Indeterminate Form Research Articles

Chagas Disease Recommendations for Solid-Organ Transplant Recipients and Donors.

Chagas Disease Recommendations for Solid-Organ Transplant Recipients and Donors.

Reporting and Handling of Indeterminate Bone Scan Results in the Staging of Prostate Cancer: A Systematic Review.

Bone scintigraphy is key in imaging skeletal metastases in newly diagnosed prostate cancer. Unfortunately, a notable proportion of scans are not readily classified as positive or negative but deemed indeterminate. The extent of reporting of indeterminate bone scans and how such scans are handled in clinical trials are not known. A systematic review was conducted using electronic databases up to October 2016. The main outcome of interest was the reporting of indeterminate bone scans, analyses of how such scans were managed, and exploratory analyses of the association of study characteristics and the reporting of indeterminate bone scan results. Seventy-four eligible clinical trials were identified. The trials were mostly retrospective (85%), observational (95%), large trials (median 195 patients) from five continents published over four decades. The majority of studies had university affiliation (72%), and an author with imaging background (685). Forty-five studies (61%) reported an indeterminate option for the bone scan and 23 studies reported the proportion of indeterminate scans (median 11.4%). Most trials (44/45, 98%) reported how to handle indeterminate scans. Most trials (n = 39) used add-on supplementary imaging, follow-up bone scans, or both. Exploratory analyses showed a significant association of reporting of indeterminate results and number of patients in the study (p = 0.024) but failed to reach statistical significance with other variables tested. Indeterminate bone scan for staging of prostate cancer was insufficiently reported in clinical trials. In the case of indeterminate scans, most studies provided adequate measures to obtain the final status of the patients.

TGF-β Polymorphisms Are a Risk Factor for Chagas Disease.

Transforming growth factor β1 (TGF-β1) is an important mediator in Chagas disease. Furthermore, patients with higher TGF-β1 serum levels show a worse clinical outcome. Gene polymorphism may account for differences in cytokine production during infectious diseases. We tested whether TGFB1 polymorphisms could be associated with Chagas disease susceptibility and severity in a Brazilian population. We investigated five single-nucleotide polymorphisms (−800 G>A, −509 C>T, +10 T>C, +25 G>C, and +263 C>T). 152 patients with Chagas disease (53 with the indeterminate form and 99 with the cardiac form) and 48 noninfected subjects were included. Genotypes CT and TT at position −509 of the TGFB1 gene were more frequent in Chagas disease patients than in noninfected subjects. Genotypes TC and CC at codon +10 of the TGFB1 gene were also more frequent in Chagas disease patients than in noninfected subjects. We found no significant differences in the distribution of the studied TGFB1 polymorphisms between patients with the indeterminate or cardiac form of Chagas disease. Therefore, −509 C>T and +10 T>C TGFB1 polymorphisms are associated with Chagas disease susceptibility in a Brazilian population.

The Presence and Extension of Myocardial Fibrosis in the Undetermined Form of Chagas' Disease: A Study Using Magnetic Resonance.

BackgroundPrevious data has shown that patients in the indeterminate form of Chagas disease may present myocardial fibrosis as shown on through magnetic resonance imaging (MRI). However, there is little information available regarding the degree of severity of myocardial fibrosis in these individuals. This variable has the potential to predict the evolution of Chagas’ disease into its cardiac form.ObjectivesTo describe the frequency and extent of myocardial fibrosis evaluated using an MRI in patients in the indeterminate form, and to compare it with other forms of the disease.MethodsPatients were admitted one after another. Their clinical history was collected and they were submitted to laboratory exams and an MRI.ResultsSixty-one patients with Chagas’ disease, with an average age of 58 ± 9 years old, 17 patients in the indeterminate form, 16 in the cardiac form without left ventricular (LV) dysfunction and 28 in the cardiac form with LV dysfunction were studied. P <0.05 was considered to be statistically significant. Late enhancement was detected in 37 patients (64%). Myocardial fibrosis was identified in 6 individuals in indeterminate form (41%; 95% CI 23-66) in a proportion similar to that observed in cardiac form without LV dysfunction (44%); p = 1.0. Among the individuals with fibrosis, the total area of the affected myocardium was 4.1% (IIQ: 2.1 - 10.7) in the indeterminate form versus 2.3% (IIQ: 1-5) in the cardiac form without LV (p = 0.18). The left ventricular fraction ejection in subjects in the indeterminate form was similar to that of the individuals in the cardiac form without ventricular dysfunction (p = 0.09).ConclusionThe presence of fibrosis in the indeterminate form of Chagas’ disease has a frequency and extension similar to that of in the cardiac form without dysfunction, suggesting that the former is part of a subclinical disease spectrum, rather than lacking cardiac involvement.

