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au:ANDRADE, ZILTON DE ARAUJO

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Wound healing - A literature review
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Gonzalez, Ana Cristina de Oliveira

; Costa, Tila Fortuna

; Andrade, Zilton de Araújo

; Medrado, Alena Ribeiro Alves Peixoto

Anais Brasileiros de Dermatologia

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oct 2016, Volume 91 N. 5 Pages 614 - 620

Abstract: En | Text: En | PDF: En

Abstract: Regeneration and tissue repair processes consist of a sequence of molecular and cellular events which occur after the onset of a tissue lesion in order to restore the damaged tissue. The exsudative, proliferative, and extracellular matrix remodeling phases are sequential events that occur through the integration of dynamic processes involving soluble mediators, blood cells, and parenchymal cells. Exsudative phenomena that take place after injury contribute to the development of tissue edema. The proliferative stage seeks to reduce the area of tissue injury by contracting myofibroblasts and fibroplasia. At this stage, angiogenesis and reepithelialization processes can still be observed. Endothelial cells are able to differentiate into mesenchymal components, and this difference appears to be finely orchestrated by a set of signaling proteins that have been studied in the literature. This pathway is known as Hedgehog. The purpose of this review is to describe the various cellular and molecular aspects involved in the skin healing process.

https://doi.org/10.1590/abd1806-4841.20164741 19925 downloads

The significance of the amoebocyte-producing organ in Biomphalaria glabrata
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Souza, Samaly dos Santos

; Andrade, Zilton Araújo

Memórias do Instituto Oswaldo Cruz

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aug 2012, Volume 107 N. 5 Pages 598 - 603

Abstract: En | Text: En | PDF: En

In molluscs, internal defence against microorganisms is performed by a single cell type, i.e., the haemocyte or amoebocyte. The origin of these cells in Biomphalaria glabrata was initially thought to be localised within the vasculo-connective tissue. More recently, origin from a single organ, termed the amoebocyte-producing organ (APO), has been postulated based on the occurrence of hyperplasia and mitoses during Schistosoma mansoni infection. The present investigation represents a histological, immuno-histochemical and ultra-structural study of the B. glabrata APO, whereby histological identification was facilitated by means of collecting epithelial basophilic cells. These cells were comprised of single-cell layers that cover a portion of the stroma, which contains many small, round cells and haemolymph sinuses, as well as a small area of the pericardial surface of the reno-pericardial region. On occasion, this epithelial component vaguely resembled the vertebrate juxtaglomerular apparatus, which reinforces its presumed relationship to the kidney. Both in normal and infected molluscs, mitoses were only occasionally found. The present quantitative studies failed to demonstrate the presence of APO cellular hyperplasia, either in normal or schistosome-infected B. glabrata. Conversely, several structural details from the APO region in B. glabrata were found to be consistent with the hypothesis that the APO is a filtration organ, i.e., it is more closely related to the kidney rather than the bone marrow, as has been suggested in the literature.

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Dynamics of Capillaria-hepatica-induced hepatic septal fibrosis in rats
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Gaban, Lidiane

; Ramos, Cleber Douglas Lucinio

; Barbosa Júnior, Aryon Almeida

; Souza, Márcia Maria de

; Andrade, Zilton de Araújo

Revista da Sociedade Brasileira de Medicina Tropical

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dec 2010, Volume 43 N. 6 Pages 643 - 646

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: Um extenso material de patologia experimental arquivado em blocos de parafina, ilustrativo das diferentes fases da fibrose hepática septal, que 100% dos ratos desenvolvem em seguida uma infecção com o nematódeo Capillaria hepatica. MÉTODOS: O material foi sistematicamente estudado com métodos morfológicos e morfométricos, no sentido de se verificar o comportamento dos elementos celulares e matriciais durante a evolução da fibrose hepática septal ao longo de um período de um ano. RESULTADOS: Foi constatado que a fibrose septal se origina de vários espaços porta ao mesmo tempo, com proliferação vascular (angiogênese), multiplicação de células actino-positivas (pericitos, miofibroblastas) e progressivo depósito de colágeno. Ao fim dos 4-5 meses há uma involução regressiva de todos estes indícios morfológicos, mas com alguns septos persistindo bem evidentes até o fim de um ano. CONCLUSÕES: Além de ilustrar o papel fundamental desempenhado pela angiogênese, o modelo se mostrou adequado para futuros estudos funcionais relacionados com a indução, progressão e regressão da fibrose hepática.

