Positive Serology For Chagas Disease Research Articles

Increased Natural Killer (NK)-cell cytotoxicity and Trypanosoma cruzi-specific memory B cells in subjects with discordant serology for Chagas disease

The presence of memory T cell specific for Trypanosoma cruzi in subjects with discordant serology for Chagas disease supports a cleared infection in these subjects. Using high-dimensional flow cytometry, ELISPOT assays and quantitative PCR, antibody-secreting cells and memory B cells specific for T. cruzi, total B-cell phenotypes, innate immune responses and parasite DNA were evaluated in serodiscordant, seropositive and seronegative subjects for T. cruzi infection. T. cruzi-specific memory B cells but no antibody-secreting cells specific for T. cruzi, increased proportion of nonclassical monocytes and increased levels of polyfunctional NK cells were found in serodiscordant compared with seropositive subjects. None of the serodiscordant subjects evaluated showed detectable parasite DNA, most of them did not show cardiac abnormalities and a group of them had had confirmed positive serology for Chagas disease. The unique immune profiles in serodiscordant subjects support that T. cruzi infection was cleared or profoundly controlled in these subjects.

Gastrointestinal Manifestations of Chagas Disease: A Systematic Review with Meta-Analysis.

The aims of this study were to estimate the prevalence of gastrointestinal manifestations among individuals with positive serology for Chagas disease (ChD) and to describe the clinical gastrointestinal manifestations of the disease. A systematic review with meta-analysis was conducted based on the criteria and recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PubMed, Scopus, Virtual Health Library, Web of Science, and Embase databases were used to search for evidence. Two reviewers independently selected eligible articles and extracted data. RStudio® software was used for the meta-analysis. For subgroup analysis, the studies were divided according to the origin of the individuals included: 1) individuals from health units were included in the health care service prevalence analysis, and 2) individuals from the general population were included in the population prevalence analysis. A total of 2,570 articles were identified, but after removal of duplicates and application of inclusion criteria, 24 articles were included and 21 were part of the meta-analysis. Most of the studies were conducted in Brazil. Radiological diagnosis was the most frequent method used to identify the gastrointestinal clinical form. The combined effect of meta-analysis studies showed a prevalence of gastrointestinal manifestations in individuals with ChD of 12% (95% CI, 8.0-17.0%). In subgroup analysis, the prevalence for studies involving health care services was 16% (95% CI, 11.0-23.0%), while the prevalence for population-based studies was 9% (95% CI, 5.0-15.0%). Megaesophagus and megacolon were the main forms of ChD presentation in the gastrointestinal form. The prevalence of gastrointestinal manifestations of ChD was 12%. Knowing the prevalence of ChD in its gastrointestinal form is an important step in planning health actions for these patients.

Abstract 12139: Left Ventricular Myocardial Work in Patients With Chagas Disease From a Quaternary Hospital in Brazil

Background: Left ventricular (LV) function assessment in patients (pts) with Chagas disease (ChD) is challenging. LV ejection fraction (LVEF) as a marker of myocardial contractility in these pts has issues, and alterations in myocardial deformation (MD) may occur in early stages of cardiac disease (CD) before the decline of LVEF. LV global longitudinal strain (GLS) is a good parameter to evaluate LV MD, but is dependent on afterload. LV myocardial work (MW) is a technique which integrates afterload to the calculation of GLS Purpose: To analyze LV function using MW in pts with ChD Methods: 39 pts with positive serology for ChD, (74,4% women, age 68,8 ± 9,7) followed in a quaternary Brazilian hospital, were divided in groups of stages of CD: G1 - normal Echocardiography (Echo) and ECG, G2 - alterations in ECG a/o Echo, normal LVEF, G3 - reduced LVEF. LV MW was measured integrating GLS with non-invasive blood pressure as an afterload index, for generation of pressure-strain loops by specific software(fig.1). Global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) were measured. Results: 11 pts (28,2%) were in G1, 14 (35,9%) in G2, and 14 (35,9%) in G3. In overall population median values of MW were within normal ranges: GWI = 1760mmHg% (>968), GCW = 2046mmHg% (>1550), GWW= 178mmHg% (<331), GWE = 92 (>83). Values of GWI, GCW and GWE were significantly lower and GWW was higher in G3, compared to G1 and G2, translating into less LV mechanical efficiency (ME) in these pts with more advanced CD (table 1). Despite LVEF and GLS similar between G1 and G2, values of GCW were 12% lower in G2 compared to G1, which could point to a tendency of early alterations in these pts, although not reaching statistical significance (p > 0,05). Conclusion: In pts with advanced stages with Chagas CD (G3) there were significant alterations in parameters that evaluate ME, with reduced values of GWI, GCW and GWE, with higher GWW