Analysis of Iron Metabolism in Chronic Chagasic Cardiomyopathy.

Changes in iron metabolism in heart failure (HF) have been described as an important prognostic marker.To check if the markers of iron kinetics are related to the morbidity and etiology of chagasic cardiomyopathy.Patients with Chronic Chagasic Cardiomyopathy (CCC, n = 40), with indeterminate form (IND, n = 40), besides non-chagasic cardiomyopathy (NCh, n = 40).The mean age was 50.98 ± 5.88 in CCC, 50% were male, 49.68 ± 5.28 in IND, 52.2% were male, and 49.20 ± 10.09 in NCh, 12.5% were male. Lower levels of iron (FeSe) were observed in the CCC groups (93.15 ± 36.53), when compared to IND (125.30 ± 22.79) and NCh (114.77 ± 18.90) (p = 0.0004), lower IST transferrin saturation index in CCC (29.48 ± 6.59), when compared to IND (30.95 ± 7.06) and in the NCh group (39.70 ± 7.54) p = 0.0001), total binding capacity of the lower CTLF iron in the CCC group (297.30 ± 36.46), when compared to the IND group (196.52 ± 56.95) and the NCh group (275.18 ± 33, 48) (p = 0.0001), lower ferritin in the CCC group (134.55, 1.56-42.36), when compared to the IND group (156,25, 1,72-42,20) and the NCh group (112.95, 2.88-42.66) (p = 0.0004). It was also observed that FeSe (95% CI 1.00-1.04, p = 0.0014), IST (95% CI 1.02-1.22) (p = 0.0012) and gender (95% CI 1.07-14.43 p = 0.0038) were independently associated with the degree of ventricular dysfunction in chagasic cardiomyopathy.CCC patients showed greater change in iron metabolism regarding the indeterminate form and other forms of cariomyopathies.

Restricted Lie (Super)Algebras in Characteristic 3

We give explicit formulas proving restrictedness of the following Lie (super)algebras: known exceptional simple vectorial Lie (super)algebras in characteristic 3, deformed Lie (super)algebras with indecomposable Cartan matrix, and (under certain conditions) their simple subquotients over an algebraically closed field of characteristic 3, as well as one type of the deformed divergence-free Lie superalgebras with any number of indeterminates in any characteristic.

Morphological Description of Calcareous Nannofossils Assemblage of a Middle-Miocene to Late-Miocene Section in the Niger-Delta, Nigeria

Forty four (44) different forms of nannofossils recovered from the middle-Miocene to late-Miocene sediments of a section ((8900 - 11,000) ft (2713 - 3353 m)) of a well in the prolific oil producing Niger delta, Nigeria were described and grouped into twelve, though not on phylogenetic relationship, for documentation purpose. The standard strewn-slide technique was used to recover the fossils. The aim is to present the distinguishing morphological features of each of the nannofossils group. Of the recovered forms Genus, Discoaster, was found prominent and divisible into six sub-groups: 6-rayed discoaster with bifurcations, 6-rayed discoasters without bifurcation, 5-rayed discoasters, 5-rayed discoaster with acute bifurcations, 5-rayed nannolith and the indeterminate forms. Genus Sphenolithus recovered is also divisible into two: species without prominent apical spines and species with prominent, monocrystalline apical spines. Other genera found and described are Catinaster, Cyclicargolithus, Coccolithu, Minylitha, Syracosphaera, Helicosphaera, Pontosphaera, Calcidiscus and Reticulofenestra. All the nannofossils fall within NN11, NN10, NN9, NN8 and NN5 zones belonging to the Middle-Late Miocene age.