INTRODUCTION: The pathogenesis of septal hepatic fibrosis, induced in rats by Capillaria hepatica infection, was studied with the aid of a large collection of stored paraffin blocks, representative of the different evolutive phases of fibrosis which appeared in 100% of infected rats. METHODS: Studies were conducted involving histology, immunohistochemistry, immunofluorescence and morphometric methods, in order to observe the dynamic behavior of the cellular and matrix components of fibrosis, over a one year period of evolution. RESULTS: Observation verified that septal fibrosis originates from several portal spaces simultaneously. Its origin and progression involve blood vessel proliferation (angiogenesis), multiplication of actin-positive cells (pericytes and myofibroblasts) and progressive collagen deposition. By the end of 4-5 months, a progressive decrease in all these components was observed, when signs of regression of septal fibrosis became more evident over time. CONCLUSIONS: Besides indicating the fundamental role played by angiogenesis in the pathogenesis of fibrosis, these morphological data concerning the dynamics of this C. hepatica experimental model proved to be adequate for future investigations regarding the functional aspects of fibrosis induction, progression and regression.

1865 downloads Cited 2 times in SciELO

Capillaria hepatica-induced septal fibrosis in rats: a contribution to the study of liver fibrogenesis
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Barbosa, Valter Lucas Chaves

; Andrade, Zilton de Araújo

Revista da Sociedade Brasileira de Medicina Tropical

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oct 2010, Volume 43 N. 5 Pages 504 - 507

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: A fibrose septal do fígado se desenvolve regularmente em ratos infectados pelo nematódeo Capillaria hepatica. O tratamento curativo da infecção, feito antes do 15º dia da infecção, mas não mais tarde, impediu o aparecimento da fibrose septal. O presente trabalho procura verificar qual o estado do parasitismo aos 15 dias da infecção, crucial para patogenia da fibrose septal. MÉTODOS: Ratos foram infectados por via digestiva com 600 ovos embrionados de C. hepatica e tratados com Ivermectina e mebendazol, em grupos separados, aos 10, 12, 15, 17 ou 20 dias após a infecção. O animal de cada grupo e seus respectivos controles foram mortos e examinados aos 40 dias após o fim do tratamento. RESULTADOS: Os achados aos 15 dias da infecção mostraram a maturação completa da parasitose, com presença de ovos e vermes, circundados por reação necro-inflamatória, mas ainda sem fibrose septal. Daí por diante, a fibrose septal se fez presente. CONCLUSÕES: Como os vermes morrem espontaneamente após o 15º dia da infecção, não apenas a origem, mas o posterior crescimento e a manutenção da fibrose septal dependem da presença dos ovos acumulados no fígado, os quais são os únicos elementos parasitários presentes após o 15º dia da infecção por C. hepatica no rato.

INTRODUCTION: Septal fibrosis of the liver regularly develops in rats infected with the nematode Capillaria hepatica. Curative treatment of the infection prevents the development of septal fibrosis when intervention occurs up to postinfection day (PID) 15, but not later. The present investigation aimed to demonstrate which parasitic factors are present when the process of septal fibrosis can no longer be prevented by curative treatment. METHODS: Wistar rats were infected with 600 embryonated eggs of C. hepatica administered by gavage and treated with ivermectin and mebendazole in separate groups at PIDs 10, 12, 15, 17 or 20. Rats from each group and their nontreated controls, were killed and examined 40 days after the end of treatment. RESULTS: Findings by PID 15 were compatible with the stage of complete maturation of infection, when worms and eggs were fully developed and a complex host-parasite multifocal necroinflammatory reaction showed greater intensity, but with no signs of septal fibrosis, which appeared from PID 17 onward. CONCLUSIONS: Since the worms spontaneously died by PID 15, not only septal fibrosis production, but also its maintenance and further development appeared dependent on the presence of eggs, which were the only parasitic factor remaining thereafter.