Prevalence and clinical course of patients with chronic heart failure secondary to chronic Chagas heart disease associated with obstructive coronary artery disease.

The prevalence and the outcomes of patients with chronic Chagas heart disease with obstructive coronary artery disease (CCHD-CAD) and chronic heart failure (CHF) with precordial chest pain are unsettled. Accordingly, the aim of this study was to determine the prevalence and clinical course of patients with CHF secondary to CCHD-CAD. Patients with positive serology for Chagas disease and systolic CHF were included; those with precordial chest pain and at least two risk factors for CAD underwent coronary arteriogram. In total 262 patients were included in the investigation; 234 (89%) had CHF secondary to CCHD alone, and 28 (11%) with CHF secondary to CCHD-CAD, as observed at coronary arteriogram. The survival probability of patients with CHF secondary to CCHD alone at 12, 24, 36, 48 and 72 mo was 79%, 64%, 54%, 44% and 33%, respectively, whereas survival probability for patients with CHF secondary to CCHD-CAD at 12, 24, 36, 48 and 72 mo was 96%, 80%, 71%, 66% and 57%, respectively (p=0.04). In patients with CCHD with CHF, the prevalence of CAD of 11% is not neglectable in those with precordial chest pain. The outcome for patients with precordial chest pain with CHF secondary to CCHD-CAD is better than that observed in patients with CHF secondary to CCHD alone.

240.8: Outcomes of Kidney Transplantation in Recipients Exposed to the Risk of Chagas Disease Reactivation

Introduction: Chagas disease (CD) affects approximately eight million people worldwide, implying that, in the endemic regions, a large number of donors/recipients are exposed to contaminated organs. Symptoms range varies from asymptomatic to severe cardiac and digestive complications. Therefore screening is vital since immunosuppression predisposes to disease activation. Method: A retrospective uncontrolled cohort study with renal transplant recipients (RTR), performed between 2012 and 2020, with recipients with positive serology for Chagas disease (R+), donors with positive serology (D+), or both positive (D+ and R+). Patients were identified by reviewing medical records or dispensing Benznidazole used in the postoperative period. Patients were monitored for CD recurrence by parasitemia, serology, and PCR. Results: Fifty-three deceased donor KTR were included, 36 men (67.9%), 51 caucasoid (96.2%), with a mean age of 53.9±12.4 years. The cause of renal failure was from undetermined etiology in 17 patients (32%), diabetic nephropathy in 10 patients (18.8%), and hypertension in 9 patients (16.9%). In all transplants, there was a positive serology for CD. There were 40 positive donors (75%) nine positive recipients (16%), ad in four cases, both the donor and the recipient were seropositive. All patients received post-transplant prophylaxis with benznidazole at a 100–500 mg/day dose for 4-90 days (median for 22 days). One patient presented urticaria and angioedema as an adverse event determining early benznidazole discontinuation. The most commonly used initial immunosuppressive regimen was thymoglobulin (ATG), sodium mycophenolate (MFS), and methylprednisolone in 25 patients (47.1%), and 40 patients (75.4%) received a regimen containing ATG. The maintenance immunosuppression consisted of MFS, tacrolimus, and prednisone in 51 patients (98%). The incidence of acute rejection in the first year after transplantation was 11% (six cases). No cases of Chagas disease reactivation occurred. Patient and graft survival rates were 75% and 81%, respectively, five years after grafting. Conclusions: Chagas disease-positive serology, either in the donor, in the recipient, or both, in KTR receiving benznidazole prophylaxis, allowed more patients to be transplanted. The primary transplant outcomes were similar to those observed in KTR not exposed to Chagas disease.