PP116 Health Utilities And Neglected Conditions: A Chagas Disease Study

Introduction:Chagas disease (ChD), also known as American trypanosomiasis, is a neglected tropical disease caused by the protozoan parasite Trypanosoma cruzi. About 6 to 7 million people worldwide are estimated to be infected, most in Latin America. Health-related quality of life (HRQoL) and utility measures are still poorly employed for assessment of ChD lifetime impairments. Brazilian HRQoL published data showed that the cardiac subgroup of patients have worse scores than other ChD chronic groups. For the time being, utility scores are not available yet for the ChD population. The present study aims to assess quality of life (QoL), as utility scores, of patients with chronic Chagas Disease.Methods:This is a cross-sectional study. Data were collected from 183 outpatients with chronic ChD in a reference center in Brazil. Information pertaining to sociodemographics, clinical status, and quality of life were collected using self-administered questionnaires. Utilities were obtained by the European Quality of Life – 5 Dimensions (EQ-5D) questionnaire. Comparisons were made between clinical subtypes and population normative values. Continuous variables were compared using t-test or ANOVA, and categorical variables were compared using Chi-square test. Associations between QoL and patient characteristics stratified by demographics, clinical status were identified by linear regression models.Results:Most subjects were female (61 percent). The average age of men was 53.3 years and women 56.6. When analyzing the EQ-5D utility scores, it was observed that the results were lower for cardiac patients (0.610–95% CI 0.582–0.638) in comparison to indeterminate form patients (0.659–0.632–0.687). When comparing patients with the general population of the same age and sex, patients with ChD showed lower utility scores than normative values (0.624–95% CI 0.596–0.652).Conclusions:Chronic ChD causes a negative impact on quality of life, physical functioning, as well as psychosocial function, with the impairment becoming worse in cardiac patients.

Democracia e luta por hegemonia

Este artigo parte do conceito de democracia como forma indeterminada de poder, em um esforço para pensar o sentido concreto da organização social orientada pela democracia, assim compreendida. A democracia parece admitir tanto uma organização material socialista quanto liberal. Daí a necessidade de distinguir o nível formal de abertura democrática e o nível material de luta por hegemonia em que essa alternativa aparece, entendendo ambos como determinações contingentes em disputa.

Additional contributions to the knowledge of the Taquaral Member, Irati Formation (Lower Permian, Paraná Basin): Taphonomy and paleoenvironmental implications

The silty shale facies of the Taquaral Member (Irati Formation), which is one of the Permian units in the Brazilian Parana Basin, is discussed here based on the taphonomy relevant to the paleoenvironmental interpretation. The fossils are crustaceans (Clarkecaris and other indeterminate forms), isolated teeth, scales and bones of Actinopterygii, Palaeonisciformes , which are the most common vertebrate remains, and also frequent scales of Coelacanthiformes. The scales, teeth and disarticulated bones are found together in accumulations, which may be interpreted as coprolites. Many of the fossil crustaceans display characteristics of ecdysis.

