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#86 De: Joao Pinto Dias <jcpdias@cpqrr.fiocruz.br>
Enviado: Miercoles 15 de Marzo de 2000 09:56
Asunto: Seguimiento Chagas/Chagas follow up
Sponsored by: Productos Roche
Dr. Rivero:
En 1999 hubo dos talleres internacionales bajo el patrocinio de la OMS y de la Soc. Brasil. Med.Tropical, sobre el asunto, con las siguientes conclusiones sobre los 3 puntos que Ud presenta: a) agudos y congénitos: tratamiento durante 60 DIAS; b) crónico indeterminado: mantener vigilancia clínica (cardíaca, digestiva, neurológica), basicamente.
Tratamiento a ser decidido entre médico y paciente, bajo protocolo de investigación. Puede traer beneficio de cura (entre 8 y 50%, según idades yregiones) y clinicamente retrazar o interrumpir la evolución clínica, conforme algunas publicaciones con seguimiento de largo plazo (15 años o +); c)En general no tratar individuos yá con cardiopatia o megas avanzados.
Atentamente.

Dr. Rivero:
In 1999, there were two international workshops under the sponsorship of the WHO and the Brazilian Society of Tropical Medicine about the subject, with the following conclusions about the 3 items that you presented: a) acute and congenital: treatment for 60 DAYS; b) indeterminate chronic: to keep clinical watch (cardiac, digestive, neurological), basically.
The treatment should be decided by the physician and the patient, under protocol of investigation. It may bring the benefit of cure (between 8 and 50%, according to ages and regions), and clinically delay or stop clinical evolution, according to some publications with long-term follow up (15 years or more); c) In general, not treatment for individuals who already have heart diseases or megaviscera in advanced states.
Sincerely,
João carlos Pinto Dias, Investigador de FIOCRUZ, Brasil.

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#87 De: Edgardo Schapachnik <edgardo@schapachnik.com.ar
Enviado: Miercoles 15 de Marzo de 2000 14:33
Asunto: Seguimiento Chagas/ Chagas follow up
Sponsored by: Productos Roche
Estimados amigos:
En relacion a la pregunta de Rosendo Rivero Melgar referente a las pautas de terapeutica en los distintos estadios de la Enfermedad de Chagas o en sus distintas formas de presentacion clinica, el tema fue ampliamente debatido en el Foro.
Todos los mensajes que hacen a ese intercambio estan disponibles.
En este Foro, que reune a reconocidismos expertos de Brasil, Venezuela, Chile y Argentina y colegas y amigos de otros paises afectados por la endemia, se han dado opiniones coincidentes con las pautas que seniala Rosendo, discutidas en 1987 en Salta, en 1994 en La Plata y opiniones  opuestas en el sentido de indicar tratamiento parasiticida en la Fase cronica de la afeccion, en ausencia de compromiso organico. Este es un tema reverberante que -obviamente- nos encanta discutir a los "chagologos".
Personalmente participo de esa discusion desde 1976 y hay aqui colegas con los que desde entonces continuamos intercambiando puntos de vista. Sin embargo -y esta es una autocritica que en primer lugar me hago a mi mismo- nuestros argumentos mucho no han cambiado desde entonces. Señal que tal vez nos estemos volviendo un poco (nada más que un poco) mas viejos. :-) Creo que en el terreno de la Enfermedad de Chagas no existen puntos fuertes que avalen una u otra postura. Los unicos estudios en que se basan las posturas, son retrospectivos. No conozco ningun estudio PROSPECTIVO. doble ciego, cruzado, de 20 años de duracion que brinde EVIDENCIA en uno u otro sentido.
¿Por que digo de 20 años de duracion?
Porque a diferencia de la enfermedad coronaria -para tomar un ejemplo- donde en cinco años de seguimiento suceden todos los eventos factibles de presentarse en la evolucion de esta enfermedad, el Chagas tiene una evolucion mas torpida y para decir fehacientemente que una terapeutica es eficaz y debe aplicarse a todos los afectados, se necesita ese periodo.
Un tratamiento EFICAZ seria aquel que:
* negativizara la parasitemia
* negativizara la respuesta inmune (serologia)
* evitara la aparicion de cardiopatias, megas o compromiso neurologico
Para tener esas respuestas, hace falta ese lapso prolongado.
Solo tratando a miles de pacientes HOY y comparando en 20 años qué efectos en cuanto a esos items tendran los tratados con parasiticidas vs los tratados con placebo, podran RECIEN ENTONCES, sacarse las conclusiones.
En otras palabras: lo que existe hoy para responder de parte de unos y otros es EXPERIENCIA.
Pero la fase de la Medicina basada en la experiencia ha dejado su lugar a la Medicina basada en la EVIDENCIA.
Mi opinion es que los "chagologos" latinoamericanos estamos en deuda. No hemos producuido esa evidencia. Y los unicos responsables en producirla somos nosotros (o nuestros hijos)
Me parece que hoy estamos en mejores condiciones para producir esa informacion que en 1986 cuando intentabamos hacer una Historia
Clinica unica. Internet incluso es una herramienta que puede servirnos para hacer diseños epidemiologicos y planificar a futuro.
Sé que hay colegas que no estan de acuerdo en diseñar ese estudio porque -ya lo han expresado no sin justas razones- la inversion en el campoque nos ocupa debiera mas volcarse en erradicar ranchos y vinchucas que en "grandes trials".
Pero, segun pienso, la pregunta de Rosendo riene una sola respuesta: FALTA EVIDENCIA. Para poder contestar su inquietud, HAY QUE
CREAR ESA EVIDENCIA.
Si es correcto crearla o no, cuando hay otras prioridades, creo que es otra discusion.
Un abrazo.