Seroprevalence of Trypanosoma cruzi infection in blood donors in the extreme South of Brazil.

ABSTRACTBackground: We aimed to evaluate the seroprevalence of Chagas disease among blood donors in southern Rio Grande do Sul, Brazil. Methods: The study was conducted from 2010 to 2019 based on data registered by the Hemocentro Regional de Pelotas, Rio Grande do Sul. Results: There were 106,320 blood donations, and the discard rate of blood bags, either due to positive reactions to anti-T. cruzi antibodies or inconclusive results was 0.27% (283 bags). Conclusions: The usage of methods that enable the safe identification of donors with positive serology for Chagas disease is fundamental to ensure transfusional safety.

Asociación entre interleuquinas inflamatorias y la presencia de trastornos intraventriculares de la conducción en pacientes con serología positiva para enfermedad de Chagas y función ventricular conservada

Background: Intraventricular conduction disturbances are common in patients with Chagas disease and preserved left ventricular ejection fraction, but their association with higher inflammatory activity is unknown. Objectives: The aim of this study was to determine the presence of an association between interleukin levels and intraventricular conduction disturbances in patients with positive serology for Chagas disease and preserved left ventricular function. Methods: Twenty-two patients between 22 and 80 years of age with positive serology test for Chagas disease with more than 20 years progression and left ventricular ejection fraction ≥50% were included in the study and compared with a control group of 14 healthy individuals. Plasma levels of IFN-γ, IL-1β, IL-6, IL-10, IL-12 (p70), IL-15, IL-17A, MCP-1/CCL2, MIP-1 a/CCL3, TNF-a and IL-2 were measured in patients and controls. Right bundle branch block, left anterior hemiblock or left bundle branch block were considered intraventricular conduction disturbances. Results: Among the 22 patients with positive serology for Chagas disease, 10 presented intraventricular conduction disturbances (45.4%). This group had elevated levels of interleukins with high inflammatory effect such as INF-γ, IL-15, IL-2, IL-12, MIP-1 α, compared with the control group, and high levels of IL-10 as a regulatory mechanism of an excessive immune response. Conclusions: The association between elevated levels of inflammatory interleukins and intraventricular conduction disturbances suggests that chronic inflammation may play a role in the development of these abnormalities in patients with positive serology for Chagas disease and preserved left ventricular ejection function.

Seroprevalencia de chagas y toxoplasmosis en pacientes con enfermedades reumatológicas. Informe preliminar

Introduction: The use of biological therapy has been associated with an increased risk for different types of infections. In this sense, the development of strategies for prevention and treatment of infections in patients with rheumatic diseases with biological therapy is essential. Currently there is little information on the seroprevalence of Chagas disease (CD) and toxoplasmosis in patients with rheumatic diseases. Objective: To analyze the seroprevalence of CD and toxoplasmosis in patients with rheumatic diseases in plans to start BT. Methodology: Retrospective study of patients with rheumatic diseases whit criteria to start a BT in the Rheumatology Service of the IPS Central Hospital. Clinical, epidemiological, serological and treatment-related variables were recorded. The frequency of positive serology for CD and toxoplasmosis was analyzed and the association with the collected variables was studied. Results: 228 patients were included (RA = 176, Sp = 43, Collagenopathy = 9), 74.6% were women with a mean age of 46.2 years. Chagas seroprevalence was 2.9% and toxoplasmosis 63.1%. No significant associations were identified with the analyzed variables. Conclusion: The seroprevalence of toxoplasmosis and Chagas disease was similar to that described in studies of the general population of our country and the region, so it is important to always keep them in mind especially in developing countries.1Q In the present study, a reactivation of the disease after the onset of BT was not found.

