Trypanocidal therapy among children infected by Trypanosoma cruzi. Serological and electrocardiographic changes over a mean twenty-five-years follow-up period.

This study compared the serological and electrocardiographic evolution among patients with chronic T. cruzi infection treated during childhood or left untreated. A retrospective cohort study was conducted during a mean follow-up period of 25 years in 82 patients: half of them underwent treatment (nifurtimox 8, benznidazole 33) before being 15 years old, whereas the other half remained untreated. During the follow-up, negative seroconversion occurred in 92.7% of the treated children, while all the untreated ones remained positive for conventional serology. At baseline, 2 patients from each group had electrocardiographic abnormalities. During the study period, 4/41 (9.75%) and 9/41 (21.95%) of treated and untreated patients displayed an altered electrocardiogram, respectively. In multivariate analyses, the probability of developing electrocardiographic abnormalities was significantly reduced among treated patients (OR = 0.18, 95% CI = 0.04-0.79; p = 0.023). Electrocardiographic abnormalities attributable to Chagas cardiomyopathy were seen in 3 patients from the untreated group (complete right bundle branch block + left anterior fascicular block, frequent ventricular extrasystole, and left anterior fascicular block). The remarkable seronegativization seen in Benznidazole and Nifurtimox recipients underlines the parasiticidal effect of both compounds. Such demonstration along with the fact that CCC-related alterations were only present in the untreated group, reinforces the view of trypanocidal treatment in chronically T. cruzi-infected children as decreasing the risk for cardiomyopathy development.

Evaluation of patient outcomes after operative treatment of intra-articular calcaneus fractures.

BACKGROUND: Percutaneous reduction with fixation and open reduction internal fixation are often used to treat intra-articular calcaneus fractures with no consensus on the preferred method. Open techniques have been associated with an increased risk of wound complications, while percutaneous techniques may result in inferior reduction capabilities. These injuries pose a challenge to patients as they often result in poor patient outcomes. We retrospectively analyzed patient outcomes of a single surgeon's experience in treating these injuries at a busy urban Level 1 trauma center. METHODS: Patients with intra-articular calcaneus fractures managed operatively over 10 years with a minimum six-month follow-up were included. Patients were divided into two cohorts based on operative technique: closed reduction and percutaneous fixation (CRPF) or open reduction internal fixation (ORIF). Descriptive analysis of each cohort included postoperative infection, the need for repeat operations, development of post-traumatic subtalar arthritis, and reduction capabilities as assessed by Bohler's angle. RESULTS: Sixty-two patients were included in this study, with 33 patients in the CRPF group and 29 patients in the ORIF group. Infection requiring a return to the operating room occurred in 1 (3%) CRPF and 7 (24%) ORIF patients. Instrumentation was removed in 23 (70%) CRPF and 9 (31%) ORIF patients. Clinical subtalar arthritis developed in 10 (30%) CRPF and 7 (24%) ORIF patients, requiring arthrodesis in 2 (6%) and 5 (17%) patients, respectively. Both techniques had acceptable restoration of Bohler's angle immediately postoperatively and at final follow-up. CONCLUSIONS: Percutaneous reduction with fixation and open reduction internal fixation may both be considered for the surgical treatment of intra-articular calcaneal fractures. Indications for each technique may vary between surgeons, and each has its own set of risk factors and complications, however, both have been shown to result in an acceptable reduction. LEVEL OF EVIDENCE: Level IV.

Pedf derived peptides affect colorectal cancer cell lines resistance and tumour re-growth capacity.

Relapse after chemotherapy treatment depends on the cancer initiating cells (CICs). PEDF (Pigmented Epithelium Derived Factor) is an anti-angiogenic, neurotrophic and self-renewal regulator molecule, also involved in CICs biology. Acute and chronic exposition of colon cancer cell lines to CT/CTE PEDF-derived peptides decreased drug-resistance to conventional colorectal cancer treatments, such as oxaliplatin or irinotecan. We confirmed a reduction in the irinotecan and oxaliplatin IC50 doses for all tested tumour cell lines. After xenograft transplantation, CT/CTE treatments also produced a reduction in resistance to conventional chemotherapy treatments as in culture-assays. Metastatic capacity of these treated cell lines was also depleted. The PEDF signaling pathway could be a future therapeutic tool for use as an adjuvant therapy that decreases IC50 dosis, adverse effects and treatment costs. This pathway could also be involved in an increase of the time relapse in patients, decreased tumourigenicity, and decreased capacity to produce metastasis.