2542 downloads

In vitro and in vivo experimental models for drug screening and development for Chagas disease
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Romanha, Alvaro José

; Castro, Solange Lisboa de

; Soeiro, Maria de Nazaré Correia

; Lannes-Vieira, Joseli

; Ribeiro, Isabela

; Talvani, André

; Bourdin, Bernadette

; Blum, Bethania

; Olivieri, Bianca

; Zani, Carlos

; Spadafora, Carmenza

; Chiari, Egler

; Chatelain, Eric

; Chaves, Gabriela

; Calzada, José Eduardo

; Bustamante, Juan Manuel

; Freitas-Junior, Lucio H

; Romero, Luz I

; Bahia, Maria Terezinha

; Lotrowska, Michel

; Soares, Milena

; Andrade, Sonia Gumes

; Armstrong, Tanya

; Degrave, Wim

; Andrade, Zilton de Araújo

Memórias do Instituto Oswaldo Cruz

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mar 2010, Volume 105 N. 2 Pages 233 - 238

Abstract: En | Text: En | PDF: En

Chagas disease, a neglected illness, affects nearly 12-14 million people in endemic areas of Latin America. Although the occurrence of acute cases sharply has declined due to Southern Cone Initiative efforts to control vector transmission, there still remain serious challenges, including the maintenance of sustainable public policies for Chagas disease control and the urgent need for better drugs to treat chagasic patients. Since the introduction of benznidazole and nifurtimox approximately 40 years ago, many natural and synthetic compounds have been assayed against Trypanosoma cruzi, yet only a few compounds have advanced to clinical trials. This reflects, at least in part, the lack of consensus regarding appropriate in vitro and in vivo screening protocols as well as the lack of biomarkers for treating parasitaemia. The development of more effective drugs requires (i) the identification and validation of parasite targets, (ii) compounds to be screened against the targets or the whole parasite and (iii) a panel of minimum standardised procedures to advance leading compounds to clinical trials. This third aim was the topic of the workshop entitled Experimental Models in Drug Screening and Development for Chagas Disease, held in Rio de Janeiro, Brazil, on the 25th and 26th of November 2008 by the Fiocruz Program for Research and Technological Development on Chagas Disease and Drugs for Neglected Diseases Initiative. During the meeting, the minimum steps, requirements and decision gates for the determination of the efficacy of novel drugs for T. cruzi control were evaluated by interdisciplinary experts and an in vitro and in vivo flowchart was designed to serve as a general and standardised protocol for screening potential drugs for the treatment of Chagas disease.

12866 downloads Cited 9 times in SciELO

Role of partial hepatectomy on Capillaria hepatica-induced hepatic fibrosis in rats
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Santos, Carolina Cincurá Silva

; Onofre-Nunes, Záira

; Andrade, Zilton Araujo

Revista da Sociedade Brasileira de Medicina Tropical

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oct 2007, Volume 40 N. 5 Pages 495 - 498

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Sabe-se que a fibrose hepática pode sofrer uma redução em seqüência uma hepatectomia parcial, uma vez que o parênquima hepático se regenera muito rápido, mas não o excesso de tecido fibroso. O presente trabalho avalia esta hipótese ao observar como se comporta a fibrose septal sistematizada induzida pela Capillaria hepática no rato, após infecção de 30 ou 90 dias de duração, em animais submetidos à hepatectomia parcial. Os resultados revelaram que a fibrose em si mesma não foi afetada na sua morfologia, mas a sua quantidade relativa apareceu diminuída significativamente no campo microscópico como conseqüência do aumento da massa de tecido hepático pós-regeneração.

It is known that hepatic fibrosis may regress following partial hepatectomy, since the hepatic parenchyma regenerates very rapidly, but not the excess of fibrous tissue. The present study evaluated this hypothesis by observing the behavior of systematized septal fibrosis induced by either 30 or 90-day-old Capillaria hepatica infection, in rats subjected to partial hepatectomy. The results revealed that the morphology of the fibrosis was unaffected, but its relative quantity within the microscope field appeared significantly decreased, as a consequence of the increased liver tissue mass following regeneration.