Kinins and nitric oxide in patients with chronic chagas disease and systemic arterial hypertension

BackgroundChronic Chagas disease (CCHD) associated with Systemic Arterial Hypertension (SAH) is frequently found in areas where the disease is endemic. The pathogenesis of patients with both pathologies (CCHD-SAH) is unsettled. Nitric Oxide (NO) and Kinins are important players in the myocardial inflammation process in experimental CCHD. No previous study has addressed this question in patients with CCHD, particularly in those with CCHD-SAH. Accordingly, this study was undertaken in an attempt to contribute to the understanding of the pathogenesis of patients with CCHD-SAH. MethodsThirty-seven patients with a positive serology for Chagas disease were enrolled; 15 had CCHD alone, 22 had CCHD-SAH (abnormal ECG/Doppler echocardiogram plus a systolic blood pressure > 140 mmHg or diastolic blood pressure > 90 mmHg on admission), and 11 had SAH alone. Thirty healthy individuals matched by age and sex served as controls. Plasma High-molecular (Hkg) and low-molecular weight (LKg) kininogens, plasma kallikrein levels (Pkal and Tcal), Kininase II, and plasma NO were measured. ResultsHKg and LKg were lower in CCHD-SAH patients in comparison with other groups (P < .0001). Pkal and Tcal were higher in CCHD-SAH patients in comparison with the other groups (P< .0001). Kininase II levels were similar in SAH, CCHD, and CCHD-SAH patients, but lower in comparison with controls (P< .0001). NO levels were similar in CCHD and CCHD-SAH patients, but higher in comparison with SAH patients and controls (P > .0001). ConclusionSuch findings suggest increased Kinin and NO activity in patients with CCHD-SAH, thus contributing to the understanding of the pathogenesis of this condition.

Influence of Angiotensin-converting Enzyme Insertion/Deletion Gene Polymorphism in Progression of Chagas Heart Disease.

INTRODUCTION: Chagas disease (CD) is a neglected disease caused by the parasite Trypanosoma cruzi. One-third of infected patients will develop the cardiac form, which may progress to heart failure (HF). However, the factors that determine disease progression remain unclear. Increased angiotensin II activity is a key player in the pathophysiology of HF. A functional polymorphism of the angiotensin-converting enzyme (ACE) gene is associated with plasma enzyme activity. In CD, ACE inhibitors have beneficial effects supporting the use of this treatment in chagasic cardiomyopathy. METHODS: We evaluated the association of ACE I/D polymorphism with HF, performing a case-control study encompassing 343 patients with positive serology for CD staged as non-cardiomyopathy (stage A; 100), mild (stage B1; 144), and severe (stage C; 99) forms of Chagas heart disease. For ACE I/D genotyping by PCR, groups were compared using unconditional logistic regression analysis and adjusted for nongenetic covariates: age, sex, and trypanocidal treatment. RESULTS: A marginal, but not significant (p=0.06) higher prevalence of ACE I/D polymorphism was observed in patients in stage C compared with patients in stage A. Patients in stage C (CD with HF), were compared with patients in stages A and B1 combined into one group (CD without HF); DD genotype/D carriers were prevalent in the HF patients (OR = 2; CI = 1.013.96; p = 0.04). CONCLUSIONS: Our results of this cohort study, comprising a population from the Northeast region of Brazil, suggest that ACE I/D polymorphism is more prevalent in the cardiac form of Chagas disease with HF.