Foot and Ankle Injuries in Soccer.

The ankle is one of the most commonly injured joints in soccer and represents a significant cost to the healthcare system. The ligaments that stabilize the ankle joint determine its biomechanics-alterations of which result from various soccer-related injuries. Acute sprains are among the most common injury in soccer players and are generally treated conservatively, with emphasis placed on secondary prevention to reduce the risk for future sprains and progression to chronic ankle instability. Repetitive ankle injuries in soccer players may cause chronic ankle instability, which includes both mechanical ligamentous laxity and functional changes. Chronic ankle pathology often requires surgery to repair ligamentous damage and remove soft-tissue or osseous impingement. Proper initial treatment, rehabilitation, and secondary prevention of ankle injuries can limit the amount of time lost from play and avoid negative long-term sequelae (eg, osteochondral lesions, arthritis). On the other hand, high ankle sprains portend a poorer prognosis and a longer recovery. These injuries will typically require surgical stabilization. Impingement-like syndromes of the ankle can undergo an initial trial of conservative treatment; when this fails, however, soccer players respond favorably to arthroscopic debridement of the lesions causing impingement. Finally, other pathologies (eg, stress fractures) are highly encouraged to be treated with surgical stabilization in elite soccer players.

BAMOS: A recording application for BAsso MOuse scale of locomotion in experimental models of spinal cord injury.

Transparency in science is increasingly a hot topic. Scientists are required to show not only results but also evidence of how they have achieved these results. In experimental studies of spinal cord injury, there are a number of standardized tests, such as the Basso-Beattie-Bresnahan locomotor rating scale for rats and Basso Mouse Scale for mice, which researchers use to study the pathophysiology of spinal cord injury and to evaluate the effects of experimental therapies. Although the standardized data from the Basso-Beattie-Bresnahan locomotor rating scale and the Basso Mouse Scale are particularly suited for storage and sharing in databases, systems of data acquisition and repositories are still lacking. To the best of our knowledge, both tests are usually conducted manually, with the data being recorded on a paper form, which may be documented with video recordings, before the data is transferred to a spreadsheet for analysis. The data thus obtained is used to compute global scores, which is the information that usually appears in publications, with a wealth of information being omitted. This information may be relevant to understand locomotion deficits or recovery, or even important aspects of the treatment effects. Therefore, this paper presents a mobile application to record and share Basso Mouse Scale tests, meeting the following criteria: i) user-friendly; ii) few hardware requirements (only a smartphone or tablet with a camera running under Android Operating System); and iii) based on open source software such as SQLite, XML, Java, Android Studio and Android SDK. The BAMOS app can be downloaded and installed from the Google Market repository and the app code is available at the GitHub repository. The BAMOS app demonstrates that mobile technology constitutes an opportunity to develop tools for aiding spinal cord injury scientists in recording and sharing experimental data.

Supramolecular Recognition of Escherichia coli Bacteria by Fluorescent Oligo(Phenyleneethynylene)s with Mannopyranoside Termini Groups.

Escherichia coli is one the most common bacteria responsible of uropathogenic diseases, which motives the search for rapid and easy methods of detection. By taking advantage of the specific interactions between mannose and type 1 fimbriae, in this work two fluorescent phenyleneethynylene (PE) trimers bearing one or two 4-aminophenyl-α-D-mannopyranoside termini groups were synthesized for the detection of E. coli. Three bacterial strains: ORN 178 (fimbriae I expression), ORN 208 (mutant serotype with no fimbriae expression) and one obtained from a local hospital (SS3) were used. Laser Scanning Confocal Microscopy (LSCM) and Surface Plasmon Resonance (SPR) were applied for the interaction studies following two different approaches: (1) mixing the oligomer solutions with the bacterial suspension, which permitted the observation of stained bacteria and by (2) biosensing as thin films, where bacteria adhered on the surface-functionalized substrate. LSCM allows one to easily visualize that two mannose groups are necessary to have a specific interaction with the fimbriae 1. The sensitivity of SPR assays to E. coli was 104 colony forming unit (CFU)/mL at 50 µL/min flow rate. The combination of PE units with two mannose groups results in a novel molecule that can be used as a specific fluorescent marker as well as a transducer for the detection of E. coli.

