Hospital General Regional "Dr. Rafael Pascacio Gamboa" de Tuxtla Gutiérrez, Chiapas. El diagnóstico fue establecido en forma independiente y el estudio seroinmunológico fue ciego. Resultados: Quince (54%) de 28 sujetos con MD tenían anticuerpos a T. cruzi. Todos provenían de medio rural pobre, su cuadro clínico incluyó insuficiencia cardíaca y/o trastornos del ritmo o conducción. Conclusiones: Esta evidencia sugiere que en Chiapas, una zona endémica de enfermedad de Chagas, hay CCC. Dentro del estudio de la MD, la etiología chagásica, debe ser considerada, ya que las condiciones socioeconómicas, culturales y regionales favorecen su presencia.

Chagas disease is caused by the flagellate protozoan T. cruzi. Seroepidemiological surveys in Chiapas, Mexico have shown seropositive individuals, therefore, we searched for people affected by the chronic form of Chagas disease which involves the heart, causing a chronic, progressive and fatal disease called Chronic Chagasic Cardiopathy (CCC). Material and methods: To establish the frequency of CCC we studied 28 patients seen at the Hospital General Regional "Dr. Rafael Pascacio Gamboa" during October 2002 through October 2003 in Tuxtla Gutierrez, Chiapas, the State capital city, with diagnosis of dilated cardiomyopathy (DC), a serological survey for antibodies against T. cruzi was done. This hospital cares for people from all parts of Chiapas, Mexico. Clinical diagnosis of DC was established there and blind serological studies were performed in Mexico City. Results: Fifteen out of 28 DC patients (54%) had anti T. cruzi antibodies. All of them came from poor rural villages and they had heart failure and/or arrhythmia or heart blockade on EKG. Conclusions: This observation suggest that in Chiapas were Chagas disease is endemic, there are CCC patients. Any case with a clinical diagnosis of DC should be tested for antibodies against T. cruzi. The low socioeconomic status, culture and environment in this Mexican State favour the presence and transmission of this parasitic disease.

Estudo clínico durante 13 anos de 190 chagásicos crônicos de Mambaí, Goiás, Brasil / A 13-year clinical study on 190 chronic chagasic patients from Mambaí, Goiás, Brazil

A prospective study was performed on the clinical, electrocardiographic (ECG) and radiologic aspects of the esophagus in 190 chagasic patients, for on average follow-up period of 13 years. We found 108 (56.8%) patients who remained in the same clinical state, 72 (37.9%) patients with progressive illness and 10 (5.3%) patients whose previous ECG abnormalities subsided. Thirty nine out of 72 patients with progressive disease developed cardiopathy or aggravation of previous illness, 32 developed into megaesophagus or an existing picture deteriorated and 12 developed or showed worsening of the colopathy. Of 72 patients, 11 presented with associated forms. The development of cardiopathy was greater in males 29.6% (21/71) than in females 15.1% (18/119), p =0.015. There were 19 new cases of cardiopathy, and 20 of aggravated previous disease. The incidence of megaesophagus was 14.9% (23/154), with nine patients whose previous disease worsened. The progression of colopathy was greater in females 9.2% (11/119) than in males 1.4% (1/71), p = 0.026.

Foram estudados prospectivamente 190 chagásicos, do ponto de vista clínico, eletrocardiográfico e abreugráfico do esôfago, no período médio de 13 anos, sendo encontrados 108 (56,8%) com a forma clínica inalterada, 72 (37,9%) com doença progressiva e 10 (5,3%) nos quais houve normalização do eletrocardiograma. Nos 72, em que a doença progrediu, 39 desenvolveram cardiopatia ou agravaram a já existente, 32 evoluíram para, ou pioraram o megaesôfago prévio e, 12 evoluíram para colopatia ou agravaram a já existente. Dentre os 72, 11 tinham formas clínicas associadas. A evolução da cardiopatia foi maior no sexo masculino 29,6% (21/71) que no feminino 15,1% (18/119), p = 0,015. Houve 19 casos novos de cardiopatia e 20 agravaram a cardiopatia prévia. A incidência de megaesôfago foi 14,9% (23/154) e nove agravaram o megaesôfago já existente. A evolução da colopatia foi maior no sexo feminino 9,2% (11/119), que no masculino 1,4% (1/71), p =0,026.