Clinical and manometric investigation in constipated Chagasic patients with and without megacolon

BackgroundChagasic colopathy is the second most common digestive manifestation, and constipation is the main symptom. The absence of the Rectoanal Inhibitory Reflex plays an important role in constipation and anal manometry is crucial for appropriate evaluation. PurposeEvaluate anal manometry findings (mainly Rectoanal Inhibitory Reflex) in Chagasic patients with chronic constipation, with and without megacolon and correlate these findings with clinical and demographic data. MethodsCross-sectional study of patients with chronic constipation who underwent Chagasic serologic test, barium enema, and anal manometry. The absence of Rectoanal Inhibitory Reflex was evaluated using the mid-P Exact Test. Results64 Patients were included: 23 Chagasic patients with megacolon/megarectum (G1), 21 Chagasic patients without megacolon/megarectum (G2) and 20 non-Chagasic patients without megacolon/megarectum (G3). Chagasic patients with megacolon had a higher incidence of fecaloma (39%) compared to the other two groups (9.5% and 10% for G2 and G3, respectively, p=0.03). Rectal capacity on manometry was statically higher for G1 patients. Rectoanal Inhibitory Reflex was absent in 91.3% of patients in G1, 47.29% in G2 and present in all patients in G3. There was a significant difference in the absence of the Rectoanal Inhibitory Reflex when comparing the groups (G1 vs. G2: p=0.002, G1 vs. G3: p<0.001, G2 vs. G3: p<0.001). ConclusionThe absence of RAIR confirms the diagnosis of Chagasic colopathy and endorses surgical treatment whenever clinical treatment fails. The presence of the RAIR in patients with positive serology for Chagas disease without megacolon/megarectum might not be due chagasic colopathy and other causes should be considered.

Lost opportunities in Congenital Chagas disease: retrospective study in a high complexity hospital of La Plata city

Background: Congenital Chagas disease causes high morbimortality in new-borns. Timely diagnosis is of upmost importance, since treatment is highly effective in curing the disease. Methods & Materials: Retrospective, observational study. Clinical records were collected from pregnant patients with positive serology for Chagas disease, and from their children born at the maternity of the General Hospital “General San Martín” between 2011 and 2016. A diagnosis of Chagas disease was considered in the pregnant woman when two methods resulted reactive (being one of them ELISA or IIF). A diagnosis of congenital Chagas disease was considered after the direct detection of the parasite in blood of an infant under 10 months of age, using a parasitological micromethod. In negative cases, and those older than 10 months, it was considered congenital Chagas disease when two serological methods resulted positive (one of them being ELISA or IIF). Results: 55 mother–son binomials were analysed. 54.3% of the mothers were born in Bolivia (30/55), 30.9% were born in Argentina (17/55) and 14.5% were born in Paraguay (8/55). 3.6% (2/55) of the mothers recounted a history of transfusion of blood products. Serological diagnosis in the mother was attained before pregnancy in 47.3% (26/55), during the first trimester in 5.5% (3/55), in the second trimester in 38.2% (21/55) and in the third trimester in 9.1% (5/55%). 96.4% of the new-borns from women with Chagas disease were asymptomatic at birth (53/55) and 3.6% were symptomatic (2/55). The symptom identified was low birth weight. A microstrout assay was performed in 65.5% (36/55) of newborns, with 2.7% (1/36) of positive results. Follow-up with serological tests was performed in merely 18.2% (10/55) of the children, with negative results. Conclusion: With the data analysed we infer that follow-up of children under the year of age is deficient, with lost opportunities in early diagnosis and prompt treatment and thus cure of the disease. Given the small number of patients and lost data from clinical charts, the incidence of congenital Chagas disease could not be estimated.

Wide QRS complex tachycardia in patients with Chagas’ disease: Sustained ventricular tachycardia until proven otherwise

Algorithms used for the differential diagnosis of wide QRS complex tachycardia are extremely important in clinical practice, but they have limitations and should be applied with caution. We describe a case of a patient with positive serology for Chagas disease and normal echocardiogram who presented an episode of wide QRS complex tachycardia. It was initially diagnosed as sustained ventricular tachycardia using the Brugada and Vereckei algorithms and it was sent to the reference service for the implant of a cardioverter defibrillator. However, the clinical history, electrocardiogram in sinus rhythm and the electrophysiological study were fundamental to the correct diagnosis and treatment of a posterolateral atrioventricular accessory pathway.

Reporting of adverse reactions to benznidazole: does medical expertise matter?