Dear friends:
In regard to the question by Rosendo Rivero Melgar about therapeutic guidelines in different stages of Chagas disease or in different forms of clinical presentation, the topic was widely discussed in the Forum.
All messages concerning this exchange are available.
In this Forum that gathers renowned experts from Brazil, Venezuela, Chile, and Argentina, and colleagues and friends from other countries affected by the disease, opinions have been expressed which agree with the guidelines that Rosendo mentions, discussed in 1987 in Salta, in 1994 in La Plata, and opposite opinions in the sense of indicating parasiticide treatment in the chronic phase of the ailment, where there is absence of organic compromise. This is a powerful topic that -obviously- we, "chagologists" love to discuss.
Personally, I have been taking part in this discussion since 1976, and there are colleagues with whom we have been exchanging points of view  ever since then.
However, -and this is a self-criticism that firstly I made to myself- our arguments have not changed much since then.
This is a sign that maybe we are becoming a little (just a little) older.
I think that in the field of Chagas disease there are no strong items to support one stance or the other.
The only studies on which stances are based, are retrospective.
I do not know any PROSPECTIVE study, double blind, crossed, that lasted 20 years, that would provide EVIDENCE in one sense or
another.
Why do I say 20 years?
Because, unlike coronary disease -to provide en example- where all the possible events that may arise in the evolution of this disease, happen in five years of follow up, Chagas has a more torpid evolution; and to state irrefutably that a therapeutic is effective, and must be applied to all those who suffer from the disease, such period of time is required.
An EFFECTIVE treatment would be the one that:
*would negativize parasitemia
*would negativize immune response (serology)
*would prevent appearance of heart diseases, megaviscera, or neurologic compromise.
To obtain these answers, this extended period of time is needed.
Only by treating thousands of patients TODAY, and comparing which effects in regard to the former items will the people treated with parasiticides vs. those treated with placebo present in 20 years, ONLY THEN it will be possible to draw conclusions.
In other words: today there is EXPERIENCE to reply for ones or the others.
But the stage of Medicine based on experience has yielded the floor to Medicine based on EVIDENCE. My opinion is that Latin-American "chagologists" are indebted.
We have not produced that evidence. And the only responsible ones to produce it is us (or our children).
It seems to me that today we are in better conditions to produce this information than in 1986 when we tried to make a single Clinical History. Even the Internet is a tool that may be useful to make epidemiological designs and to plan the future.
I know that there are colleagues that do not agree with designing this study because -they have already expressed it with fair reasons- the investment in the field we deal with, should turn more towards the eradication of huts and bugs, than to "great trials".
But, the way I see it, Rosendo's question has only one answer: LACK OF EVIDENCE. In order to be able to reply to his concern, WE HAVE TO CREATE THIS EVIDENCE.
Whether it is correct to create it or not, when there are other priorities, I think is a subject for another argument.
Hugs,
Edgardo

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#88 De:  Celia Cordon-Rosales <ccrz@cdc.gov>
Enviado: Jueves 16 de Marzo de 2000 03:15 PM
Asunto: Presentacion/Presentation
Sponsored by: Deutsche Bank
Empezamos nuestros estudios de Chagas en Guatemala hace más o menos 6 años con la evaluación de la eficacia del rociamiento domiciliar con insecticidas para el control de T. dimidiata y R. prolixus. Hemos continuado con aspectos de biología molecular de las poblaciones de vectores, seroglogía en niños, patología asociada a Chagas, simbiontes para el control de Chagas.
Para mayor información revisar el sitio http://cc.cdc.uvg.edu.gt/ y hacer click en MERTUG

We began to study Chagas in Guatemala more or less 6 years ago by assessing the efficiency of spraying homes with insecticides for control of T. dimidiata and R. prolixus. We continued with aspects of molecular biology in vector populations, serology in children, pathology associated to Chagas, symbionts for Chagas control. For further information check the site  http://cc.cdc.uvg.edu.gt/ and click on MERTUG
Dra Celia Cordon Rosales
Guatemala

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#89 De: Manzullo Enrique  <manzullo@megabit.com.ar>
Enviado: Jueves 16 de Marzo de 2000 07:18 PM
Asunto: Seguimiento Chagas/Chagas follow up
Sponsored by: Deutsche Bank
Dr. Rosendo Rivero Melgar:
Distiguido colega:
Coincido en todos los puntos que Ud. menciona. Los criterios fueron fijados en 1982 de acuerdo a las evidencias existentes:
1- Tratamiento parasitológico del agudo
2- Seguimiento anual del crónico sin tratamiento paraciticida.
3- Terapeutica cardiológica según presencia de cardiopatía.
Sin embargo existen otras posiciones: El colega Brasilero Annis Rassi encuentra negativizacion serologica, 5 a 15 anos despues en parte de un grupo de cronicos tratados. Sosa Estani y Elsa Segura refieren negativizacion serologica del 61% en niños tratados con beznidazole.  Posiblemente apoyado en este estudio existe una resolucion del Ministerio de Accion Social de Argentina del año 1998 o 99 que señala la conveniencia de tratar a todos los infectados por Chagas menores de 14 años de edad.
El Dr Romeu Cancado refiere 75% de efectividad en agudos y 7- 8% de negativizacion serologica en seguimientos de 6 a 18 anos de cronicos.
Los trabajos que responden a estas citas se encuentran en "Memorias do Instituto Oswaldo Cruz" vol 94, Suppl. 1 1999.
Distinguido Rosendo: Mi actitud respecto al beznidazole es la que Ud. menciona, sin embargo cada medico decide su uso ( dado que el medicamento esta a la venta)de acuerdo a su buen criterio. Lo que no se puede aceptar en esta y en niguna enfermedad son tratamientos por Resoluciones Ministeriales. Le sugiero leer los trabajos que menciono que fueron presentados en abril de 1999 (Rio de Janeiro)en el Simposio Internacional de Chagas al cumplirse el 90 aniversario de su descubrimiento.
Alli bajo la presidencia y enorme esfuerzo del Dr. Coura se reunieron maestros y discipulos, con opiniones encontradas o armonicas y libremente se expuso y se publico. De su lectura facilmente diferenciara los trabajos consistentes de aquellos que no lo son y obtendra sus propias conclusiones.
Un cordial saludo.

