Research Progress in Ischemic Stroke Treated by TCM Based on Therapeutic Angiogenesis Intervention / 中国中医药信息杂志

Ischemic stroke is one of the main diseases which harm the health of the elderly. To promote angiogenesis is of great significance for treating ischemic stroke. In recent years, treatment by TCM based on therapeutic angiogenesis intervention for ischemic stroke has achieved great development. Pharmacological and clinical studies have shown that TCM can promote angiogenesis, thereby improving cerebral ischemia and neurological function. This article reviewed the current situation in this field and provided references for clinical treatment of ischemic stroke.

Chagas disease: What is known and what should be improved: a systemic review / Doença de Chagas: O que é conhecido e o que deve ser melhorado: uma visão sistêmica

This study consists of a broad review on what is known and what should be improved regarding knowledge of Chagas disease, not only through analysis on the main studies published on the topics discussed, but to a large extent based on experience of this subject, acquired over the past 50 years (1961-2011). Among the subjects covered, we highlight the pathogenesis and evolution of infection by Trypanosoma cruzi, drugs in use and new strategies for treating Chagas disease; the serological tests for the diagnosis and the controls of cure the infection; the regional variations in prevalence, morbidity and response to treatment of the disease; the importance of metacyclogenesis of T. cruzi in different species of triatomines and its capacity to transmit Chagas infection; the risks of adaptation of wild triatomines to human dwellings; the morbidity and need for a surveillance and control program for Chagas disease in the Amazon region and the need to prioritize initiatives for controlling Chagas disease in Latin America and Mexico and in non-endemic countries, which is today a major international dilemma. Finally, we raise the need for to create a new initiative for controlling Chagas disease in the Gran Chaco, which involves parts of Argentina, Bolivia and Paraguay.

Neste trabalho, fazemos uma ampla revisão sobre o que sabemos e o que deve ser melhorado no conhecimento da doença de Chagas, não somente através da análise dos principais trabalhos publicados sobre os tópicos discutidos, mas em grande parte com base na experiência sobre o assunto, que adquirimos nos últimos 50 anos (1961-2011). Entre os assuntos abordados, destacamos a patogenia e evolução da infecção pelo Trypanosoma cruzi, drogas em uso e novas estratégias para o tratamento da doença de Chagas; os testes sorológicos para o diagnóstico e o controle de cura da infecção; as variações regionais da prevalência, morbidade e resposta ao tratamento da doença; a importância da metaciclogênese do T. cruzi em diferentes espécies de triatomíneos e sua capacidade de transmissão da infecção chagásica; os riscos de adaptação dos triatomíneos silvestres ao domicílio humano; a morbidade e a necessidade de um programa de vigilância e controle da doença de Chagas na região Amazônica e a necessidade de priorização das Iniciativas de controle da Doença de Chagas na América Latina e México e nos países não endêmicos, hoje um grande dilema internacional. Finalmente, levantamos a necessidade da criação de uma nova iniciativa de controle da doença de Chagas no Gran Chaco, que envolve parte da Argentina, Bolívia e Paraguai.

Vacinas:: progrsssos e novos desafios para o controle de doenças imunopreveníveis / Vacunas:: progresos y nuevos retos para el control de enfermedades prevenibles / Vaccines:: Progress and Challenges for the Control of Preventable Diseases

Há mais de 200 anos a vacinação tem sido uma ferramenta muito efetiva na prevenção de doenças infecciosas e juntamente com o saneamento básico, o efeito prático da vacinação pode ser considerado o maior benefício à saúde pública do século XX. No entanto, o desenvolvimento de vacinas permanece um objetivo importante no campo da imunologia e na última década observa-se uma mudança em direção a uma abordagem mais racional, baseada em uma compreensão molecular da patogenicidade microbiana, na utilização de novas tecnologias recombinantes e no desenvolvimento de sistemas de liberação de vacinas mais efetivos. Este trabalho descreve o progresso no desenvolvimento de vacinas a partir dos primeiros relatos das práticas de vacinação, passando pelo estado atual de desenvolvimento de vacinas, pelas novas estratégias vacinais e pelo impacto da vacinação no controle das doenças imunopreveníveis.