ABSTRACTThis study evaluated and compared follow-up and adverse drug reaction (ADR) reporting for Chagas disease (CD) patients treated with benznidazole (BZN) by two health teams with different levels of experience, using medical records for 204 patients participating in the first year of a scaled-up public health program for CD case detection and treatment conducted at all 46 primary health care centers in La Plata district, Buenos Aires, Argentina, in 2014. Both teams were experienced in CD patient management and trained in BZN administration, and included senior physicians, but one team had no experience in administering BZN while the other team had three years of experience due to their participation in the program's pilot project. Patients with positive serology for CD were treated with 5 mg/kg/day of BZN for 60 days. Patients’ median age was 35 years and 84.3% were female. There was a statistically significant difference in the number of ADRs reported by the experienced versus the inexperienced health teams (18 versus 44 respectively; P < 0.001). Health team experience in administering BZN to CD patients, and treatment duration, were significantly associated with reporting of ADRs (adjusted odds ratios (aORs) 0.340 (95% confidence interval (CI): 0.177–0.652) and 0.967 (CI: 0.942–0.993) respectively). ADR reporting increased with patient age, occurring at the highest frequency (42.9%) in people 50+ years old. All treatment discontinuations (nine) occurred in patients followed up by the inexperienced health team. Level of experience in BZN administration to CD patients was significantly and inversely associated with frequency of ADR reports: inexperienced health team members tended to report more.

Extracellular Traps and Co-Stimulatory Molecules in Leukocytes of Patients with Positive Serology for Chagas Disease

Extracellular Traps and Co-Stimulatory Molecules in Leukocytes of Patients with Positive Serology for Chagas Disease

Human Neutrophils in Patients with Positive Serology for Chagas Disease

Human Neutrophils in Patients with Positive Serology for Chagas Disease

PREVALENCE OF CHAGAS DISEASE AMONG BLOOD DONOR CANDIDATES IN TRIANGULO MINEIRO, MINAS GERAIS STATE, BRAZIL.

Despite public health campaigns and epidemiological surveillance activities, Chagas disease remains a major health problem in Latin America. According to data from the World Health Organization, there are approximately 7-8 million people infected with Trypanosoma cruzi worldwide, a large percentage of which in Latin America. This study aims to examine the serological profile of blood donors in blood banks of Hemominas hematology center, in the town of Ituiutaba, Minas Gerais State, Brazil. The study sample consisted of 53,941 blood donors, which were grouped according to gender and age. Sample collections were performed from January 1991 to December 2011, and 277 donors (0.5%) were considered serologically ineligible due to Chagas disease. Analysis of data showed no significant difference between genders. As for age, the highest proportion of ineligible donors was from 40 to 49 years (30%), and there was a positive correlation between increasing age and the percentage of patients seropositive for Chagas disease. Therefore, adopting strategies that allow the safe identification of donors with positive serology for Chagas disease is essential to reduce or eliminate indeterminate serological results.

The Prevalence of Atrial Fibrillation and Conduction Abnormalities in Chagas' Disease: A Meta-Analysis.

Chagas' disease (CD) has been associated with atrial fibrillation (AF) and electrocardiographic (ECG) conduction defects. However, prior studies have shown conflicting results. We performed a meta-analysis comparing the prevalence of AF and conduction abnormalities between CD and non-CD patients. PubMed, EMBASE, Cochrane Central, and Latin American databases were searched for studies that directly compared the prevalence of AF and conduction defects in CD and non-CD patients. Odds ratios (OR) were computed using random-effects model due to anticipated heterogeneity. We further performed subanalyses limited to studies that included only patients with cardiomyopathy. A total of 17,238 patients from 30 studies were included, of whom 6,840 (40%) had a positive serology for CD. In the pooled data, AF was significantly more prevalent in the CD group (OR 1.62; 95%CI 1.21-2.15; P = 0.001). However, no significant difference was observed between groups when the analysis included only patients with cardiomyopathy (OR 1.21; 95%CI 0.97-1.50; P = 0.08) or heart failure (OR 1.09; 95%CI 0.81-1.47; P = 0.55). The combination of right bundle branch block (RBBB) and left anterior fascicular block (LAFB) had the highest OR for increased prevalence in patients with Chagas' cardiomyopathy compared to non-CD etiologies (OR 5.31; 95%CI 1.23-22.86; P = 0.03). Our meta-analysis suggests that the prevalence of AF in patients with Chagas' cardiomyopathy is not significantly different from non-CD cardiomyopathies. The pattern of RBBB and LAFB in patients with cardiomyopathy of unknown etiology and epidemiologic risk factors should raise the possibility of CD and prompt specific diagnostic testing.