2183 downloads

Morbidity due to Schistosoma mansoni - Entamoeba histolytica coinfection in hamsters (Mesocricetus auratus)
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Dolabella, Silvio Santana

; Coelho, Paulo Marcos Zech

; Borçari, Izabela Torquetti

; Mello, Nelson Azevedo Santos Teixeira

; Andrade, Zilton de Araújo

; Silva, Edward Felix

Revista da Sociedade Brasileira de Medicina Tropical

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apr 2007, Volume 40 N. 2 Pages 170 - 174

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Dados sobre a co-infecção Schistosoma mansoni-Entamoeba histolytica são escassos na literatura. No presente estudo, hamsters com 70 dias de infecção por Schistosoma mansoni (cepa LE) foram inoculados com trofozoítos de Entamoeba histolytica, cepa ICB-EGG (virulenta) e cepa ICB-RPS (não virulenta), via veia porta. O mais evidente resultado da co-infecção foi o aumento da morbidade e mortalidade, quando comparado com os animais com somente uma das infecções. Histologicamente, não houve sinais evidentes da interação entre as duas infecções. O aspecto morfológico do granuloma esquistossomótico e do abcesso hepático amebiano são similares aos observados nos controles, com somente uma infecção. Entretanto, foi observado que os animais co-infectados apresentavam-se mais debilitados e com maior número de lesões amebianas no fígado. Os resultados obtidos indicam que a esquistossomose agrava o curso da infecção amebiana em hamsters.

Data on Schistosoma mansoni-Entamoeba histolytica coinfection are scarce in the literature. In the present study, hamsters that had been infected for 70 days with Schistosoma mansoni (LE strain) were inoculated via the portal vein with two strains of trophozoites of Entamoeba histolytica: ICB-EGG (highly virulent) and ICB-RPS (non-virulent). The most evident result of coinfection was increased morbidity and mortality, in comparison with either of the infections alone. Histologically, there were no evident signs of interaction between these two infections. The morphological findings of schistosomal granuloma and amoebic abscesses in the liver were similar to those seen in the respective single-infection controls. However, there was severe wasting of the animals with both infections and greater numbers of amoebic lesions in their livers. The results obtained indicated that schistosomiasis aggravates the course of amoebiasis in hamsters.

2734 downloads

The influence of low-level laser therapy on biomodulation of collagen and elastic fibers
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Pugliese, Lívia Souza

; Medrado, Alena Peixoto

; Reis, Sílvia Regina de Almeida

; Andrade, Zilton de Araújo

Pesquisa Odontológica Brasileira

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dec 2003, Volume 17 N. 4 Pages 307 - 313

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

O estudo da terapia a laser de baixa densidade de energia sobre os diversos constituintes da matriz extracelular é crucial para o entendimento do processo cicatricial sob esse agente. Todavia, pouco se sabe sobre a interferência do laser em relação às fibras colágenas e elásticas. Realizaram-se ferimentos cutâneos padronizados no dorso de setenta e dois ratos Wistar e, em seguida, aplicação pontual do raio laser de baixa potência do tipo Arseneto de Gálio-Alumínio (Ga-Al-As) com diferentes densidades de energia. Os animais foram sacrificados com 24, 48 e 72 horas e aos 5, 7 e 14 dias. Procedeu-se à análise das secções teciduais coradas por hematoxilina-eosina, sírius vermelho e orceína. Observou-se, que nos grupos submetidos à terapia a laser, houve maior redução do edema e infiltrado inflamatório. Os animais tratados apresentaram uma maior expressão de fibras colágenas e elásticas, embora sem significância estatística (p > 0,05). No tratamento com a fluência de 4 J/cm² observaram-se melhores resultados do que naquele em que foi utilizada a fluência de 8 J/cm². Neste estudo, pôde-se concluir que o laser contribuiu para uma maior expressão de fibras colágenas e elásticas durante o processo cicatricial.

