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Abstract 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 .

https://doi.org/10.1590/0037-8682-0505-2016 9267 downloads

II Consenso Brasileiro em Doença de Chagas, 2015
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Dias, João Carlos Pinto

; Ramos Jr., Alberto Novaes

; Gontijo, Eliane Dias

; Luquetti, Alejandro

; Shikanai-Yasuda, Maria Aparecida

; Coura, José Rodrigues

; Torres, Rosália Morais

; Melo, José Renan da Cunha

; Almeida, Eros Antonio de

; Oliveira Jr., Wilson de

; Silveira, Antônio Carlos

; Rezende, Joffre Marcondes de

; Pinto, Fabiane Scalabrini

; Ferreira, Antonio Walter

; Rassi, Anis

; Fragata Filho, Abílio Augusto

; Sousa, Andréa Silvestre de

; Correia Filho, Dalmo

; Jansen, Ana Maria

; Andrade, Glaucia Manzan Queiroz

; Britto, Constança Felícia De Paoli de Carvalho

; Pinto, Ana Yecê das Neves

; Rassi Jr., Anis

; Campos, Dayse Elisabeth

; Abad-Franch, Fernando

; Santos, Silvana Eloi

; Chiari, Egler

; Hasslocher-Moreno, Alejandro Marcel

; Moreira, Eliane Furtado

; Marques, Divina Seila de Oliveira

; Silva, Eliane Lages

; Marin-Neto, José Antonio

; Galvão, Lúcia Maria da Cunha

; Xavier, Sergio Salles

; Valente, Sebastião Aldo da Silva

; Carvalho, Noêmia Barbosa

; Cardoso, Alessandra Viana

; Silva, Rafaella Albuquerque e

; Costa, Veruska Maia da

; Vivaldini, Simone Monzani

; Oliveira, Suelene Mamede

; Valente, Vera da Costa

; Lima, Mayara Maia

; Alves, Renato Vieira

Epidemiologia e Serviços de Saúde

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jun 2016, Volume 25 N. spe Pages 7 - 86

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

RESUMO A doença de Chagas é uma condição crônica negligenciada com elevada carga de morbimortalidade e impacto dos pontos de vista psicológico, social e econômico. Representa um importante problema de saúde pública no Brasil, com diferentes cenários regionais. Este documento traduz a sistematização das evidências que compõe o Consenso Brasileiro de Doença de Chagas. O objetivo foi sistematizar estratégias de diagnóstico, tratamento, prevenção e controle da doença de Chagas no país, de modo a refletir as evidências científicas disponíveis. Sua construção fundamentou-se na articulação e contribuição estratégica de especialistas brasileiros com conhecimento, experiência e atualização sobre diferentes aspectos da doença. Representa o resultado da estreita colaboração entre a Sociedade Brasileira de Medicina Tropical e o Ministério da Saúde. Espera-se com este documento fortalecer o desenvolvimento de ações integradas para enfrentamento da doença no país com foco em epidemiologia, gestão, atenção integral (incluindo famílias e comunidades), comunicação, informação, educação e pesquisas.

ABSTRACT 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.

https://doi.org/10.5123/s1679-49742016000500002 63592 downloads

II Consenso Brasileiro em Doença de Chagas, 2015
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Dias, João Carlos Pinto