Propuesta educativa para elevar los niveles de conocimiento sobre sexualidad en adolescentes síndrome de Down / Educational proposal to raise levels of knowledge about sexuality in adolescents Down syndrome

Estudios recientes demuestran la importancia de educar la sexualidad en pacientes con síndrome de Down desde la infancia, con el propósito de darle respuesta a las curiosidades sexuales de la etapa, así como prepararlos para arribar a la adultez. A partir de esta afirmación, la presente investigación tuvo como objetivo general determinar el nivel de conocimientos de los adolescentes con síndromes de Down en relación con la sexualidad y crear un programa de intervención educativa, con el fin de propiciarles una sexualidad sana; para ello se escogieron 6 adolescentes de edades entre 10 y 15 años, pertenecientes a la escuela especial Francisco Vicente Aguilera del municipio Manzanillo de la provincia Granma. Los referentes teóricos se apoyaron en una concepción humanista-desarrolladora y en la teoría del reforzamiento positivo. La estrategia estuvo en función del trabajo interrelacionado de los adolescentes con síndrome de Down. Se partió de las necesidades educativas arrojadas en el diagnóstico, se diseñó el programa con sus objetivos, posibilitó que estos adolescentes consoliden su identidad sexual, identificándose de acuerdo con su sexo, se incluyeron los genitales en su esquema corporal denominándolos, fomentaron hábitos de higiene relacionados con el cuidado del cuerpo y estimularon las relaciones afectivas a través de los juegos de roles. Se recomienda ampliar esta investigación, con seguimiento hasta la adultez y llevar a la comunidad una estrategia que sensibilice a sus integrantes con la sexualidad de los síndromes de Down(AU)

Recent studies demonstrate the importance of educating sexuality in patients with Down syndrome since infancy, in order to respond to the sexual curiosities of the stage, as well as prepare them to reach adulthood. Based on this assertion, the present research had as general objective to determine the level of knowledge of the adolescents with Down syndromes in relation to the sexuality and to create a program of educational intervention, in order to propitiate them a healthy sexuality; six teenagers between 10 and 15 years of age, belonging to the Francisco Vicente Aguilera special school in the Manzanillo municipality of the Granma province were chosen. The theoretical references were based on a humanist-developmental conception and on the theory of positive reinforcement. The strategy was based on the interrelated work of adolescents with Down syndrome. It was based on the educational needs of the diagnosis, the program was designed with its objectives, enabled these adolescents to consolidate their sexual identity, identified according to their sex, included the genitals in their body schema, naming them, fostered related hygiene habits With the care of the body and stimulated the affective relations through the role plays. It is recommended to expand this research, with follow-up until adulthood and bring to the community a strategy that sensitizes its members with the sexuality of Down syndrome(EU)

INFIX/EXFIX: Massive Open Pelvic Injuries and Review of the Literature.

Introduction. Open pelvic fractures make up 2-5% of all pelvic ring injuries. Their mortality has been reported to be as high as 50%. During Operation Enduring Freedom protocols for massive open pelvic injuries lead to the survival of injuries once thought to be fatal. The INFIX is a subcutaneous anterior fixator for pelvic stabilization which is stronger than external fixation. The purpose of this paper is to describe the use of INFIX and modern algorithms for massive open pelvic injuries. Methods. An IRB approved retrospective review describes 4 cases in civilian practice with massive open pelvic injuries. We also review the modern literature on open pelvic injures. Discussion. Key components in the care of massive open pelvic injuries include hemorrhage control by clamping of the aorta or REBOA when necessary and fecal/urinary diversion. The INFIX can be used internally, as a partial INFIX partial EXFIX, or as an EXFIX. Its low profile allows for easy application of wound vacs and wound care and when subcutaneous avoids pin tract infections. Conclusion. Massive open pelvic injuries are a difficult problem. Following modern protocols can help prevent mortality.