Dr. Rosendo Rivero Melgar:
Distinguished colleague:
I agree with all the items you mention. The criteria were established in 1982 according to the existing evidence:
1- Parasitologic treatment of acute patients
2- Annual follow up of chronic patients without parasiticide treatment.
3- Cardiac therapeutic according to presence of heart disease.
However, there are other stances: the Brazilian colleague Annis Rassi finds serologic negativization, 5 to 15 years afterwards, in part of a group of treated chronic patients. Sosa Estani and Elsa Segura mention serologic negativization in a 61% of children treated with beznidazole. Possibly based in this study, there is a decree from the Ministry of Social Welfare from Argentina, year 1998 or 99, that points out the usefulness of   treating all children under 14 years old infected with Chagas.
Dr Romeu Cancado mentioned 75% of effectiveness in acute patients and 7-8% of serologic negativization in follow-ups from 6 to 18 years on chronic patients.
The works from where the quotes were extracted are in "Memorias do Instituto Oswaldo Cruz" vol 94, Suppl. 1 1999.
Distinguished Rosendo: My position in regard to beznidazole is the same that you mention, however each physician decides upon its use (since medication is on sale) according to his/her criteria. What we cannot accept in regard to this, or to any other disease   are treatments decreed by a Ministry.
I suggest you to read the works that I mentioned that were presented in April, 1999 (Rio de Janeiro) in the International Symposium on Chagas at the 90th anniversary of its discovery. There, under the presidency and great effort from Dr. Coura, masters and disciples were gathered, with opposite or agreeing opinions, and there was freedom in expositions and publications. From reading this you will easily distinguish consistent works from those which are not, and you will draw your own conclusions.
Cordially,
Enrique Manzullo

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#90 De: Grupo Provincial de Cardiologia <hevarela@finlay.cmw.sld.cu>
Enviado: Viernes 17 de Marzo de 2000 19:08
Asunto: Presentacion/Introduction
Sponsored by: Pfizer
Estimados colegas, un saludo desde Cuba.
Es un placer poder insertarme en este foro, donde se vierten opiniones de tan destacados profesores de la especialidad.
Realmente no tengo experiencia con Chagas porque es una afeccion que no aparece en nuestro pais y por otra parte no he prestado asistencia o coolaboracion en otro hermano pais latinoamericano que me permitiera desarrollarla. Esta es la causa que me llevo a incorporarme a la lista, pues soy un cardiologo de nueva formacion, y quiero a traves de sus opiniones adquirir informacion de esta importante enfermedad.
Fraternalmente.

Dear colleagues, greetings from Cuba.
I am glad to join this forum, where opinions are expressed by such distinguished professors in the specialty.
I have really no experience with Chagas because this is a disease that does not appear in our country, and on the other hand I have not delivered assistance or collaboration in a Latin-American, brother country that would allow me to develop it. This is the cause that lead me to join the list, since I am a cardiologist recently trained, and I want to acquire through your opinions information about this important disease.
Warm regards,
Dr. Hugo Escobar
Cardiologo
Camaguey
Cuba

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#91 De: Sergio V. Perrone <svperrone@interlink.com.ar>
Enviado: Jueves 16 de Marzo de  2000 22:47
Asunto: Chagas y transplante: Fresquito como la lechuga/Chagas and transplantation: fresh as a lettuce
Sponsored by: Pfizer
Recientemente presentado por Bocchi en el ACC de Anaheim.
Espero que les sea de utilidad a todos.
Hay que tener en cuenta que recopila datos historicos con pacientes transplantados hace muchos anios donde las cifras de sueprvivencia al anio de transplante no es la que se ve actualmente. Pero demuestra claramente que el Chagas es una patologia transplantable al igual que todas las demas.
Gracias DR. Bocchi por tan buena recopilacion de casos.
Dr. Sergio V. Perrone
Cita: Supplement to Journal of the American College of Cardiology February 2000, Vol. 35, Issue 2, Suppl. A, page 168
Cardiopatia chagasica: Etiologia asociada con mejor sobrevida luego de transplante cardiaco comparada con etiologias isquemicas e idiopaticas
Edimar A. Bocchi, Alfredo Fiorelli
Clinica de Transplante e Insuficiencia Cardiaca, Instituto del Corazon, Sao Paulo, Facultad de Medicina, Sao Paulo, Brasil
Los resultados de transplantes cardiacas pueden ser influidos por muchos factores, incluyendo la etiologia. Investigamos la influencia de edad, sexo, etiologia, periodo de transplante cardiaco, sobre los resultados de transplante cardiaco y causas de muerte en un estudio multicentrico.
Metodos: 835 pacientes transplantados del corazon, entre junio de 1984 y abril 1999 en 16 centros se incluyeron en este estudio, 632 de sexo masculino, menores de 7 anios 30 pts., entre 7 y 30 anios 125 pts., entre 30 y 60 anios 568 pts., > 60 anios 56 pts., y la etiologia fue cardiomiopatia dilatada idiopatica en 407 pts., isquemica en 196 pts., cardiopatia chagasica en 117, valvular en 29 pts., congenita en 14 pts., periparto en 12 pts., hipertrofica en 7 pts., retransplante en 6 pts., restrictiva en 5 pts., alcoholica en 4 pts., y drogas en 1pt.
Resultados: el  porcentaje de sobrevida a 1, 4 y 8 anios fue 66%, 54%, y 40% respectivamente. La sobrevida mejoro entre 1990 y 1999 (p < 0,0001), y fue mejor en la etiologia chagasica comparada con la idiopatica y la isquemica (p < 0,02) (Fig. 1). La edad y el sexo no influyeron sobre la sobrevida. En relacion a las causas de muerte: rechazo y neoplasia fueron mas comunes en la etiologia chagasica, hemorragia postoperatoria en isquemica, enfermedad de bypass de arteria coronaria y disfuncion de injerto en idiopatica e isquemica. Hubo reactivacion de enfermedad de Chagas en el 15% de los pacientes en el seguimiento.
Conclusion: la etiologia puede influir la sobrevida y las causas de muerte. La cardiomiopatia chagasica es una indicacion definida de transplante cardiaco con mejores resultados comparada con otras etiologias.