; Ramos Jr., Alberto Novaes

; Gontijo, Eliane Dias

; Luquetti, Alejandro

; Shikanai-Yasuda, Maria Aparecida

; Coura, José Rodrigues

; Torres, Rosália Morais

; Melo, José Renan da Cunha

; Almeida, Eros Antonio de

; Oliveira Jr., Wilson de

; Silveira, Antônio Carlos

; Rezende, Joffre Marcondes de

; Pinto, Fabiane Scalabrini

; Ferreira, Antonio Walter

; Rassi, Anis

; Fragata Filho, Abílio Augusto

; Sousa, Andréa Silvestre de

; Correia Filho, Dalmo

; Jansen, Ana Maria

; Andrade, Glaucia Manzan Queiroz

; Britto, Constança Felícia De Paoli de Carvalho

; Pinto, Ana Yecê das Neves

; Rassi Jr., Anis

; Campos, Dayse Elisabeth

; Abad-Franch, Fernando

; Santos, Silvana Eloi

; Chiari, Egler

; Hasslocher-Moreno, Alejandro Marcel

; Moreira, Eliane Furtado

; Marques, Divina Seila de Oliveira

; Silva, Eliane Lages

; Marin-Neto, José Antonio

; Galvão, Lúcia Maria da Cunha

; Xavier, Sergio Salles

; Valente, Sebastião Aldo da Silva

; Carvalho, Noêmia Barbosa

; Cardoso, Alessandra Viana

; Silva, Rafaella Albuquerque e

; Costa, Veruska Maia da

; Vivaldini, Simone Monzani

; Oliveira, Suelene Mamede

; Valente, Vera da Costa

; Lima, Mayara Maia

; Alves, Renato Vieira

Epidemiologia e Serviços de Saúde

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jun 2016, Volume 25 N. spe. Pages 7 - 86

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

https://doi.org/10.5123/S1679-49742016000500002 3725 downloads

High levels of B-type natriuretic peptide predict weaning failure from mechanical ventilation in adult patients after cardiac surgery
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Lara, Thiago Martins

; Hajjar, Ludhmila Abrahao

; Almeida, Juliano Pinheiro de

; Fukushima, Julia Tizue

; Barbas, Carmem Silvia Valente

; Rodrigues, Adriano Rogerio Baldacin

; Nozawa, Emilia

; Feltrim, Maria Ignes Zanetti

; Almeida, Elisangela

; Coimbra, Vera

; Osawa, Eduardo

; Ianotti, Rafael de Moraes

; Leme, Alcino Costa

; Jatene, Fabio Biscegli

; Auler-Jr., Jose Otavio Costa

; Galas, Filomena Regina Barbosa Gomes

Clinics

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jan 2013, Volume 68 N. 1 Pages 33 - 38

Abstract: En | Text: En | PDF: En

OBJECTIVE: The failure to wean from mechanical ventilation is related to worse outcomes after cardiac surgery. The aim of this study was to evaluate whether the serum level of B-type natriuretic peptide is a predictor of weaning failure from mechanical ventilation after cardiac surgery. METHODS: We conducted a prospective, observational cohort study of 101 patients who underwent on-pump coronary artery bypass grafting. B-type natriuretic peptide was measured postoperatively after intensive care unit admission and at the end of a 60-min spontaneous breathing test. The demographic data, hemodynamic and respiratory parameters, fluid balance, need for vasopressor or inotropic support, and length of the intensive care unit and hospital stays were recorded. Weaning failure was considered as either the inability to sustain spontaneous breathing after 60 min or the need for reintubation within 48 h. RESULTS: Of the 101 patients studied, 12 patients failed the weaning trial. There were no differences between the groups in the baseline or intraoperative characteristics, including left ventricular function, EuroSCORE and lengths of the cardiac procedure and cardiopulmonary bypass. The B-type natriuretic peptide levels were significantly higher at intensive care unit admission and at the end of the breathing test in the patients with weaning failure compared with the patients who were successfully weaned. In a multivariate model, a high B-type natriuretic peptide level at the end of a spontaneous breathing trial was the only independent predictor of weaning failure from mechanical ventilation. CONCLUSIONS: A high B-type natriuretic peptide level is a predictive factor for the failure to wean from mechanical ventilation after cardiac surgery. These findings suggest that optimizing ventricular function should be a goal during the perioperative period.

https://doi.org/10.6061/clinics/2013(01)OA05 2680 downloads Cited 1 time in SciELO

Urban outbreak of acute Chagas disease in Amazon region of Brazil: four-year follow-up after treatment with benznidazole
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Pinto, Ana Yecê das Neves

; Ferreira Jr., Alberto Gomes

; Valente, Vera da Costa

; Harada, Geraldo Saburo

; Valente, Sebastião Aldo da Silva

Revista Panamericana de Salud Pública

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jan 2009, Volume 25 N. 1 Pages 77 - 83