Why the Edgeworth and Russell Reviews of the a Treatise on Probability Are So Vastly Superior to the Two F.P. Ramsey Reviews: Edgeworth and Russell Both Recognized Keynes's Interval Valued Concept of Probability While F. P. Ramsey Completely Failed to Comprehend the Most Basic Concepts of Interval Valued Probability

Both F. P. Ramsey reviews of J M Keynes’s A Treatise on Probability demonstrate an abysmal lack of understanding on Ramsey’s part of Keynes’s Boolean concept of upper and lower probabilities. Ramsey had absolutely no idea about what an interval valued concept of probability was or how an axiomatic treatment of such a probability concept would have to proceed. Ramsey had no idea about what an imprecise and/or indeterminate probability was. The same problem arises with respect to the two articles by Richard Braithwaite on Keynes’s A Treatise on Probability. Even more lacking was Braithwaite’s Foreword to Volume 8 of the CWJMK version of the A Treatise on Probability published in 1973. Braithwaite commentary in this foreword simply shows that he does not have a clue about what an interval valued probability would be. Both Braithwaite and Ramsey could only understand what an ordinal and a cardinal (numerical) probability was. On the other hand, both Edgeworth and Russell dealt explicitly in their reviews of the A Treatise on Probability with Keynes’s concept of interval valued probability. Unfortunately, none of the heterodox Post Keynesians or “Fundamentalist” Keynesians and Institutionalists (Skidelsky, O’Donnell, Carabelli, Fitzgibbons, Lawson, Meeks, Runde, S.Dow, T. Raffaelli, Gillies, Mellor, etc.) ever read Edgeworth’s or Russell’s reviews of the A Treatise on Probability. What they read, instead, was Ramsey’s and Braithwaite’s works, which never mentioned interval valued probability because they had no idea about what an interval valued probability concept was. Keynes, as expected, wasted none of his very valuable time in replying to such individuals, since all they had to do was read Russell and Edgeworth. This would explain why such individuals, heavily concentrated in the Economics and Philosophy Departments at Cambridge University, England, are unable to deal with Keynes’s concept of interval valued probability and constantly confused ordinal probability with interval valued probability. Entire books have been written on Keynes, probability, uncertainty, and decision making where no mention is made of Keynes’s interval valued approach to probability,Boole ,upper and lower probabilities, and Keynes’s indeterminate or imprecise probabilities because Ramsey was totally ignorant of even a concept of interval valued probability. One example is the 2003 book, titled “The Philosophy of Keynes’ Economics”, by Runde and Mizuhara. It will soon become apparent to the reader of this book that the reviews by Ramsey play an inordinate role in the assessment of Keynes’s TP. Over half of the 19 articles published in the Runde–Mizuhara book place the Ramsey reviews at the center of their evaluation of Keynes’s logical theory of probability. Correspondingly, there is no mention of the Edgeworth, Broad, or Russell reviews that DID discuss Keynes’s interval valued approach to probability or Boole. Interval valued Probability, in both the imprecise form and indeterminate form, are the major accomplishment of the TP. Edgeworth, Russell, and Broad succeeded in pointing this out in their reviews. Ramsey and Braithwaite completely failed to correctly assess Keynes’s interval valued approach.

Lack of association between serum syndecan-4, myocardial fibrosis and ventricular dysfunction in subjects with chronic Chagas disease.

BackgroundSyndecan-4 is a transmembrane glycoprotein associated with inflammation and fibrosis. Increased syndecan-4 levels were previously detected after acute myocardial infarction and in subjects with heart failure. However, the levels of syndecan-4 in subjects with Chagas disease have not so far been investigated. The aim of this study was to investigate the potential role of serum sydencan-4 as a novel biomarker for myocardial fibrosis and cardiac dysfunction in subjects with Chagas disease.MethodsThis study comprised subjects with Chagas disease (n = 56), being 14 (25%) with the indeterminate form, 16 (29%) with the cardiac form without ventricular dysfunction, and 26 (46%) with the cardiac form with ventricular dysfunction.ResultsSyndecan-4 serum concentrations did not correlate with presence or absence of myocardial fibrosis (P = 0.386) nor disease severity in subjects with Chagas disease (P = 0.918). Additionally, no correlation was found either between the degree of myocardial fibrosis and serum syndecan-4 [r = 0.08; P = 0.567] or between left ventricular ejection fraction and syndecan-4 [r = 0.02; P = 0.864]. In contrast, NT-proBNP levels correlated with ejection fraction and myocardial fibrosis.ConclusionsOur results demonstrate the lack of correlations between serum syndecan-4, myocardial fibrosis and cardiac dysfunction in subjects with Chagas disease. Further studies are required to show if syndecan-4 concentrations can be marker for prognosis assessment or disease progression.