Conocimientos sobre VIH/sida, percepción de riesgo y comportamiento sexual en estudiantes universitarios / Knowledge on HIV/ aids, risk perception and sexual behavior in university students

Cada año aumenta la cifra de personas infectadas con el VIH/sida en el mundo, los adolescentes y jóvenes continúan siendo los más afectados. Se realizó un estudio descriptivo de corte transversal, en el período comprendido entre enero y febrero de 2013, con el objetivo de describir el nivel de conocimientos sobre el VIH/sida, la percepción de riesgo ante esta infección y el comportamiento sexual en los estudiantes de la Facultad de Ciencias Técnicas de la Universidad de Ciencias Pedagógicas Blas Roca Calderío. La población quedó constituida por los 67 estudiantes del primero al tercer año de las carreras de Economía y Educación Laboral -Informática, la muestra la conformaron 24 estudiantes. Para la obtención de la información se empleó la encuesta. El procesamiento estadístico se realizó mediante números absolutos y por cientos. En los estudiantes encuestados predominó un nivel medio de conocimientos sobre el VIH/sida, una percepción de riesgo media ante esta infección y un comportamiento sexual irresponsable(AU)

Every year increases the number of people infected with HIV/AIDS worldwide, adolescents and youth are still the most affected. It was performed a descriptive cross -sectional studyin the period of January- February 2013 with the aim of describing the level of knowledge on HIV/AIDS, the risk perception towards this infection and sexual behavior in students of the Faculty of Technical Sciences at the University of Pedagogical Sciences Blas Roca Calderío. The population was constituted by 67 students from first to third year of Economics and Labor Education -Computer, the sample was constituted by 24 students. To obtain the information it was applied a survey. Statistical processing was performed using absolute numbers and percentages. In the surveyed students there was prevalence in the average level on HIV/AIDS knowledge, an average risk perception towards this infection and irresponsible sexual behavior(EU)

Evaluation of the ELISA-F29 test as an early marker of therapeutic efficacy in adults with chronic Chagas disease.

This work compared the time at which negative seroconversion was detected by conventional serology (CS) and by the ELISA-F29 test on a cohort of chronic chagasic patients treated with nifurtimox or benznidazole. A retrospective study was performed using preserved serum from 66 asymptomatic chagasic adults under clinical supervision, and bi-annual serological examinations over a mean follow-up of 23 years. Twenty nine patients received trypanocide treatment and 37 remained untreated. The ELISA-F29 test used a recombinant antigen which was obtained by expressing the Trypanosoma cruzi flagellar calcium-binding protein gene in Escherichia coli. Among the untreated patients, 36 maintained CS titers. One patient showed a doubtful serology in some check-ups. ELISA-F29 showed constant reactivity in 35 out of 37 patients and was negative for the patient with fluctuating CS. The treated patients were divided into three groups according to the CS titers: in 13 they became negative; in 12 they decreased and in four they remained unchanged. ELISA-F29 was negative for the first two groups. The time at which negativization was detected was significantly lower for the ELISA-F29 test than for CS, 14.5 ± 5.7 and 22 ± 4.9 years respectively. Negative seroconversion was observed in treated patients only. The results obtained confirm that the ELISA-F29 test is useful as an early indicator of negative seroconversion in treated chronic patients.

Evaluation of the ELISA-F29 test as an early marker of therapeutic efficacy in adults with chronic Chagas disease / Avaliação do tratamento tripanossomicida em coorte de adultos chagásicos crônicos através de técnicas sorológicas convencionais e ELISA-F29

This work compared the time at which negative seroconversion was detected by conventional serology (CS) and by the ELISA-F29 test on a cohort of chronic chagasic patients treated with nifurtimox or benznidazole. A retrospective study was performed using preserved serum from 66 asymptomatic chagasic adults under clinical supervision, and bi-annual serological examinations over a mean follow-up of 23 years. Twenty nine patients received trypanocide treatment and 37 remained untreated. The ELISA-F29 test used a recombinant antigen which was obtained by expressing the Trypanosoma cruzi flagellar calcium-binding protein gene in Escherichia coli. Among the untreated patients, 36 maintained CS titers. One patient showed a doubtful serology in some check-ups. ELISA-F29 showed constant reactivity in 35 out of 37 patients and was negative for the patient with fluctuating CS. The treated patients were divided into three groups according to the CS titers: in 13 they became negative; in 12 they decreased and in four they remained unchanged. ELISA-F29 was negative for the first two groups. The time at which negativization was detected was significantly lower for the ELISA-F29 test than for CS, 14.5 ± 5.7 and 22 ± 4.9 years respectively. Negative seroconversion was observed in treated patients only. The results obtained confirm that the ELISA-F29 test is useful as an early indicator of negative seroconversion in treated chronic patients.