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

The objective of this report is to describe treatment outcomes over a four-year period of patients with acute Chagas disease in the Amazon region of Brazil. An outbreak of Chagas disease in a low-income district of urban Belém, in September 2000, affected 11 people simultaneously, indicating the likelihood of indirect, oral transmission of Trypanosoma cruzi. Prior to treatment, patients underwent physical and clinical tests; blood samples were processed with immunofluorescence assay (IFA) and quantitative buffy coat (QBC). Following treatment with benznidazole, parasitological and serologic tests (artificial xenodiagnosis and blood culture for T. cruzi), electrocardiogram, and echocardiogram were administered at intervals over a four-year period. Four years after treatment for acute Chagas disease, all patients presented with negative parasitological tests and persistent IgG anti-T. cruzi antibodies with lowered titers; three patients presented electrocardiogram abnormalities consistent with chronic Chagas disease or sequel of acute disease. The satisfactory response to treatment and relevance of serial parasitological examinations of patients with acute Chagas disease are discussed.

El objetivo de este informe es describir los resultados del tratamiento para la enfermedad aguda de Chagas durante un seguimiento de cuatro años en pacientes de la región amazónica de Brasil. Un brote de la enfermedad de Chagas en un distrito de bajos ingresos de la parte urbana de Belém afectó simultáneamente a 11 personas en septiembre de 2000; al parecer, la transmisión de Trypanosoma cruzi fue indirecta por vía oral. Antes del tratamiento, los pacientes se sometieron a un examen físico y pruebas clínicas; las muestras de sangre se estudiaron mediante inmunofluorescencia - indirecta y análisis cuantitativo de la capa leucocitaria (buffy coat). Después del - tratamiento con benznidazol se realizaron pruebas parasitológicas y serológicas (xenodiagnóstico artificial y hemocultivo de T. cruzi), electrocardiogramas y ecocardiogramas periódicos durante cuatro años. Cuatro años después del tratamiento por enfermedad aguda de Chagas, todos los pacientes eran negativos en los análisis parasitológicos y disminuyeron los títulos de anticuerpos IgM anti-T. cruzi persistentes; tres pacientes presentaron alteraciones electrocardiográficas indicadoras de enfermedad crónica de Chagas o de secuelas de la enfermedad aguda. Se discute la respuesta satisfactoria al tratamiento y la importancia de los análisis parasitológicos seriados de los pacientes con enfermedad aguda de Chagas.

4461 downloads

Fase aguda da doença de Chagas na Amazônia brasileira: estudo de 233 casos do Pará, Amapá e Maranhão observados entre 1988 e 2005
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Pinto, Ana Yecê das Neves

; Valente, Sebastião Aldo

; Valente, Vera da Costa

; Ferreira Junior, Alberto Gomes

; Coura, José Rodrigues

Revista da Sociedade Brasileira de Medicina Tropical

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dec 2008, Volume 41 N. 6 Pages 602 - 614

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

Foram estudados 233 casos de fase aguda da doença de Chagas, oriundos do Pará, Amapá e Maranhão, observados no período de 1988 a 2005, cento e sessenta deles retrospectivamente de 1988 a 2002 e setenta e três prospectivamente de 2003 a 2005. Entre os casos estudados 78,5% (183/233) faziam parte de surtos provavelmente por transmissão oral, acometendo em média 4 pessoas e 21,5% (50/233) eram casos isolados. Foram considerados casos agudos aqueles que apresentaram exames parasitológicos diretos (a fresco, gota espessa ou Quantitative Buffy Coat - QBC) e/ou IgM anti-Trypanosoma cruzi positivos. Foram feitos ainda xenodiagnósticos em 224 pacientes e hemoculturas em 213. Todos foram avaliados clinica e epidemiologicamente. As manifestações clínicas mais freqüentes foram febre (100%), cefaléia (92,3%), mialgia (84,1%), palidez (67%), dispnéia (58,4%), edema de membros inferiores (57,9%), edema de face (57,5%) dor abdominal (44,2%), miocardite (39,9%) e exantema (27%). O eletrocardiograma mostrou alterações de repolarização ventricular em 38,5% dos casos, baixa voltagem de QRS em 15,4% e desvio de SAQRS em 11,5%, extra-sístoles ventriculares em 5,8%, bradicardia em 5,8% e taquicardia em 5,8%, bloqueio de ramo direito em 4,8% e fibrilação atrial em 4,8%. A alteração mais freqüente vista no ecocardiograma foi o derrame pericárdico em 46,2% dos casos. Treze (5,6%) pacientes evoluíram para o óbito, 10 (76,9%) dos quais por comprometimento cardiovascular, dois por complicações de origem digestiva e um de causa mal definida.