The study of low-level laser therapy upon extracellular matrix elements is important to understand the wound healing process under this agent. However, little is known about the interference of laser light in relation to collagen and elastic fibers. Cutaneous wounds were performed on the back of 72 Wistar rats and a Ga-Al-As low-level laser was punctually applied with different energy densities. The animals were killed after 24, 48, 72 hours and 5, 7 and 14 days. Tissues were stained with hematoxilin-eosin, sirius red fast green and orcein and then analyzed. It was observed that the treated group exhibited larger reduction of edema and inflammatory infiltrate. The treated animals presented a larger expression of collagen and elastic fibers, although without statistical significance (p > 0.05). Treatment with a dosage of 4 J/cm² exhibited more expressive results than that with 8 J/cm². In this study, the authors concluded that low-level laser therapy contributed to a larger expression of collagen and elastic fibers during the early phases of the wound healing process.

9507 downloads Cited 14 times in SciELO

Reinfecções e desenvolvimento da fibrose periportal esquistossomótica no modelo murino
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Santos, Antonio Benigno Araújo

; Souza, Marcia Maria de

; Andrade, Zilton A.

Revista da Sociedade Brasileira de Medicina Tropical

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apr 2000, Volume 33 N. 2 Pages 197 - 200

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A fibrose periportal esquistossomótica observada no modelo murino apareceu muito mais freqüentemente (69,2%) em camundongos submetidos à múltiplas infecções pelo Schistosoma mansoni do que naqueles animais com infecção única (11,1%). A contagem dos ovos depositados no fígado não diferiu significativamente nos dois grupos ao término dos experimentos. Embora não tenha ficado esclarecido o motivo pelo qual as infecções repetidas favorecem o desenvolvimento da fibrose periportal esquistossomótica, os dados observados fornecem apoio experimental às observações clínico-epidemiológicas que sugerem ter as reinfecções um papel na patogenia da forma hepato-esplênica da esquistossomose.

Experimental pipestem fibrosis of the liver developed more frequently (69.2%) in mice submitted to repeated infections with Schistosoma mansoni, than with single infection (11.1%). The counting of eggs in the liver revealed no significant differences between the two experimental groups. Although the reason why multiple infections favor the development of pipestem fibrosis has not been elucidated, the data obtained represent an experimental support to clinico-epidemiological claims that repeated infections play a role in pathogenesis of hepatosplenic schistosomiasis

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10.

Aspectos morfológicos dos autotransplantes de tireóide da rata
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Mota, José Carlos Nunes

; Silva, Alcino Lázaro da

; Andrade, Zilton de Araujo

; Barbosa Jr., Aryon de Almeida

Revista do Colégio Brasileiro de Cirurgiões

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jun 1999, Volume 26 N. 3 Pages 135 - 139

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Foram operadas cinqüenta ratas Wistar, adultas, separadas em seis grupos: 1, 2, 3, grupos isotado 1 e 2 e um grupo piloto. O lobo esquerdo da tireóide da rata foi dividido em três fragmentos similares e implantados no músculo esternoclidomastóideo, na raiz do mesentério e no ovário. Os tecidos implantados foram examinados histologicamente após dez, vinte e trinta dias. No grupo isolado I, depois de trinta dias a porção restante da tireóide in situ foi removida, passando a viver somente com os implantes. Para verificar aspectos funcionais, foram implantados três fragmentos da tireóide em um grupo isolado na raiz do mesentério. T3 T4 e TSH foram dosados no soro antes e após a retirada da tireóide. O exame histológico mostrou que o tecido tireóideo implantado sofria inicialmente discreta hipotrofia, retomando em seguida para os limites da normalidade. Os melhores resultados foram obtidos com o implante no mesentério. Os valores de T 3 e T 4 eram baixos e os de TSH altos. Apoiado nos resultados histológicos e hormonais, concluiu-se que no período estudado, a tireóide autotransplantada manteve sua arquitetura folicular, cumprindo a função de produzir os hormônios.

The left thyroid lobe of Wistar rats were separated into three fragments and implanted on the sternumcleidomastoid muscle, mesentery and right ovary. The implanted tissues were removed after 10, 20and 30 days and examined histologically. For each time period of transplantation ten rats were used. After 30 days the remaing thyroid tissue was removed. The animais subsequently lived with the transplants only. To verify implant function, three thyroid fragments were implanted on the mesentery in group one. The levels of T3 T4 and TSH were measured in serum before and after the surgery. Histologic examination showed mild atrophy in the beginning which subsequently returned to normality. The best results of transplantation were obtained with the implant on the mesentery. There were low T3 and T4 levels and high TSH levels. 1n conclusion, the autotransplanted thyroid gland sustained its folicular architecture and its endocrinological function, in the studied period.