It has been recently presented by Bocchi at the ACC at Anaheim.
I hope this is useful for everyone.
It should be taken into account that it compiles historical data with patients transplanted many years ago, when survival figures after a year of  transplantation is not the same than the one currently observed. But it proves clearly that Chagas is a pathology that could be transplanted just as any other one.
Thank you Dr. Bocchi for such a good compilation of cases.
Dr. Sergio V. Perrone
Citation: Supplement to Journal of the American College of Cardiology February 2000, Vol. 35, Issue 2, Suppl. A, page 168
Chagas' Heart Disease: An Etiology Associated With Better Survival After Heart Transplantation in Comparison With Ischemic and Idiopathic Etiologies Edimar A. Bocchi, Alfredo Fiorelli
Transplantation and Heart Failure Clinics, Heart Institute, S=E3o Paulo University Medical School, S=E3o Paulo, Brazil
Results of heart transplantation may be influenced by many factors including etiology. We investigated the influence of age, sex, etiology, period of heart transplantation, on the results of heart transplantation and causes of death in a multicenter study.
Methods: 835 patients who underwent heart transplantation, from June 1984 to April 1999 in 16 centers were included in this study, 632 male, age less than 7 years 30 pts, from 7 to 30 years 125 pts, from 30 to 60 years 568 pts, >60 years 56 pts, and the etiology was idiopathic dilated  cardiomyopathy in 407 pts, ischemic in 196 pts, chagas heart disease in 117 pts, valvular in 29 pts, congenital in 14 pts, peripartum in 12 pts, hypertrofic in 7 pts, retransplantation in 6 pts, restrictive in 5 pts, alcoholic in 4 pts, and drug in 1 pt.
Results: The survival rate at 1, 4 and 8 years was 66%, 54% and 40%, respectively. Survival improved from 1990 to 1999 (p < 0.0001), and it was better in chagasic etiology compared with idiopathic and ischemic (p < 0.02) (Fig 1). Sex and age didn't influence survival. Regarding the causes of death: rejection and neoplasia were more commom in chagasic etiology, postoperative bleeding in ischemic, graft coronary artery disease and graft disfunction in idiopathic and ischemic. Reactivation of Chagas' disease occurred in 15% of the pts. during follow-up.
In conclusion: The  etiology can influence the survival and causes of death. Chagasic cardiomyopathy is a defined indication for heart transplantation with better results in comparison with other etiologies.

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#92 De:  Marcelo Bassino <marbas@teletel.com.ar>
Enviado: Lunes, 20 de Marzo de 2000 12:47 p.m.
Asunto: Presentacion de casos/Presentation of cases
Sponsored by: Pfizer
Estimados colegas :
Como actividad proxima de la lista Chagas , tenemos en vista la realizacion de Ateneos con la presentacion de casos clinicos , los cuales seran aportados por nosotros mismos , es decir los participantes del foro . Por favor quien quiera enviarlos y los insto especialmente a ello dirigir mail a marbas@teletel.com.ar para comentar de que manera hacerlo .
Saludos.

Dear colleagues:
As an activity of the Chagas list for the near future, we are considering making Athenaeums with presentation of clinical cases, which will be provided by ourselves, that is to say the forum's participants. Please, those of you who want to send them, and I especially encourage you to do it, address them to marbas@teletel.com.ar to comment how to make it.
Greetings,
Dr Marcelo Bassino
Moderator
Chagas-FVCC
Trenque Lauquen . Pcia Bs As
Argentina

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#93 De: Edgardo Schapachnik <edgardo@schapachnik.com.ar>
Enviado: Sabado 18 de Marzo de 2000 19:53
Asunto: Actualizacion bibliografica/Actualizacion bibliografica
Sponsored by: Pfizer
Queridos amigos:
Creo que estaremos en condiciones de mantener este servicio: una actualizacion semanal de la nueva bibliografia que vaya apareciendo en Medline.
Digo "creo", sin ser aun taxativo porque solo el proximo viernes sabre si el sistema de actualizacion automatica que instalo mi hijo Fernando ennuestro servidor funciona regularmente.
Este es el primer envio que recibi con las ultimas 50 citas bibliograficas del Medline.
Espero lo disfruten. El servicio no inclute el envio de los articulos "full text".
Un abrazo.