Desde hace más de 200 años la vacunación ha sido una herramienta efectiva en la prevención de enfermedades infecciosas junto con el saneamiento ambiental. El efecto práctico de la vacunación puede ser considerado como el mayor beneficio para la salud pública del siglo XX. Sin embargo, el desarrollo de vacunas sigue siendo un objetivo importante en inmunología y en la última década ha habido un cambio hacia un enfoque más racional, basada en los hallazgos moleculares de patogenia microbiana, el uso de nuevas tecnologías recombinantes y el desarrollo de sistemas de suministro de las vacunas más eficaces. En este trabajo se describen los progresos en el desarrollo de vacunas, partiendo de los primeros informes de prácticas de vacunación, hasta el estado actual del desarrollo de vacunas, las nuevas estrategias de vacunas y el impacto de la vacunación en el control de enfermedades prevenibles.

For over 200 years, vaccination has been a very effective tool to prevent infectious diseases along with sanitation. In practical terms, it can be considered the greatest public health benefit of the twentieth century. However, vaccine development remains as a developing domain in the field of immunology and in the last decade there has been a shift towards a more rational approach in vaccination design, based on a molecular understanding of microbial pathogenesis, the use of new recombinant technologies and the development of more effective delivery systems for vaccines. This paper describes the progress in vaccine development from the first reports of vaccination practices, through the current state of vaccine development, the new vaccine strategies and the impact of vaccination in the control of preventable diseases.

Chronic phase of Chagas disease: why should it be treated? A comprehensive review

The pathogenesis and evolutive pattern of Chagas disease suggests that the chronic phase should be more widely treated in order to (i) eliminate Trypanosoma cruzi and prevent new inflammatory foci and the extension of tissue lesions, (ii) promote tissue regeneration to prevent fibrosis, (iii) reverse existing fibrosis, (iv) prevent cardiomyopathy, megaoesophagus and megacolon and (v) reduce or eliminate cardiac block and arrhythmia. All cases of the indeterminate chronic form of Chagas disease without contraindications due to other concomitant diseases or pregnancy should be treated and not only cases involving children or recently infected cases. Patients with chronic Chagas cardiomyopathy grade II of the New York Heart Association classification should be treated with specific chemotherapy and grade III can be treated according to medical-patient decisions. We are proposing the following new strategies for chemotherapeutic treatment of the chronic phase of Chagas disease: (i) repeated short-term treatments for 30 consecutive days and interval of 30-60 days for six months to one year and (ii) combinations of drugs with different mechanisms of action, such as benznidazole + nifurtimox, benznidazole or nifurtimox + allopurinol or triazole antifungal agents, inhibition of sterol synthesis.

Present situation and new strategies for Chagas disease chemotherapy: a proposal

Treatments for Chagas disease have been administered since the first attempts by Mayer & Rocha Lima (1912, 1914) and up to the drugs currently in use (nifurtimox and benznidazole), along with potential drugs such as allopurinol and first, second and third-generation antifungal agents (imidazoles and triazoles), in separate form. Several diseases such as tuberculosis, leprosy and AIDS only came under control after they were treated with associations of drugs with different mechanisms of action. This not only boosts the action of the different compounds, but also may avoid the development of parasite resistance .To this end, over the short term, we propose experimental studies on laboratory animals and clinical trials with the following associations: (i) nifurtimox (8 mg/kg/day) + benznidazole (5 mg/kg/day) x 60 consecutive days; (ii) nifurtimox (8 mg/kg/day) or benznidazole (5 mg/kg/day) + allopurinol (8-10 mg/kg/day) x 60 days and (iii) nifurtimox (8 mg/kg/day) or benznidazole (5 mg/kg/day) + ketoconazole, fluconazole or itraconazole (5-6 mg/kg/day) x 60 consecutive days. The doses of the drugs and the treatment schedules for the clinical trials must be adapted according to the side effects. From these, other double or triple associations could be made, using drugs with different mechanisms of action. This proposal does not exclude investigations on new drugs over the median and long terms, targeting other aspects of the metabolism of Trypanosoma cruzi. Until such time as the ideal drug for specific treatment of Chagas disease might be discovered, we need to develop new strategies for achieving greater efficacy with the old drugs in associations and to develop rational experimentation with new drugs.