Case-fatality From Orally-transmitted Acute Chagas Disease: A Systematic Review and Meta-analysis.

Orally-transmitted acute Chagas disease (CD) is emerging as an important public health problem. The prognosis of acute infection following oral transmission is unknown. The aim of this study was to analyze and summarize data on orally-transmitted acute CD. We searched for publications from 1968 to 31 January 2018. We included studies and unpublished data from government sources that reported patients with acute orally-transmitted CD. We identified 41 papers and we added 932 unpublished cases. In all, our study covered 2470 cases and occurrence of 97 deaths. Our meta-analysis estimated that the case-fatality rate was 1.0% (95% CI 0.0-4.0%). Lethality rates have declined over time (P = .02). In conclusion, orally-transmitted acute CD has considerable lethality in the first year after infection. The lethality in symptomatic cases is similar to that from other routes of infection. The lethality rate of orally-acquired disease has declined over the years.

Contrast echocardiography can save nondiagnostic exams in mechanically ventilated patients.

Patients in an intensive care unit (ICU) under mechanical ventilation (MV) are very difficult to image by transthoracic echocardiography, diminishing the beneficial information that could be obtained by this noninvasive approach. The objective of this study is to assess whether the addition of a contrast agent to fundamental imaging (FI) can improve or change the initial diagnosis in cardiac postoperative patients under mechanical ventilation by enhancing endocardial border delineation and Doppler flow signal. Thirty mechanically ventilated post-cardiac surgery patients (20 men, mean age 61 +/- 13 years) were evaluated with FI before and after intravenous injection of contrast. Left ventricular endocardial border delineation score index (EBDSI), estimated left ventricular ejection fraction (LVEF), and color and spectral Doppler were analyzed. The use of contrast resulted in a significant increase in the number of well-delineated segments, with a salvage rate of 77% of nondiagnostic studies. EBDSI was 1.62 +/- 0.61, before contrast, increasing to 2.05 +/- 0.53 after it (P < 0.001). There was a change in the LVEF estimation in 5 exams, and a new wall motion abnormality was detected in other 4 exams, after the use of contrast. Moreover, a significant change was observed in the quantification of mitral regurgitation in 5 patients, in the aortic transvalvular peak gradient in 1 patient, and measurement of tricuspid regurgitation peak flow velocity in 8 patients. It is concluded that in cardiac postoperative patients under mechanical ventilation, intravenous injection of a contrast agent using FI resulted in a high salvage rate of studies and changed the initial diagnosis in a significant number of patients.

Hand-carried ultrasound performed at bedside in cardiology inpatient setting - a comparative study with comprehensive echocardiography.

BACKGROUND: Hand-carried ultrasound (HCU) devices have been demonstrated to improve the diagnosis of cardiac diseases over physical examination, and have the potential to broaden the versatility in ultrasound application. The role of these devices in the assessment of hospitalized patients is not completely established. In this study we sought to perform a direct comparison between bedside evaluation using HCU and comprehensive echocardiography (CE), in cardiology inpatient setting. METHODS: We studied 44 consecutive patients (mean age 54 +/- 18 years, 25 men) who underwent bedside echocardiography using HCU and CE. HCU was performed by a cardiologist with level-2 training in the performance and interpretation of echocardiography, using two-dimensional imaging, color Doppler, and simple calliper measurements. CE was performed by an experienced echocardiographer (level-3 training) and considered as the gold standard. RESULTS: There were no significant differences in cardiac chamber dimensions and left ventricular ejection fraction determined by the two techniques. The agreement between HCU and CE for the detection of segmental wall motion abnormalities was 83% (Kappa = 0.58). There was good agreement for detecting significant mitral valve regurgitation (Kappa = 0.85), aortic regurgitation (kappa = 0.89), and tricuspid regurgitation (Kappa = 0.74). A complete evaluation of patients with stenotic and prosthetic dysfunctional valves, as well as pulmonary hypertension, was not possible using HCU due to its technical limitations in determining hemodynamic parameters. CONCLUSION: Bedside evaluation using HCU is helpful for assessing cardiac chamber dimensions, left ventricular global and segmental function, and significant valvular regurgitation. However, it has limitations regarding hemodynamic assessment, an important issue in the cardiology inpatient setting.

Fase crônica da doença de Chagas: aspectos clínicos e evolutivos / Chronic Chagas' Disease. Clinical and Evolutive Aspects

Objetivo - Avaliar aspectos clínicos e evolutivos de pacientes chagásicos crônicos. Métodos - Estudaram-se retrospectivamente, 300 pacientes chagásicos crônicos, sendo 180 femininos, com idades variando de 19 a 81 (55,6 ñ 13,1) anos. Dividiram-se os pacientes em portadores das formas: indeterminada, cardíaca dilatada, cardíaca arritmogênica, cardíaca mista, digestiva isolada e digestiva associada e cardiopatia. As variáveis analisadas foram: prevalência de cada forma, sintomas, padräo eletrocardiográfico e evoluçäo clínica. Resultados - Ao Início do estudo, 73 (24,3 por cento) pacientes encontravam-se na forma indeterminada, 106 (35,3 por cento) na cardíaca arritmogênica, 95 na mista, 7 na dilatada, 16 na digestiva assciada a cardiopatia e 3 na digestiva pura. Os sintomas predominantes foram dispnéia aos esforços (57 por cento), palpitaçäo (41,33 por cento e precordialgia (33 por cento); 19 (6,3 por cento) eram assintomáticos. O padräo eletrocardiográfico predominante foi a associaçäo de bloqueo de ramo direito (BRD). Bloqueio divisional ântero-superior esquerdo (BDASE) esteve presente em 30 por cento dos casos. No tempo médio de 7,8 ñ 6,1 anos, a evoluçäo foi boa em 20 (6,6 por cento) pacientes, estável e, 214 (71,3 por cento e má em 66(23 por cento). Ao final, 9 (12,3 por cento) evoluiram da forma indeterminada para a cardíaca e 19 (17,92 por cento) da forma cardíaca arritmogênica para a mista. Perdeu-se o seguimento de 79 (26,3 por cento) pacientes, muitos dos quais, possíveis óbitos. Conclusäo - No prazo médio de 7,8 anos, 12,3 por cento dos pacientes da forma indeterminada evoluíram para a cardíaca ou digestiva; a associaçäo de BRD + BDASE foi o achado eletrocardiográfico mais freqüente; a evoluçäo clínica estável ou boa na maioria dos pacientes