Dear friends:
I think that we will be fit to keep this service: a weekly update of the new bibliography that is  appearing on Medline.
I say "I think", without being specific yet, because only on next Friday I will get to know if the automatic updating system that my son Fernando has installed in our server operates properly.
This is the first dispatch I have received with the last 50 bibliographical quotes from Medline.
I hope you enjoy it. The service does not include sending of "full text" articles :-)
Hugs,
Edgardo
> Paper #1
>10717783 Guerra MO, et al.
>Interceptive effect of Lapachol in rats.
>Contraception. 1999 Nov;60(5):305-7.
>[MEDLINE record in process]
>PMID: 10717783; UI: 20182246.
>________________________________________
>Paper #2
>10717752 Sartori AM, et al.
>Reactivation of Chagas disease manifested by skin lesions in a patient with AIDS.
>Trans R Soc Trop Med Hyg. 1999 Nov-Dec;93(6):631-2.
>No abstract available.
>[MEDLINE record in process]
>PMID: 10717752; UI: 20182215.
>________________________________________
>Paper #3
>10717744 Betonico GN, et al.
>Evaluation of a synthetic tripeptide as antigen for detection of IgM and >IgG antibodies to Trypanosoma cruzi in serum samples from patients >with Chagas disease or viral diseases.
>Trans R Soc Trop Med Hyg. 1999 Nov-Dec;93(6):603-6.
>[MEDLINE record in process]
>PMID: 10717744; UI: 20182207.
>________________________________________
>Paper #4
>10717739 Romana CA, et al.
>Palm trees as ecological indicators of risk areas for Chagas disease.
>Trans R Soc Trop Med Hyg. 1999 Nov-Dec;93(6):594-5.
>No abstract available.
>[MEDLINE record in process]
>PMID: 10717739; UI: 20182202.
>________________________________________
>Paper #5
>10715697 Rivarola HW, et al.
>Thioridazine treatment modifies the evolution of Trypanosoma cruzi  infection in mice.
>Ann Trop Med Parasitol. 1999 Oct;93(7):695-702.
>[MEDLINE record in process]
>PMID: 10715697; UI: 20180562.
>________________________________________
>Paper #6
>10715696 Ribeiro-Dos-Santos G, et al.
>An improved, PCR-based strategy for the detection of Trypanosoma cruzi in human blood samples.
>Ann Trop Med Parasitol. 1999 Oct;93(7):689-94.
>[MEDLINE record in process]
>PMID: 10715696; UI: 20180561.
>________________________________________
>Paper #7
>10709842 Garcia CA, et al.
>Protective immunity induced by a Trypanosoma cruzi soluble extract antigen in experimental Chagas' disease. Role of interferon gamma.
>Immunol Invest. 2000 Feb;29(1):1-12.
>[MEDLINE record in process]
>PMID: 10709842; UI: 20173076.
>________________________________________
>Paper #8
>10708009 Ferreira LF, et al.
>Paleoparasitology of Chagas disease revaled by infected tissues from Chilean mummies.
>Acta Trop. 2000 Feb 25;75(1):79-84.
>[MEDLINE record in process]
>PMID: 10708009; UI: 20170282.
>________________________________________
>Paper #9
>10707756 Bestetti R.
>Stroke in a hospital-derived cohort of patients with chronic Chagas' disease.
>Acta Cardiol. 2000 Feb;55(1):33-8.
>[MEDLINE record in process]
>PMID: 10707756; UI: 20172747.
>________________________________________
>Paper #10
>10697461 [No authors listed]
>Chagas disease, Chile.
>Wkly Epidemiol Rec. 2000 Jan 14;75(2):10-2. English; French.
>No abstract available.
>[MEDLINE record in process]
>PMID: 10697461; UI: 20162563.
>________________________________________
>Paper #11
>10696415 dos Santos S de S, et al.
>Ocular myositis and diffuse meningoencephalitis from Trypanosoma cruzi in an AIDS patient.
>Trans R Soc Trop Med Hyg. 1999 Sep-Oct;93(5):535-6.
>No abstract available.
>PMID: 10696415; UI: 20161405.
>________________________________________
>Paper #12
>10677770 Oliveira Filho AM.
>Differences of susceptibility of five triatomine species to pyrethroid insecticides - implications for Chagas disease vector control.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:425-428.
>[Record as supplied by publisher]
>PMID: 10677770.
>________________________________________
>Paper #13
>10677769 Moraes-Souza H.
>Chagas infection transmission control: situation of transfusional transmission in Brazil and other countries of Latin America.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:419-423.
>[Record as supplied by publisher]
>PMID: 10677769.
>________________________________________
>Paper #14
>10677768 Ponce C.
>Elimination of the vectorial transmission of Chagas disease in Central American countries: Honduras.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:417-418.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677768.
>________________________________________
>Paper #15
>10677767 Guhl F, et al.
>Interruption of Chagas disease transmission in the Andean Countries: Colombia.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:413-415.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677767.
>________________________________________
>Paper #16
>10677766 Silveira A, et al.
>Elimination of vector-borne transmission of Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:405-411.
>[Record as supplied by publisher]
>PMID: 10677766.
>________________________________________
>Paper #17
>10677765 Moncayo A.
>Progress towards interruption of transmission of Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:401-404.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677765.
>________________________________________
>Paper #18
>10677763 Valente SA, et al.
>Considerations on the epidemiology and transmission of Chagas disease in >the Brazilian amazon.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:395-398.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677763.
>________________________________________
>Paper #19
>10677762 Aguilar V HM, et al.
>Epidemiology of Chagas disease in Ecuador. A brief review.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:387-393.
>[Record as supplied by publisher]
>PMID: 10677762.
>________________________________________
>Paper #20
>10677761 Sherlock IA.
>Epidemiology and dinamics of the vectorial transmission of Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:385-386.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677761.
>________________________________________
>Paper #21
>10677760 Coura JR, et al.
>Chagas disease: from bush to huts and houses. Is it the case of the Brazilian amazon?
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:379-384.
>[Record as supplied by publisher]
>PMID: 10677760.
>________________________________________
>Paper #22
>10677757 Carcavallo RU.
>Climatic factors related to Chagas disease transmission.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:367-369.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677757.
>________________________________________
>Paper #23
>10677755 Gontijo ED, et al.
>Chagas disease: criteria of cure and prognosis.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:357-362.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677755.
>________________________________________
>Paper #24
>10677754 Urbina JA.
>Parasitological cure of Chagas disease: is it possible? Is it relevant?
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:349-355.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677754.
>________________________________________
>Paper #25
>10677753 Silva AL.
>Chagas disease surgery.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:343-347.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677753.
>________________________________________
>Paper #26
>10677752 Meneghelli UG.
>Clinical treatment of the digestive form of Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:341-342.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677752.
>________________________________________
>Paper #27
>10677750 Cancado JR.
>Criteria of Chagas disease cure.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:331-335.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677750.
>________________________________________
>Paper #28
>10677749 Castro C.
>Longitudinal radiological study of the esophagus in Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:329-330.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677749.
>________________________________________
>Paper #29
>10677748 Ferreira MS.
>Chagas disease and immunosuppression.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:325-327.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677748.
>________________________________________
>Paper #30
>10677747 Lopes ER.
>Sudden death in patients with Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:321-324.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677747.
>________________________________________
>Paper #31
>10677746 Manzullo EC, et al.
>Risk of death due to chronic chagasic cardiopathy.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:317-320.
>[Record as supplied by publisher]
>PMID: 10677746.
>________________________________________
>Paper #32
>10677745 Macedo V.
>Indeterminate form of Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:311-316.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677745.
>________________________________________
>Paper #33
>10677744 Chapadeiro E.
>Clinical evolution and morbi-mortality in Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:309-310.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677744.
>________________________________________
>Paper #34
>10677743 Oelemann W, et al.
>Screening and confirmation in Chagas disease serology - a contribution.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:307-308.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677743.
>________________________________________
>Paper #35
>10677742 Britto C, et al.
>Polymerase chain reaction detection: new insights into the diagnosis of chronic Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:305-306.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677742.
>________________________________________
>Paper #36
>10677740 Chiari E.
>Chagas disease diagnosis using polymerase chain reaction, hemoculture and serologic methods.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:299-300.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677740.
>________________________________________
>Paper #37
>10677737 Umezawa ES, et al.
>Serological diagnosis of Chagas disease with purified and defined Trypanosoma cruzi antigens.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:285-288.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677737.
>________________________________________
>Paper #38
>10677735 Camargo ME.
>Development in the etiologic diagnosis of Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:281-282.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677735.
>________________________________________
>Paper #39
>10677734 Dosreis GA.
>The role of tissue-infiltrating T cells in immunopathology of Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:279-280.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677734.
>________________________________________
>Paper #40
>10677733 Sadigursky M.
>Evolution on the immunopathology of Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:277-278.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677733.
>________________________________________
>Paper #41
>10677732 Calabrese K.
>Immunosuppressive drugs as a tool to explore immunopathology in experimental Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:273-276.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677732.
>________________________________________
>Paper #42
>10677731 Costa SC.
>Mouse as a model for Chagas disease: does mouse represent a good model for Chagas disease?
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:269-272.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677731.
>________________________________________
>Paper #43
>10677729 Soares MB, et al.
>Immunopathology of cardiomyopathy in the experimental Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:257-262.
>[Record as supplied by publisher]
>PMID: 10677729.
>________________________________________
>Paper #44
>10677728 Correa-Oliveira R, et al.
>The role of the immune response on the development of severe clinical forms of human Chagas disease.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:253-255.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677728.
>________________________________________
>Paper #45
>10677727 Simoes-Barbosa A, et al.
>Integration of Trypanosoma cruzi kDNA minicircle sequence in the host genome may be associated with autoimmune serum factors in Chagas >disease patients.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:249-252.
>[Record as supplied by publisher]
>PMID: 10677727.
>________________________________________
>Paper #46
>10677726 Tafuri W.
>Immunopathology of Chagas disease - A historical overview.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:247-248.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677726.
>________________________________________
>Paper #47
>10677724 Costa J.
>The synanthropic process of Chagas disease vectors in Brazil, with special attention to Triatoma brasiliensis Neiva, 1911 (Hemiptera, >Reduviidae, Triatominae) population, genetical, ecological, and epidemiological aspects.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:239-241.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677724.
>________________________________________
>Paper #48
>10677717 Sousa MA.
>Morphobiological characterization of Trypanosoma cruzi Chagas, 1909 and its distinction from other Trypanosomes.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:205-210.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677717.
>________________________________________
>Paper #49
>10677698 Coutinho M, et al.
>The noble enigma: Chagas' nominations for the Nobel Prize.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:123-129.
>[Record as supplied by publisher]
>PMID: 10677698.
>________________________________________
>Paper #50
>10677697 Dias J, et al.
>The evolution of Chagas disease (American Trypanosomiasis) control after 90 years since Carlos Chagas discovery.
>Mem Inst Oswaldo Cruz. 1999 Sep;94 Suppl 1:103-121.
>No abstract available.
>[Record as supplied by publisher]
>PMID: 10677697.