On Indeterminate Forms of Exponential Type

SummaryWe apply the squeeze theorem, instead of L′Hospital′s rule, to evaluate limits in indeterminate form of exponential type. We do not require differentiability, instead needing the boundedness of a quotient.

Detection of relationships among multi-modal brain imaging meta-features via information flow

BackgroundNeuroscientists and clinical researchers are awash in data from an ever-growing number of imaging and other bio-behavioral modalities. This flow of brain imaging data, taken under resting and various task conditions, combines with available cognitive measures, behavioral information, genetic data plus other potentially salient biomedical and environmental information to create a rich but diffuse data landscape. The conditions being studied with brain imaging data are often extremely complex and it is common for researchers to employ more than one imaging, behavioral or biological data modality (e.g., genetics) in their investigations. While the field has advanced significantly in its approach to multimodal data, the vast majority of studies still ignore joint information among two or more features or modalities. New methodWe propose an intuitive framework based on conditional probabilities for understanding information exchange between features in what we are calling a feature meta-space; that is, a space consisting of many individual featurae spaces. Features can have any dimension and can be drawn from any data source or modality. No a priori assumptions are made about the functional form (e.g., linear, polynomial, exponential) of captured inter-feature relationships. ResultsWe demonstrate the framework’s ability to identify relationships between disparate features of varying dimensionality by applying it to a large multi-site, multi-modal clinical dataset, balance between schizophrenia patients and controls. In our application it exposes both expected (previously observed) relationships, and novel relationships rarely considered investigated by clinical researchers. Comparison with existing method(s)To the best of our knowledge there is not presently a comparably efficient way to capture relationships of indeterminate functional form between features of arbitrary dimension and type. We are introducing this method as an initial foray into a space that remains relatively underpopulated. ConclusionsThe framework we propose is powerful, intuitive and very efficiently provides a high-level overview of a massive data space. In our application it exposes both expected relationships and relationships very rarely considered worth investigating by clinical researchers.

Multimodality imaging evaluation of Chagas disease: an expert consensus of Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI).