Este trabalho comparou os tempos de soroconversão negativos obtidos pela sorologia convencional (CS) e teste ELISA-F29 em uma coorte de pacientes chagásicos crônicos tratados com nifurtimox ou benznidazol. Um estudo retrospectivo foi realizado com soro preservado de 66 adultos chagásicos assintomáticos com acompanhamento clínico e sorológico semestral ao longo de um seguimento médio de 23 anos. 29 pacientes receberam tratamento tripanossomicida e 37 outras permaneceram sem tratamento. O teste ELISA-F29 usou um antígeno recombinante obtido por expressão do gene de uma proteína flagelar de Trypanosoma cruzi de ligação de cálcio em Escherichia coli. Entre os pacientes não tratados, 36 mantiveram os títulos da CS. Um paciente apresentou sorologia duvidosa em alguns controles. ELISA-F29 apresentou reatividade constante em 35/37 e foi negativo no paciente com CS flutuante. Os pacientes tratados foram agrupados de acordo com os títulos da CS, em três grupos: 13 tornaram-se negativos, 12 diminuíram e quatro permaneceram inalterados. ELISA-F29 foi negativo nos dois primeiros grupos. O tempo de negativização foi significativamente menor para o teste ELISA-F29 do que para CS (14,5 ± 5,7 e 22 ± 4,9 anos, respectivamente). A soroconversão negativa foi observada somente nos pacientes tratados. Os resultados obtidos confirmam que o teste ELISA-F29 é útil como um indicador precoce de soronegativação em pacientes crônicos tratados.

Extrahepatic disease should not preclude transarterial chemoembolization for metastatic neuroendocrine carcinoma.

BACKGROUND: Transarterial chemoembolization (TACE) is often utilized for patients with inoperable neuroendocrine carcinoma liver metastases. Often, metastatic disease is not limited to the liver. The impact of extrahepatic disease (EHD) on outcomes and response after TACE has not been described. METHODS: We reviewed 192 patients who underwent TACE for large hepatic tumor burden, progression of liver metastases, or poorly controlled carcinoid syndrome due to neuroendocrine carcinoma. Demographics, clinicopathologic characteristics, response to TACE, complications, and survival were compared between patients with (n = 123) and without (n = 69) EHD. RESULTS: Demographics, histopathologic characteristics, and complications were similar between groups. As well, those with and without EHD had similar biochemical (85 vs. 88 %) and radiographic response (76 vs. 79 %) to TACE (all p = NS); however, symptomatic responses were improved in those with EHD (79 vs. 60 %, p = 0.01). The group without EHD had better overall survival compared to those with EHD disease at the time of TACE (median 62 vs. 28 months, p = 0.001). DISCUSSION: Although patients with EHD from neuroendocrine carcinoma experience shorter overall survival after TACE compared to those without EHD, they had similar symptomatic, biochemical, and radiographic response to TACE. Meaningful response to TACE is still possible in the presence of EHD and should be considered, particularly in those with carcinoid syndrome.

Perspectiva interdisciplinaria para el abordaje de una enfermedad infecciosa: chagas o tripanosomiasis americana / Interdisciplinary perspective to approach an infectious disease: american trypanosomiasis or chagas disease

La enfermedad de Chagas, producida por elTrypanosomacruziy transmitida por un insecto triatomino, es de grancomplejidad. En el control de esta endemia no puedeconsiderarse la enfermedad como un hecho individualy sólo biológico. Entre sus múltiples componentes debeconsiderarse la relación de los sujetos con el hábitat, losmodos de producción, las condiciones culturales, lasrelaciones sociales y las formas organizativas.Como profesionales del campo de la salud intentamosnuevos enfoques que integran diferentes miradas disciplinaresy modos de intervención distintos, donde “el otro” recuperesu ser sujeto y no esté convocado a desempeñar un merorol de paciente. Posiciones que implican favorecer procesosparticipativos, escuchar a los propios protagonistas (mujerescon Chagas, equipos de salud, referentes comunitarios)recuperar sus peculiares visiones, poner en palabras lo nodicho sobre esta enfermedad silenciosa y silenciada, y develarlo que el Chagas esconde. Constituye una herramientaimportante a la hora de pensar propuestas de trabajo.

