Joffre Marcondes de Rezende

American trypanosomiasis (Chagas disease).

Chagas disease, also known as American trypanosomiasis, is a chronic infection caused by Trypanosoma cruzi, a protozoan parasite. It is transmitted to human beings mainly through the feces of infected triatomine bugs. The disease affects an estimated 8 to 10 million people in the Americas, putting them at risk of developing life-threatening cardiac and gastrointestinal complications. This article provides a brief update on the epidemiology, clinical manifestations, diagnosis, and treatment of Chagas disease.

II Consenso Brasileiro em Doença de Chagas, 2015

Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

2 nd Brazilian Consensus on Chagas Disease, 2015

Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research .

Estudo radiológico longitudinal do esôfago, em área endêmica de doença de Chagas, em um período de seis anos

A radiological study of the oesophagus of a cohort of patients was carried during a 13 year period in the municipality of Mambai Goias. Barium swallow findings were recorded on 70mm film using a portable machine. Of 731 patients examined 382 (52.3%) were seropositive for T. cruzi. The sexes were equally divided. The incidence of detectable megaoesophagus was 7.9% among the cohort and 14.2% in the seropositive individuals. Progression of the disease was noted during this longitudinal study in 21.7% of males and 16.6% of females.

27 – Clinical Phases and Forms of Chagas Disease

Publisher Summary Chagas disease is characterized by an acute and a chronic phase of infection. In the acute phase most patients have the unapparent (asymptomatic) form, while the remaining infected individuals usually show a nonspecific febrile disease. In the chronic phase, two well-defined forms of disease are distinguished: indeterminate (latent, preclinical) and determinate (clinical), which is subdivided into cardiac, digestive (usually expressed as megaesophagus and/or megacolon), and cardiodigestive forms. Cardiac disease is further classified into stages, and esophageal Chagas disease into groups. Individuals with Chagas disease may be seen in two distinct phases: acute, seldom diagnosed as such, and chronic. The diagnosis of the chronic phase is based mainly on the presence of IgG antibodies against T. cruzi in patients with high suspicion of the disease or in those with a compatible clinical syndrome. Chronic Chagas infection is silent for life in more than half of the individuals. To define the clinical form of disease, a complete search for cardiovascular and gastrointestinal symptoms, and a resting 12-lead ECG are essential. Although barium swallow and enema are needed for final diagnosis of the digestive form, these tests are usually not recommended as standard practice for patients without gastrointestinal symptoms. Asymptomatic patients with a normal ECG and no gastrointestinal tract or cardiovascular symptoms have a favorable prognosis and should be followed up every 12–24 months, since about 2% of these patients progress to a clinical form of the disease each year. There are no known markers of disease progression. Patients with ECG changes consistent with Chagas heart disease should undergo a routine cardiac assessment to establish the stage of disease.

Prevalência de esofagopatia chagásica no Município de Mambaí, Goiás - Brasil

In Mambai, an endemic area for Chagas’ disease, contrast radiography of the oesophagus using 70 mm film was done in 1,145 male and I,184 female individuals. Ages ranged from 4 to 87 years. The patients were positioned in the right anterior oblique position and two films taken, one immediately after ingestion of 75 ml of barium contrast and another 60 seconds later. Seventy six (3.2%) individuals had oesophageal abnormalities of whom 71(7%) were among 1,006 seropositives and 5(0.37%) were among 1,323 seronegatives. Of the 76 patients, 47 (61.8%) were male and 29(38.1%) female. Following the classification of Rezende and colleagues, 48(63.1%), belonged to group 1,18(23.7%), to group II, 5(6.6%) and 5(6.6%) to group IV. The prevalence of oesophageal disease increased with age especially after 30 years, reaching 21.5% in the group over 59 years of age.

Advanced megaesophagus (Group III) secondary to vector-borne Chagas disease in a 20-month-old infant

The authors report the case of a female infant with Group III (or Grade III) megaesophagus secondary to vector-borne Chagas disease, resulting in severe malnutrition that reversed after surgery (Heller technique). The infant was then treated with the antiparasitic drug benznidazole, and the infection was cured, as demonstrated serologically and parasitologically. After follow-up of several years without evidence of disease, with satisfactory weight and height development, the patient had her first child at age 23, in whom serological tests for Chagas disease yielded negative results. Thirty years after the initial examination, the patients electrocardiogram, echocardiogram, and chest radiography remained normal.

Probabilidade em medicina

A palavra probabilidade não é uma criação da matemática e muito menos da estatística. O rastreamento do vocábulo nos conduz aos escritos de Cícero no século I a.C., que o empregou em latim (probabilitas, tatis) com o sentido de atributo ou caráter do que é verossímil, do que parece ser verdadeiro e suscetível de prova (1). A evolução semântica da palavra conferiu-lhe a noção de incerteza que perdura nas línguas modernas. A estatística nada mais fez do que incorporar o termo ao seu vocabulário, com acepção e definição próprias, dentro de um conceito matemático de quantificação de valores. Este é um fenômeno comum a todas as línguas, denominado em Semântica de especialização do significado a um grupo social restrito e responsável pela polissemia das palavras (2). Para um advogado, por exemplo, a palavra ação significa naturalmente a ação judicial; para um cineasta, a obtenção de uma cena; para um militar, um combate; para um empresário, um título negociável na bolsa. Isso me faz lembrar um artigo que li há tempos, escrito por um médico, justificando por que se generalizou o uso de “cirurgia” como sinônimo de “operação”. Seria para não confundir com outros tipos de “operação”, como operação financeira, bancária, etc. O Prof. Idel Becker comentou ironicamente: desse modo não vamos poder usar a palavra pé para não confundir com o pé de mesa, nem cabeça porque prego também tem cabeça. Após essa digressão e voltando à “probabilidade em medicina”, acredito que o importante é o contexto em que se emprega a expressão. Se ela é usada em sentido genérico, qualitativo, retratando uma situação ou um ponto de vista, como