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1.
Eur J Heart Fail ; 17(4): 416-23, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25678239

ABSTRACT

BACKGROUND: The significance of detection of Trypanosoma cruzi DNA in blood of antibody-positive patients for risk of development of Chagas heart disease is not well established. The objective of this study was to compare detection of T. cruzi DNA with known clinical and laboratory markers of Chagas cardiomyopathy (CC) severity. METHODS: This is a case-control study nested within a retrospective cohort developed in Brazil to understand the natural history of Chagas disease. The study enrolled 499 T. cruzi seropositive blood donors (SP-BD) and 488 frequency matched seronegative control donors (SN-BD) who had donated between 1996 and 2002, and 101 patients with clinically diagnosed CC. In 2008-2010 all enrolled subjects underwent a health questionnaire, medical examination, electrocardiograms and echocardiograms and polymerase chain reaction (PCR) analyses. A blinded panel of three cardiologists adjudicated the outcome of CC. Trypanosoma cruzi kinetoplast minicircle sequences were amplified by real-time PCR using an assay with a sensitivity of one parasite per 20 mL of blood. All testing was performed on coded samples. RESULTS: Rates of PCR detection of T. cruzi DNA were significantly (P = 0.003) higher in CC patients and SP-BD diagnosed with CC (79/105 [75.2 %]) compared with SP-BD without CC (143/279 [51.3%]). The presence of parasitaemia was significantly associated with known markers of disease progression such as QRS and QT interval duration, lower left ventricular ejection fraction, higher left ventricular index mass, and elevated troponin and NTpro-BNP levels. CONCLUSION: Trypanosoma cruzi PCR positivity is associated with presence and severity of cardiomyopathy, suggesting a direct role of parasite persistence in disease pathogenesis.


Subject(s)
Chagas Cardiomyopathy/blood , DNA, Protozoan/blood , Trypanosoma cruzi/genetics , Adult , Blood Donors , Case-Control Studies , Chagas Cardiomyopathy/parasitology , Female , Humans , Male , Middle Aged , Real-Time Polymerase Chain Reaction/methods , Retrospective Studies , Severity of Illness Index , Trypanosoma cruzi/pathogenicity
2.
Ann Intern Med ; 134(8): 637-43, 2001 Apr 17.
Article in English | MEDLINE | ID: mdl-11304103

ABSTRACT

BACKGROUND: Major surgical procedures are performed with increasing frequency in elderly persons, but the impact of age on resource use and outcomes is uncertain. OBJECTIVE: To evaluate the influence of age on perioperative cardiac and noncardiac complications and length of stay in patients undergoing noncardiac surgery. DESIGN: Prospective cohort study. SETTING: Urban academic medical center. PATIENTS: Consecutive sample of 4315 patients 50 years of age or older who underwent nonemergent major noncardiac procedures. MEASUREMENTS: Major perioperative complications (cardiac and noncardiac), in-hospital mortality, and length of stay. RESULTS: Major perioperative complications occurred in 4.3% (44 of 1015) of patients 59 years of age or younger, 5.7% (93 of 1646) of patients 60 to 69 years of age, 9.6% (129 of 1341) of patients 70 to 79 years of age, and 12.5% (39 of 313) of patients 80 years of age or older (P < 0.001). In-hospital mortality was significantly higher in patients 80 years of age or older than in those younger than 80 years of age (0.7% vs. 2.6%, respectively). Multivariate analyses indicated an increased odds ratio for perioperative complications or in-hospital mortality in patients 70 to 79 years of age (1.8 [95% CI, 1.2 to 2.7]) and those 80 years of age or older (OR, 2.1 [CI, 1.2 to 3.6]) compared with patients 50 to 59 years of age. Patients 80 years of age or older stayed an average of 1 day more in the hospital, after adjustment for other clinical data (P = 0.001). CONCLUSIONS: Elderly patients had a higher rate of major perioperative complications and mortality after noncardiac surgery and a longer length of stay, but even in patients 80 years of age or older, mortality was low.


Subject(s)
Age Factors , Elective Surgical Procedures/adverse effects , Length of Stay , Postoperative Complications/mortality , Aged , Aged, 80 and over , Female , Hospital Mortality , Humans , Male , Middle Aged , Multivariate Analysis , Prospective Studies , Regression Analysis , Statistics, Nonparametric
3.
C R Seances Acad Sci III ; 297(4): 195-7, 1983.
Article in French | MEDLINE | ID: mdl-6318928

ABSTRACT

Using indirect membrane immunofluorescence on unfixed HUT 102 cells, 24 out of 184 sera (13%) collected from regular blood donors in Martinique were found positive for HTLV-MA antibodies, 10 being strongly positive (5.4%). Six of these sera were further tested by radio-immunoprecipitation in gel electrophoresis. Antibodies to both viral main core protein (p24) and to virus specific membrane associated glycoprotein (gp 61) were detected in five of those. These findings raise the question of the existence of HTLV related conditions (leukemias or AIDS) in Martinique.


Subject(s)
Antibodies, Neoplasm/analysis , Blood Donors , Deltaretrovirus/immunology , Cell Line , Electrophoresis, Polyacrylamide Gel , Fluorescent Antibody Technique , Humans , Martinique
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