Chagas disease, caused by Trypanosoma cruzi and transmitted by a triatomine insectis extremely complicated. When controlling this endemic disease, the disease cannot beconsidered as an individual and merely biological fact. Among its many components therelationship of individuals to the habitat, production modes, cultural conditions, socialrelationships and organizational forms must be considered.As health professionals we present new approaches that integrate different disciplinesand modes of intervention, where “the other” recovers his/her individual being and isnot merely called upon to play a role as a patient. Positions that encourage participativeprocesses involving listening to the protagonists themselves (women with Chagas, healthteams, community references), recovering their unique visions, communicating what isnot said about this silent and hushed up disease, and revealing what Chagas hides areimportant tools when thinking about work proposals.

Perspectiva interdisciplinaria para el abordaje de una enfermedad infecciosa: chagas o tripanosomiasis americana / Interdisciplinary perspective to approach an infectious disease: american trypanosomiasis or chagas disease

La enfermedad de Chagas, producida por elTrypanosomacruziy transmitida por un insecto triatomino, es de grancomplejidad. En el control de esta endemia no puedeconsiderarse la enfermedad como un hecho individualy sólo biológico. Entre sus múltiples componentes debeconsiderarse la relación de los sujetos con el hábitat, losmodos de producción, las condiciones culturales, lasrelaciones sociales y las formas organizativas.Como profesionales del campo de la salud intentamosnuevos enfoques que integran diferentes miradas disciplinaresy modos de intervención distintos, donde ôel otroö recuperesu ser sujeto y no esté convocado a desempeñar un merorol de paciente. Posiciones que implican favorecer procesosparticipativos, escuchar a los propios protagonistas (mujerescon Chagas, equipos de salud, referentes comunitarios)recuperar sus peculiares visiones, poner en palabras lo nodicho sobre esta enfermedad silenciosa y silenciada, y develarlo que el Chagas esconde. Constituye una herramientaimportante a la hora de pensar propuestas de trabajo.(AU)

Chagas disease, caused by Trypanosoma cruzi and transmitted by a triatomine insectis extremely complicated. When controlling this endemic disease, the disease cannot beconsidered as an individual and merely biological fact. Among its many components therelationship of individuals to the habitat, production modes, cultural conditions, socialrelationships and organizational forms must be considered.As health professionals we present new approaches that integrate different disciplinesand modes of intervention, where ôthe otherö recovers his/her individual being and isnot merely called upon to play a role as a patient. Positions that encourage participativeprocesses involving listening to the protagonists themselves (women with Chagas, healthteams, community references), recovering their unique visions, communicating what isnot said about this silent and hushed up disease, and revealing what Chagas hides areimportant tools when thinking about work proposals.(AU)

Humoral immune response against P2ß from Trypanosoma cruzi in persons with chronic Chagas disease: its relationship with treatment against parasites and myocardial damage.

We investigated the relationship between potentially pathogenic antibodies against a Trypanosoma cruzi ribosomal protein (P2ß) and the evolution of Chagas disease and the effect of trypanocidal treatment on these variables. Seventy-eight patients with chronic Chagas disease who were followed-up for more than 20 years were divided into three groups: 30 asymptomatic persons undergoing specific treatment (group A), 37 asymptomatic persons not undergoing specific treatment (group B), and 11 patients with chronic chagasic cardiomyopathy (CCC) who were not treated. Five patients in group B showed evolution to myocardial abnormalities. Among persons with CCC, six showed no changes; the remaining persons showed progression of cardiac involvement. Levels of antibodies to P2ß in persons in group A decreased from their initial values. This finding was not observed in persons in groups B and C. Comparisons at the end of the follow-up showed lower amounts of antibodies to P2ß in groups A and C. These findings support the benefits of specific treatment during chronic infection.