To develop a document by Brazilian Cardiovascular Imaging Department (DIC) and the European Association of Cardiovascular Imaging (EACVI) to review and summarize the most recent evidences about the non-invasive assessment of patients with Chagas disease, with the intent to set up a framework for standardized cardiovascular imaging to assess cardiovascular morphologic and functional disturbances, as well as to guide the subsequent process of clinical decision-making. Chagas disease remains one of the most prevalent infectious diseases in Latin America, and has become a health problem in non-endemic countries. Dilated cardiomyopathy is the most severe manifestation of Chagas disease, which causes substantial disability and early mortality in the socially most productive population leading to a significant economical burden. Prompt and correct diagnosis of Chagas disease requires specialized clinical expertise to recognize the unique features of this disease. The appropriate and efficient use of cardiac imaging is pivotal for diagnosing the cardiac involvement in Chagas disease, to stage the disease, assess patients' prognosis and address management. Echocardiography is the most common imaging modality used to assess, and follow-up patients with Chagas disease. The presence of echocardiographic abnormalities is of utmost importance, since it allows to stage patients according to disease progression. In early stages of cardiac involvement, echocardiography may demonstrate segmental left ventricuar wall motion abnormalities, mainly in the basal segments of inferior, inferolateral walls, and the apex, which cannot be attributed to obstructive coronary artery arteries. The prevalence of segmental wall motion abnormalities varies according to the stage of the disease, reaching about 50% in patients with left ventricular dilatation and dysfunction. Speckle tracking echocardiography allows a more precise and quantitative measurement of the regional myocardial function. Since segmental wall motion abnormalities are frequent in Chagas disease, speckle tracking echocardiography may have an important clinical application in these patients, particularly in the indeterminate forms when abnormalities are more subtle. Speckle tracking echocardiography can also quantify the heterogeneity of systolic contraction, which is associated with the risk of arrhythmic events. Three-dimensional (3D) echocardiography is superior to conventional two-dimensional (2D) echocardiography for assessing more accurately the left ventricular apex and thus to detect apical aneurysms and thrombus in patients in whom ventricular foreshortening is suspected by 2D echocardiography. In addition, 3D echocardiography is more accurate than 2D Simpson s biplane rule for assessing left ventricular volumes and function in patients with significant wall motion abnormalities, including aneurysms with distorted ventricular geometry. Contrast echocardiography has the advantage to enhancement of left ventricular endocardial border, allowing for more accurate detection of ventricular aneurysms and thrombus in Chagas disease. Diastolic dysfunction is an important hallmark of Chagas disease even in its early phases. In general, left ventricular diastolic and systolic dysfunction coexist and isolated diastolic dysfunction is uncommon but may be present in patients with the indeterminate form. Right ventricular dysfunction may be detected early in the disease course, but in general, the clinical manifestations occur late at advanced stages of Chagas cardiomyopathy. Several echocardiographic parameters have been used to assess right ventricular function in Chagas disease, including qualitative evaluation, myocardial performance index, tissue Doppler imaging, tricuspid annular plane systolic excursion, and speckle tracking strain. Cardiac magnetic resonance (CMR) is useful to assess global and regional left ventricular function in patients with Chagas diseases. Myocardial fibrosis is a striking feature of Chagas cardiomyopathy and late gadolinium enhancement (LGE) is used to detect and quantify the extension of myocardial fibrosis. Myocardial fibrosis might have a role in risk stratification of patients with Chagas disease. Limited data are available regarding right ventricular function assessed by CMR in Chagas disease. Radionuclide ventriculography is used for global biventricular function assessment in patients with suspected or definite cardiac involvement in Chagas disease with suboptimal acoustic window and contraindication to CMR. Myocardial perfusion scintigraphy may improve risk stratification to define cardiac involvement in Chagas disease, especially in the patients with devices who cannot be submitted to CMR and in the clinical setting of Chagas patients whose main complaint is atypical chest pain. Detection of reversible ischemic defects predicts further deterioration of left ventricular systolic function and helps to avoid unnecessary cardiac catheterization and coronary angiography. Cardiac imaging is crucial to detect the cardiac involvement in patients with Chagas disease, stage the disease and stratify patient risk and address management. Unfortunately, most patients live in regions with limited access to imaging methods and point-of-care, simplified protocols, could improve the access of these remote populations to important information that could impact in the clinical management of the disease. Therefore, there are many fields for further research in cardiac imaging in Chagas disease. How to better provide an earlier diagnosis of cardiac involvement and improve patients risk stratification remains to be addressed using different images modalities.

The tombstone of an Ecumenical Patriarch in Muswell Hill, London: Meletios II (1700-80, r. 1768–9)

This article examines the tombstone of Meletios II, a native of Tenedos, who was briefly Ecumenical Patriarch in 1768–9. It also offers an account of his troubled patriarchate and sketches events in the rest of his ecclesiastical career. This hitherto unknown tombstone has rested for an indeterminate number of years in the garden of North Bank, a large Victorian mansion in Pages Lane in the North London suburb of Muswell Hill. It appears to have been in the grounds of North Bank before the house became an annexe of Muswell Hill Methodist Church. It is not known where in the Ottoman Empire Meletios' grave was originally situated, nor has it been possible to establish the circumstances in which the tombstone came to North Bank. On the basis of the inscription on the tombstone it is possible to establish Meletios' previously unknown date of death, 5 January 1780. It appears to be one of the earliest known tombstones of an Ecumenical Patriarch during the period of the Tourkokratia.