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#94 De: Epidemiologia
Enviado: Viernes 17 de Marzo de 2000 03:43 PM
Asunto: Actividad Cientifica/Scientific activity
Sponsored by: IntraMed
Caros Amigos:
Algunos de los resultados obtenidos en el Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia - Porto Alegre - Brasil:
Evaluación Suerológica y Ecocardiografica de Niños y Adolecentes Pré y Pós Tratamiento Etiológico del Mal de Chagas en el Estado de Rio  Grande del Sur Gus, I; Santos, M; Hatem, D; Zaslavsky,C; Gus, M; Fernandes, C; Tiecher, F; Balbinot, M; Henriques, N; Fernandes, D. Instituto  de Cardiologia do Rio Grande do Sul. LACEN/FEPPS. Porto Alegre,Brasil.
Introducción: El mal de chagas es un problema serio de Salud Pública en la mojeria de los paises latinoamericanos, donde las condiciones habitacionales y sanitarias son precarias permitindo la reproducción del vecta y la transmisión de la enfermedad. En Brasil, el estado do Rio Grande del Sur (RS) es uma de las áreas endémicas más importante donde los índices de infección por el T. Cruzi llejan 20%. La prevalencia de la infección en niños y adolecentes de áreas rurales endémicas en este estado de acuerdo con el Cuestionario Suerológico Escolar de la Fundación Nacional de Salud fui de 0,6%.(1994 - 1996).
Objetivo: El propósito de este trabajo es evaluar el impacto del tratamiento etiológico con Benzonidazol en la suerológia (Elisa, Imunofluorecencia indirecta y hemocultura) del Mal de Chagas en niños y adolecentes (7 a 14 años) com teste sericos positivos detectados en la ocasión del Cuestionario Suerológico Escolar (1994 -1996) en RS. Osto objetivo es detectar en el ecocardiograma las alteraciones miocárdicas compatibles com el progreso de la enfermidad, estableciendo en que momento y cuales alteracions estructurales cardíacas caracterizan el Mal de Chagas.
Métodos: De 1994 a 1996 el Cuestionario Suerológico Escolar de la Fundación Nacional de Salud, en Rio Grande del Sur, envió para el Laboratorio Central del Estado - LACEN - FEEPS - en Porto Alegre, 33262 muestras sanguíneas de pacientes (7 a 14 años) de áreas rurales endémicas. Estas muestras eram sometidas a los tests: Elisa, Imunofluorecencia Indirecta y Hemocultura. En muestras positivas se realizaba hemocultura. Los pacientes que realizaban hemocultura eran orientados a iniciar tratamiento etiológico en Porto Alegre, así como a someterse a control clínico y laboratorial , a más de ecocardiograma y eletrocardiograma. El tratamiento etiológico consistia en 5mg/kg p/ dia de Benzonidazol durante 60 dias. De enero a marzo de 1999, los 87 niños y adolecentes evaluados fueran convidadas a repetir esa evaluación. Resultados: De las 33262 muestras sanguíneas enviadas al Laboratório Central (LACEN - FEEPS), 188 casos terian tests séricos positivos para el Mal de Chagas; 87 de estas fueran seguidas mediante ecocardiograma, eletrocardiograma y suerologia en Porto Alegre. Setenta y dos de los 87 pacientes fueron sometidos a terapeutica etiológica en el periodo de 1996 a 1997. Em solamente uma   de las 72 y en dos de aquellos que no  utilizaram Benzonidazol el ecocardiograma fue anormal. El ECG en apenas uno de los que no utilizaram la terapeutica era anormal. En el primero se observo moderada dilatación del ventriculo izquierdo y en las dos ultimas, sobrecarga ventricular izquierda. Secenta y siete repitiron esta evaluación en el período de enero a marzo de 1999. En 54 de ellos el Benzonidazol había sido administrado (1996 - 1997): 2 pacientes presentabam tests suerológicos negativos; 21 terian tests suerológicos minimamente positivo (1:40). Dos de los 13 que no recibieron medicación presentaban tests suerológicos negativos.Ningún  paciente presentaba alteraciones miocárdicas compatibles con el Mal de Chagas en el segundo ecocardiograma, excepto las 3 de las primera evaluación (1994 - 1996). No hubo alteración significativa entre los promedios de diametros diastólicos y sistólicas de ventriculo izquierdo o fracción de ejección en las das evaluacion ecocardiografica.
Conclusión: Devido al corto periodo de observación no fue possible adquirir un concepto definitivo com respecto al tratamiento etiológico com Benzonidazol en la muestra analizada; ni si las alteraciones son unos precozmente demostrable en el ecocardiograma de que en el ECG. La literatura muestra buenos resultados com relación al uso de esta terapia. Futuras revisiones nos permitiran concluir mas definitivamente a respeito del Benzonidazol.