2701 downloads

11.

Resistência de Biomphalaria glabrata à infecção pelo Schistosoma mansoni: variações no período pré-patente e na compatibilidade
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Guimarães, Carlos Tito

; Soares, Delza de Moura

; Andrade, Zilton de Araújo

; Souza, Cecília Pereira de

Revista da Sociedade Brasileira de Medicina Tropical

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aug 1997, Volume 30 N. 4 Pages 273 - 278

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Biomphalaria glabrata de Belo Horizonte, Minas Gerais, Brasil, criada no laboratório, apresenta 90% de taxa de infecção com 20 miracídios da cepa LE, autóctone. O período pré-patente normal varia de 5 a 7 semanas enquanto 5 a 10% dos moluscos expostos não eliminam cercárias. Os descendentes de exemplares negativos foram novamente submetidos à infecção individual com 20 miracídios. A média de infecção da F14 a F20 foi de 43,6%. Cortes histológicos de moluscos da F12, F14 e F15 mostraram reações teciduais nos exemplares eliminando menos de 10 cercárias. Um período pré-patente prolongado, 17 a 32 semanas, foi observado em 35 (17,9%) dos 195 exemplares infectados. Os índices de cercárias da F12, F13 e F15 baixaram de extremamente compatíveis (classe VI) para muito compatíveis e compatíveis (classes V e III) mostrando a compatibilidade menor dos moluscos selecionados.

Biomphalaria glabrata from Belo Horizonte, Minas Gerais, Brazil, reared in laboratory, has a level of infection of 90% when exposed to 20 miracidia of the autochthonous LE strain. The prepatent period was of 5 to 7 weeks whereas 5 to 10 % of exposed snails do not shed cercariae. The eggs of negative snails were collected and the progeny was again submitted to individual infection with 20 miracidia. The mean of infection from F14 to F20 was of 43.6%. Histological sections from F12, F14 and F15 snails showed tissue reactions in those specimens shedding less than 10 cercariae. A prepatent period of 17 to 32 weeks was observed in 35 (17.9%) of 195 infected snails. The index of cercariae of control was extremely compatible and for F12, F13 and F15 snails varied from very compatible class V to compatible class III, showing less compatibility in selected snails.

2742 downloads Cited 2 times in SciELO

12.

Anatomia patológica de corações de chagásicos assintomáticos falecidos de modo violento
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Lopes, Edison Reis

; Chapadeiro, Edmundo

; Andrade, Zilton Araújo

; Almeida, Hipolito de Oliveira

; Rocha, Ademir

Memórias do Instituto Oswaldo Cruz

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jun 1981, Volume 76 N. 2 Pages 189 - 197

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Com finalidade de melhor conhecimento da forma indeterminada da doença de Chagas os autores realizaram estudo anatomopatólogico sistematizado de trinta corações de chagásicos assintomáticos falecidos de modo violento. Demonstram que nos portadores da forma em questão da tripanossomiase cruzi o coração e acometido por lesões da mesma natureza, porém de intensidade muito menor do que as observadas em chagásicos crônicos que falecem subitamente ou após periodo variável de insuficiência cardíaca. Baseados em seus achados e em outros dados da literatura, concluem que a infecção chagásica, sem inflamação do coração, se ocorre, é rara. Tecem ainda considerações a respeito do significado das lesões observadas no sistema nervoso autônomo intracardíaco no sistema de condução e sobre a gênese formal da cardite chagásica crônica humana.

With the purpose of better knowledge of the indeterminate form of Chagas's disease the authors carried out a systematized anatomopathological study of thirty hearts from symptomatic chagasics who had a violent death. In this specific form of the trypanosomiasis cruzi the hearts show lesions of the same nature but much less intense as those observed in chronic chagasics who had a sudden death or died after cardiac failure. Based on theses findings and on data from literature, we conclude that chagasic infection without a cardiac inflammatory process, if it occurs, is very rarely only. Also some comments are made upon the meaning of the lesions observed in the intra-cardiac autonomic nervous system, in the conduction system and on the formal origin of the human chronic chagasic carditis.

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