Finding binomials in polynomial ideals

We describe an algorithm which finds binomials in a given ideal Isubset mathbb {Q}[x_1,dots ,x_n] and in particular decides whether binomials exist in I at all. Binomials in polynomial ideals can be well hidden. For example, the lowest degree of a binomial cannot be bounded as a function of the number of indeterminates, the degree of the generators, or the Castelnuovo–Mumford regularity. We approach the detection problem by reduction to the Artinian case using tropical geometry. The Artinian case is solved with algorithms from computational number theory.

Marked Nominal Forms in Targum Malachi

The use of formally marked and unmarked nouns varies and has changed in Aramaic dialects throughout the course of history. Until recently, it was assumed that determination in nouns in Targum Prophets was no longer working properly since extant grammars do not point out specific rules of grammar and syntax in this regard. It has been argued that the marked form of the noun came to depose the unmarked form. However, a focused study on Targum Samuel by Renaud Kuty (2010) demonstrates that the retention or abandonment of determinate and indeterminate nominal forms functions according to two linguistic systems in this Targum. This contribution investigates the retention or abandonment of final long A in nominal forms in Targum Malachi by observing how marked and unmarked nominal forms appear in typical grammatical, syntactic, and semantic arrangements, and what the impact of discourse perspective is.

In Defence of the Actuality Principle

The thin red line theory is a form of branching indeterminism. It entails that, among the many possible developments that reality might take, one is privileged: the actual history (or ‘thin red line’). The thin red line theory is naturally paired off with a semantic thesis that may be called ‘the actuality principle’: a statement is true as used at a moment if and only if it is true at that moment on the actual history. The actuality principle has been challenged, for it would be wrong about several counterfactual reasonings. On the one hand, the actuality principle should entail that any statement uttered at a merely possible moment is untrue. On the other hand, the actuality principle should be at odds with the way we use subjunctive conditionals. This paper argues that both objections rely on an inadequate understanding of the notion of the history of use. As for the first objection, the paper argues that to assume the actuality principle amounts to taking the actual history as the history of use. As a consequence, one cannot consistently take the actual history as the history of use and, at the same time, a merely possible moment as the moment of use. As for the second objection, the paper shows that the actuality principle is consistent with any reasonable treatment of subjunctive conditionals.

Combined parasitological and molecular-based diagnostic tools improve the detection of Trypanosoma cruzi in single peripheral blood samples from patients with Chagas disease.

In order to detect Trypanosoma cruzi and determine the genetic profiles of the parasite during the chronic phase of Chagas disease (ChD), parasitological and molecular diagnostic methods were used to assess the blood of 91 patients without specific prior treatment. Blood samples were collected from 68 patients with cardiac ChD and 23 patients with an indeterminate form of ChD, followed by evaluation using blood culture and polymerase chain reaction. T . cruzi isolates were genotyped using three different genetic markers. Blood culture was positive in 54.9% of all patients, among which 60.3% had the cardiac form of ChD, and 39.1% the indeterminate form of ChD. There were no significant differences in blood culture positivity among patients with cardiac and indeterminate forms. Additionally, patient age and clinical forms did not influence blood culture results. Polymerase chain reaction (PCR) was positive in 98.9% of patients, although comparisons between blood culture and PCR results showed that the two techniques did not agree. Forty-two T . cruzi stocks were isolated, and TcII was detected in 95.2% of isolates. Additionally, one isolate corresponded to TcIII or TcIV, and another corresponded to TcV or TcVI. Blood culture and PCR were both effective for identifying T. cruzi using a single blood sample, and their association did not improve parasite detection. However, we were not able to establish an association between the clinical form of ChD and the genetic profile of the parasite.