Dear Friends:
Some of the results obtained by the "Instituto de Cardiologia de Rio Grande do Sul/Fundacao Universitaria de Cardiologia - Porto Alegre - Brasil":  Serologic Evaluation and Echocardiography in Children and Teenagers Pre and Post Etiologic Treatment of Chagas Disease in the State of Rio Grande do Sul. Gus, I; Santos, M; Hatem, D; Zaslavsky, C; Gus, M; Fernandes, C; Tiecher, F; Balbinot, M; Henriques, N; Fernandes, D. Instituto de Cardiologia do Rio Grande do Sul. LACEN/FEPPS. Porto Alegre, Brazil.
Introduction: Chagas disease is a serious Public Health problem in most Latin-American countries, where living and sanitary conditions are poor, allowing reproduction of the vector, and transmission of the disease. In Brazil, the state of Rio Grande do Sul (RS) is one of the most important endemic areas, where rates of infection by T. Cruzi reach a 20%. The prevalence of infection in children and teenagers from rural, endemic areas in this State according to the "Cuestionario Suerologico Escolar de la Fundacion Nacional de Salud" (School Serologic Questionnaire of the National Foundation of Health) was a 0,6% (1994 - 1996).
Aim: The purpose of this work is to assess the impact of etiologic treatment with Benzonidazole in serology (Elisa, indirect immunofluorescence, hemoculture) of Chagas disease in children and teenagers (7 to 14 years) with positive serum tests detected on the occasion of the "Cuestionario Suerologico Escolar" (1994 - 1996) in RS. Another aim is to detect in the echocardiogram the myocardial alterations, compatible to the progress of the disease, establishing at what time, and which heart structural alterations characterize Chagas Disease.
Methods: from 1994 to 1996 the "Cuestionario Suerologico Escolar de la Fundacion Nacional de Salud", in Rio Grande do Sul, send to the "Laboratorio Central del Estado" (Central Laboratory of the State) LACEN - FEEPS - in Porto Alegre, 33,262 blood samples from patients (7to 14 years) from endemic, rural areas. To these samples the following tests were performed: Elisa, Indirect Immunofluorescence, and Hemoculture. In positive samples hemoculture was performed. The patients in whom hemoculture was performed were advised to begin etiologic treatment in Porto Alegre, as well as undergoing clinical and laboratory control, besides echocardiogram and electrocardiogram. Etiologic treatment consisted of 5mg/kg per day of Benzonidazol for 60 days. From January toMarch 1999, the 87 children and teenagers evaluated were invited torepeat the evaluation.
Results: from the 33,262 blood samples submitted to the Central Laboratory (LACEN-FEEPS), 188 cases had positiveserum tests for Chagas disease, 87 of them were followed up through echocardiogram, ECG and serology in Porto Alegre. Seventy two out of the 87 patients underwent etiologic therapeutics in the period 1996-1997. In just one out of the 72, and in two out of those that did not use Benzonidazol, echocardiogram was abnormal. ECG in just one of those who did not use the therapeutics was abnormal. In the first one a mild dilatation was observed in the left ventricle, and in the two last, left ventricular overload. Sixty seven repeated this evaluation in the period January - March 1999. In 54 of them, Benzonidazol was administered (1996 - 1997): 2 patients presented negative serologic tests; 21 had minimally positive serologic tests (1:40). Two out of the 13 that did not receive medication presented negative serologic tests. No patient presented myocardial alterations compatible to Chagas disease in the second echocardiogram, except for the 3 of the first evaluation (1994 - 1996). There was no significant alteration between averages of diastolic and systolic diameters of left ventricle or ejection fraction in the two echocardiographic evaluations.
Conclusion: due to the short period of observation, it was not possible to acquire a definitive concept in regard to etiologic treatment with Benzonidazol in the sample analyzed; or if alterations were earlier demonstrable in the echocardiogram rather than in ECG either. Literature  shows good results concerning use of this therapy. Future revisions will allow us to reach more definite conclusions in regard to Benzonidazol.

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#95 De: Edgardo Schapachnik <edgardo@schapachnik.com.ar>
Enviado: Domimgo 19 de Marzo de 2000 20:10
Asunto: La enfermedad de Chagas en el Siglo XXI/Chagas disease in the XXI century
Queridos colegas:
A diferencia de la mecánica de los Congresos presenciales, este Congreso Virtual nos permite analizar hasta los puntos y comas de las 10  Conferencias publicadas.
Se me ocurre que podríamos iniciar una discusión de todas ellas, cuya lectura no tiene desperdicio.
Como soy el que propone la idea, me atribuyo proponer como primer material de análisis la Conferencia de Roberto Chuit, a mi modo de ver,  IMPACTANTE, Si bien recomiendo vehementemente su lectura, les adelanto una síntesis personal. La conferencia de Roberto está publicada en: http://pcvc.sminter.com.ar/cvirtual/cvirtesp/cientesp/ecesp/ecc4510c/cchuit/cchuit.htm
Podríamos intercambiar ideas, preguntar a Roberto, que es miembro de este Foro, comparar sus datos con los de Joao, etc. En una palabra agotar el tema. "Exprimirlo" al autor :-) y luego pasar a otra Conferencia.
Esta es mi síntesis:
1. La enfermedad de Chagas en el Siglo XXI - Argentina, es el tema que desarrolla el Dr. Roberto Chuit, de la Fundación Mundo Sano, Buenos Aires Argentina.
Comienza señalando los antecedentes de las actividades destinadas al control de la enfermedad y menciona desde los años 40 en adelante a Romaña, Soler, Bravo, Rosenbaum, Cerisola, para llegar a la creación en 1962 del Servicio Nacional de Control de Chagas y el Instituto Nacional de Diagnóstico de la Enfermedad de Chagas Dr. Mario Fatala Chaben, instituciones que en sus 37 años de existencia logran disminuir la prevalencia general de infección por T. Cruzii, proyectando para el año 2003 quizás lograr el control de la transmisión vectorial en la casi totalidad del territorio Nacional. En el desarrollo, Chuit plantea un estimativo del número de personas infectadas en el país, según los distintos grupos etáreos y según la diferencia de densidad poblacional de los lugares de residencia. De acuerdo a la metodologá que aplica, Chuit estima para nuestro país un total de infectados de 2.046.667, de los cuales 409.333 presentarían diversos grados de cardiopatía. Asimismo estima que el 68% de los parasitados se encuentran por encima de los 35 años y que más de la mitad, reside hoy en áreas urbanas. Evalúa la importancia de las medidas de control realizadas, dado que sin la aplicación de las mismas las cifras de parasitados hubieran superado los 3.900.000 y los cardiópatas, 650.000..
Adentrándose en pronósticos para el siglo que se inicia, señala que la transmisión vectorial está a punto de ser controlada, que las cardiopatías de origen chagásico seguirán concurriendo>a los consultorios por unos 40 años y que ostensiblemente disminuirá su prevalencia a partir del 2020. Plantea la importancia relativa de la transmisión connatal y alerta que aproximadamente 500 niños por año quedan sin diagnóstico.