Two hundred and thirty-three cases of the acute phase of Chagas disease, from Pará, Amapá and Maranhão, were observed between 1988 and 2005. One hundred and sixty were studied retrospectively from 1988 to 2002 and seventy-three were prospectively followed up from 2003 to 2005. Among the cases studied, 78.5% (183/233) formed part of outbreaks, probably due to oral transmission (affecting a mean of 4 individuals), and 21.5% (50/233) were isolated cases. Cases were taken to be acute if they presented positive direct parasitological tests (fresh blood, thick drop or Quantitative Buffy Coat, QBC) and/or positive anti Trypanosoma cruzi IgM. Xenodiagnosis was also performed on 224 patients and blood culturing on 213. All the patients had clinical and epidemiological evaluations. The most frequent clinical manifestations were fever (100%), headache (92.3%), myalgia (84.1%), pallor (67%), dyspnea (58.4%), swelling of the legs (57.9%), facial edema (57.5%), abdominal pain (44.3%), myocarditis (39.9%) and exanthema (27%). The electrocardiogram showed abnormalities of ventricular repolarization in 38.5%, low QRS voltage in 15.4%, left-axis deviation in 11.5%, ventricular ectopic beats in 5.8%, bradycardia in 5.8%, tachycardia in 5.8%, right branch block in 4.8% and atrial fibrillation in 4.8%. The most frequently observed abnormality on the echocardiogram was pericardial effusion, in 46.2% of the cases. Thirteen (5.6%) patients died: ten (76.9%) of them due to cardiovascular involvement, two due to digestive complications and one due to indeterminate causes.

18738 downloads

Emerging acute Chagas Disease in Amazonian Brazil: case reports with serious cardiac involvement
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Pinto, Ana Yecê das Neves

; Valente, Sebastião Aldo da Silva

; Valente, Vera da Costa

Brazilian Journal of Infectious Diseases

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dec 2004, Volume 8 N. 6 Pages 454 - 460

Abstract: En | Text: En | PDF: En

Four cases of serious cardiac attacks by autochthonous Trypanosoma cruzi infection from the Brazilian Amazon are reported; three of them occurred in micro-epidemic episodes. The manifestations included sudden fever, myalgia, dyspnea and signs of heart failure. Diagnosis was confirmed by specific exams, especially QBC (Quantitative Buffy Coat) and natural xenodiagnosis. Despite treatment with benznidazol, three patients died with serious myocarditis, renal failure and cardiac tamponade. The authors call attention to the emergence of this disease and reveal a previously unknown pathogenicity of T. cruzi strains in this area, added to a non-usual transmission form.

3906 downloads

Drosophila angustibucca Duda sensu Frota-Pessoa is an undescribed species (Diptera, Drosophilidae)
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Vilela, Carlos R.

; Valente, Vera L. S.

; Basso-da-Silva, Luciano

Revista Brasileira de Entomologia

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jun 2004, Volume 48 N. 2 Pages 233 - 238

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

Drosophila angustibucca Duda sensu Frota-Pessoa é uma espécie ainda não descrita (Diptera, Drosophilidae). Uma nova espécie sul-americana de Drosophila, incluída no subgrupo I do grupo tripunctata e identificada incorretamente nos últimos 50 anos como sendo a espécie costarriquenha Drosophila angustibucca (sensu Frota-Pessoa, 1954; non Duda, 1925), é descrita no presente artigo sob o binômio Drosophila nappae sp. nov. Os espécimens-tipo foram retirados de uma linhagem obtida a partir de várias fêmeas coletadas entre julho de 1994 e abril de 1995 no Morro Santana, Porto Alegre (RS), Brasil. A descrição é acompanhada de ilustrações detalhadas das terminálias masculina e feminina.