Confirman la utilidad de la quimioterapia específica en la enfermedad de Chagas crónica / Confirmation of the usefulness of chemotherapy in the treatment of chronic Chagas disease

La evaluación del tratamiento tripanocida en adultos con enfermedad de Chagas crónica requiere estudios de seguimiento muy prolongados. Ciento doce adultos con infección crónica por T. cruzi, asintomáticos, residentes en la Ciudad de Santa Fe fueron evaluados durante 23 años en promedio mediante estudios parasitológicos, serológicos y clínicos. De ellos, 55 fueron tratados (27 con nifurtimox y 28 con benznidazol) y 57 permanecieron sin tratar. Se demostró la eficacia del tratamiento específico en el 45.5% de los pacientes tratados, por su negativización parasitológica y serológica convencional persistente, acompañada de un efecto preventivo en la evolución del daño miocárdico. En este grupo tratado, otro 23.6% de los infectados presentaron serología dudosa o seroconversión negativa completa en el último control. Estos probablemente se incorporen en los próximos años al grupo de pacientes curados. En los infectados que no recibieron tratamiento específico se observó que la serología convencional permaneció siempre positiva y que las alteraciones electrocardiográficas compatibles con miocardiopatía chagásica crónica fueron 5 veces mayores que la que presentó el grupo de pacientes tratados.

Confirman la utilidad de la quimioterapia específica en la enfermedad de Chagas crónica / Confirmation of the usefulness of chemotherapy in the treatment of chronic Chagas disease

La evaluación del tratamiento tripanocida en adultos con enfermedad de Chagas crónica requiere estudios de seguimiento muy prolongados. Ciento doce adultos con infección crónica por T. cruzi, asintomáticos, residentes en la Ciudad de Santa Fe fueron evaluados durante 23 años en promedio mediante estudios parasitológicos, serológicos y clínicos. De ellos, 55 fueron tratados (27 con nifurtimox y 28 con benznidazol) y 57 permanecieron sin tratar. Se demostró la eficacia del tratamiento específico en el 45.5% de los pacientes tratados, por su negativización parasitológica y serológica convencional persistente, acompañada de un efecto preventivo en la evolución del daño miocárdico. En este grupo tratado, otro 23.6% de los infectados presentaron serología dudosa o seroconversión negativa completa en el último control. Estos probablemente se incorporen en los próximos años al grupo de pacientes curados. En los infectados que no recibieron tratamiento específico se observó que la serología convencional permaneció siempre positiva y que las alteraciones electrocardiográficas compatibles con miocardiopatía chagásica crónica fueron 5 veces mayores que la que presentó el grupo de pacientes tratados.(AU)

Mid-term follow-up after sleeve gastrectomy as a final approach for morbid obesity.

BACKGROUND: In previous publications, we demonstrated the safety and short-term efficacy of laparoscopic sleeve gastrectomy (LSG) as a final step in the treatment of morbid obesity (MO). This study aimed to assess the mid-term efficacy of LSG. METHODS: We performed a retrospective review of a prospectively collected database. Between November 2004 and January 2007, 130 consecutive patients underwent LSG as a final procedure to MO. Data including patient demographics, operative time, length of hospital stay, complications, preoperative body mass index (BMI), complications, and weight loss at 3, 6, 12, 18, and 24 months were recorded and analyzed. RESULTS: The mean age was 45.6 (range: 12-79) years while the mean BMI was 43.2 (range: 30.2-75.4) kg/m(2). The mean operative time was 97 (range, 58-180) min and all operations were completed laparoscopically. The mean hospital stay was 3.2 (range, 1-19) days with zero mortality in this series. One patient (0.7%) had leakage at the stapler line, while four patients (2.8%) developed trocar site infection. Three patients (2.1%) complained of symptoms of gastroesophageal reflux disease (GERD), three patients (2.1 %) developed symptomatic gallstones, and trocar site hernia was present in one (0.7%) patient. The mean weight loss was 21, 31.2, 37.4, 39.5, and 41.7 kg at 3, 6, 12, 18, and 24 months, respectively, while the mean BMI decreased to 36.9, 32.8, 29.5, 28, and 27.1 at 3, 6, 12 18, and 24 months, respectively. Percent of excess weight loss (%EWL) was 33.1, 50.8, 62.2, 64.4, and 67.9 at 3, 6, 12, 18, and 24 months, respectively. CONCLUSIONS: LSG is a safe and effective surgical procedure for the morbidly obese up to 2 years. Excess body weight loss seems to be acceptable at 2 years postoperatively.