Subject:

Dear colleagues:
Unlike the mechanism of the Congresses "in person", this Virtual Congress lets us analyze every minute detail of the 10 Lectures published.
I think that we could begin a discussion about all of them, since there is no waste on their reading.
As I am the one who proposes the idea, I confer myself the right to propose as first material for analysis the Lecture by Roberto Chuit, the way I see it, REMARKABLE.
Although I recommend emphatically to read it, I provide you in advance a personal summary. Roberto's lecture is available at:
http://pcvc.sminter.com.ar/cvirtual/cvirtesp/cientesp/ecesp/ecc4510c/cchuit/cchuit.htm
We could exchange ideas, ask questions to Roberto, who is a member of this Forum, compare his data with Joao's, etc. That is to say, to exhaust the topic. "To squeeze" the author And then move on to another Lecture.
This is my synthesis:
1. Chagas disease in the XXI Century - Argentina, is the subject that Dr. Roberto Chuit tackles. He belongs to the "Fundacion Mundo Sano" (Healthy World Foundation), Buenos Aires, Argentina.
He begins by pointing the precedents of the activities that attempted to control the disease, and mentions from the 40s onwards, Romana, Soler, Bravo, Rosenbaum, Cerisola, to reach the creation of the "Servicio Nacional de Control de Chagas" (National Service of Control for Chagas) and the "Instituto Nacional de Diagnostico de la Enfermedad de Chagas" (National Institute of Diagnosis for Chagas Disease) of Dr. Mario Fatala Chaben in 1962, both institutions that in their 37 years of existence managed to diminish the general prevalence of infection by T. Cruzii, with the project for year 2003 to maybe achieve control of vector transmission in almost all the National territory. In its development, Chuit poses an estimate of the figure of people infected in the country, according to different age groups, and according to the difference in population density of the places to live in. According to the methodology applied, Chuit estimates for our country a total of infected people of 2,046,667, from which 409,333 would present different degrees of heart disease. Likewise, he estimates that a 68% of parasite carriers are 35 years or older, and more than a half of them, live today in urban areas. He assesses the importance of the measures of control carried out, since without their application the figures would have surpassed 3,900,000, and 650,000 of heart diseased individuals. Advancing into prognosis for the century that is beginning, he points out that vector transmission is about to be controlled, that chagasic heart diseases will go on appearing in our offices for some 40 years, and its prevalence will obviously diminish since 2020. He poses the relative importance of connate transmission, and warns that approximately 500 children per year remain undiagnosed.

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#96 De: Susana Ginestar <burgy@arnet.com.ar>
Enviado: Domingo 19 de Marzo de 2000 11:23
Asunto: Allopurinol en tratamiento para adultos/Allopurinol in treatment for adults
Sponsored by: IntraMed
Estimados colegas del foro, si bien no he participado activamente si he leido y guardado todas vuestras opiniones las cuales y no en funcion de quedar bien, son importantisimas y ojala pudieramos realmente, realizar estudios de seguimiento a 20 anios o mas, que creo, seria tal vez, el primer escalon para poder comenzar tratamientos efectivos basados en la evidencia.
El motivo de esta comunicacion, es evidencia, soy una medica cardiologa de mendoza, pertenesco al area de salud de guaymallen y en los programas provinciales de salud contemplan el tratamiento en ninios hasta 15 anios de edad, como sabemos todos, el punto es que se nos informa, que si deseamos tratar adultos cronicos con allopurinol debemos presentar evidencias de trabajos que avalen esta situacion, de esa manera el estado nos proveeria de esta medicacion, no de drogas clasicas, ya que se tiene el concepto formado que hasta la fecha no han sido suficientemente efectivas.
Agradecere cualquier informacion al respecto, trabajos cientificos, datos estadisticos, de nuestro pais y de todos aquellos que estan un paso adelante del nuestro, creo que por lo menos, que se nos de la oportunidad de intentar presentar fundamentos para tratamiento, es un paso mas que importante, donde habitualmente siempre encontramos las puertas cerradas.
Un cordial saludo para todos los integrantes del foro.

Dear colleagues of the forum, although I have not participated actively, I did read and saved all your opinions that -and not because I wish to make a good impression- are very, very important and I wish we could really make follow up studies in 20 years or more, which I think would be maybe, the first step to be able to begin effective treatment based in evidence.
The reason for this communication is that I want evidence; I am a cardiologist from Mendoza (Argentina), I belong to the health area from Guaymallen, and in the health programs of the province the treatment in children up to 15 years old is covered, as we all know; the point is that we have been informed that if we wish to treat chronic adults with allopurinol we must present evidence from works that would back up this situation, thus the state would provide us with this medication, instead of classical drugs, since there is the concept that to date they have not been effective enough.
I will thank any information about it: scientific papers, statistical data, from our country and all that are a step ahead of us, I think that at least, that we should be given the chance to try to present foundations for this treatment is a step more than important, where we usually find closeddoors always.
Kind regards for all the members of the forum.
Dra. Susana G. Ginestar

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Update
Mar/29/2000