Hyponatremia in Chagas disease heart failure: Prevalence, clinical characteristics, and prognostic importance

BackgroundThe prevalence, the clinical characteristics and the impact of hyponatremia on the prognosis of patients with chronic heart failure secondary to Chagas cardiomyopathy is unknown. MethodsAll patients with positive serology for Chagas disease and a left ventricular ejection fraction <55% on echocardiography routinely followed at the cardiomyopathy service of the university hospital from January, 2000 to December, 2008 were screened. The work-up consisted of anamnesis, physical examination, standard laboratory tests, 12-lead resting ECG, and 2-D echocardiography. Hyponatremia was defined as serum sodium levels <135mEq/L. Results246 patients were entered in the study; 30 (12%) patients were found to have hyponatremia. A multivariate stepwise logistic regression analysis revealed that the need of inotropic support [hazard ratio (HR)=2.97; 95% Confidence Interval (CI) 1.24 to 7,18; p=0.01], left ventricular systolic diameter (HR=1.05; 95% CI 1.0 to 1.1, p=0.03), and diastolic blood pressure (HR: 0,96; 95% CI 0,92 to 0,99; p=0.04) were independent predictors of hyponatremia. A Cox regression analysis showed that the need of inotropic support (HR=1,84; 95% CI 1,24 to 2,72; p=0,0002), hyponatremia (HR=2,05; 95% CI 1,25 to 3,38; p=0.005), Betablocker therapy (hazard ratio=0,33; 95% Confidence Interval 0,22 to 0,50; p<0,0005), and digoxin use (HR=2,79; 95% CI 1,42 to 5,46; p=0003) were independent predictors of all-cause mortality. ConclusionHyponatremia is an independent predictor of all-cause mortality of patients with chronic heart failure secondary to Chagas cardiomyopathy in the contemporary era of syndrome management. Hyponatremia can be predicted by variables consistent with syndrome severity.

Endoscopic and histopathologic gastric changes in chronic users of proton-pump inhibitors.

Proton-pump inhibitors have been used for at least two decades. They are among the most commonly sold drugs in the world. However, some controversy remains about the indications for their use and the consequences of their prolonged use. To evaluate and compare the endoscopic and histopathologic gastric changes in chronic users of proton-pump inhibitors to changes in non-users. A prospective study performed at a tertiary Public Hospital involving 105 patients undergoing upper-gastrointestinal endoscopy. Subjects included 81 proton-pump inhibitor users and 24 non-users (control group). Biopsies of the antral-type mucosa, the antral-fundic transition, and the fundus were evaluated by the Sydney System. The presence of erosion or ulceration, lymphatic follicles, reactive gastropathy, and polypoid or epithelial hyperplasia was also determined. Serum levels of gastrin were measured. We found two polyps, one in each group, both of which were negative for Helicobacter pylori. There were two cases of parietal cell hyperplasia in users of proton-pump inhibitors. Gastrin was elevated in 28 users of proton-pump inhibitors and in four members of the control group. We did not find statistically significant differences in the endoscopic or histopathologic findings between the two groups. Chronic use of proton-pump inhibitors for the duration examined was not associated with significant gastric changes. An interesting finding was that the 4 chronic users of proton-pump inhibitors who had serum gastrin levels above 500 pg/mL also had positive serology for Chagas disease.