Drosophila nappae sp. nov. , belonging to the subgroup I of the Drosophila tripunctata species group of the subgenus Drosophila, is described from flies of one strain established from several females collected from July 1994 through April 1995 at Morro Santana, Porto Alegre, state of Rio Grande do Sul, Brazil. This species has been misidentified during the past fifty years as Drosophila angustibucca (sensu Frota-Pessoa, 1954; non Duda, 1925, described from Costa Rica). Illustrations of male and female terminalia are also provided.

1797 downloads

10.

Acometimento cardíaco em pacientes com doença de Chagas aguda em microepidemia familiar, em Abaetetuba, na Amazônia Brasileira
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Pinto, Ana Yecê das Neves

; Harada, Geraldo Saburo

; Valente, Vera da Costa

; Abud, José Elson Araújo

; Gomes, Francisco dos Santos

; Souza, Gilberto César Rodrigues de

; Valente, Sebastião Aldo da Silva

Revista da Sociedade Brasileira de Medicina Tropical

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oct 2001, Volume 34 N. 5 Pages 413 - 419

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

Os autores mostram os principais achados clínicos relativos ao acometimento cardíaco, em pacientes portadores de doença de Chagas aguda em mais um episódio de microepidemia familiar na Amazônia brasileira. Foram estudados 13 pacientes com doença de Chagas aguda, procedentes do município de Abaetetuba-PA e submetidos à avaliação clínica e cardiológica, eletrocardiograma e ecocardiograma. As extra-sístoles supraventriculares e/ou ventriculares ocorreram em 38,5% dos casos. Bloqueios de ramo direito e bloqueios átrio-ventriculares de 1º e 2º graus, foram encontrados em 30,8% dos doentes. Chamam atenção dois achados no ecodopplercardiograma: derrame pericárdico e imagem sugestiva de formação aneurismática em dois pacientes respectivamente. Os achados revelam comprometimento cardíaco agudo, com evidências de miocardiopatia e alterações no sistema de condução do coração, havendo similaridade com a descrição da doença em áreas endêmicas.

The authors describe the main clinical findings relative to cardiac involvement, in patients with acute Chagas' disease (CD) in yet another familial micro-epidemic episode of CD in Amazon region. Thirteen patients were studied with acute Chagas' disease, resident in the city of Abaetetuba in Pará state; they were submitted to clinical and heart evaluation, with electrocardiograph and echocardiograph exams. Ventricular extrasystole occurred in 38.5% of the cases. Right bundle branch block and 1st and 2nd degree atrioventricular block were found in 30.8% of the patients. Attention is called to two findings in the Doppler echocardiography: pericardiac involvement and an image suggestive of aneurismatic formation in two patients. The findings reveal acute heart disease, with evidence of cardiomyopathy and alterations in the conduction system of the heart, bearing similarity with the description of the disease in endemic areas.

8939 downloads

11.

Potencial de domiciliação de Panstrongylus geniculatus (Latreille, 1811) (Hemiptera, Reduviidae, Triatominae) no município de Muaná, Ilha de Marajó, nordeste do Estado do Pará, Brasil
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Valente, Vera da Costa

Revista da Sociedade Brasileira de Medicina Tropical

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oct 1999, Volume 32 N. 5 Pages 595 - 597

Abstract: Pt | Text: Pt | PDF: Pt

1664 downloads Cited 1 time in SciELO

12.

Potential for domestication of Panstrongylus geniculatus (Latreille, 1811) (Liemiptera, Reduviidae, Triatominae) in the municipality of Muaná, Marajó Island, state of Pará, Brazil
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Valente, Vera da Costa

Memórias do Instituto Oswaldo Cruz

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sep 1999, Volume 94 Suppl. 1 Pages 399 - 400

Abstract: En | Text: En | PDF: En

1569 downloads Cited 6 times in SciELO

13.

Considerations on the epidemiology and transmission of Chagas disease in the Brazilian amazon
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Valente, Sebastião Aldo da Silva

; Valente, Vera da Costa

; Fraiha Neto, Habib

Memórias do Instituto Oswaldo Cruz

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sep 1999, Volume 94 Suppl. 1 Pages 395 - 398

Abstract: En | Text: En | PDF: En

5425 downloads Cited 1 time in SciELO

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