Functional capacity in Chagas disease

Ribeiro, Antônio Luiz Pinho

doi:10.1590/0037-8682-0324-2018

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…Chagas disease persists as an important and neglected cause of loss of years of healthy life due to premature mortality and disability 57 ; furthermore, robust clinical trials are scarce in Chagas disease and the recommendations are often based on guidelines for other cardiopathies 58,59 .…”

Section: Current Challengesmentioning

confidence: 99%

Exercise tests in Chagas cardiomyopathy: an overview of functional evaluation, prognostic significance, and current challenges

Costa

Lima

et al. 2020

Rev. Soc. Bras. Med. Trop.

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Patients with Chagas cardiomyopathy (ChC) usually progress with fatigue and dyspnea. Exercise tests are valuable for the functional evaluation of these patients. However, information about the applicability of the exercise tests is scattered, and no studies have systematically reviewed the results. Thus, the present review explored the general aspects and prognostic value of exercise tests in patients with ChC. A literature search of the MEDLINE, Web of Science, CINAHL, Scopus, and LILACS databases was performed to identify relevant studies. There were no data restrictions, and articles that met the objective of the study were selected. Articles written in English, Portuguese, and Spanish were considered, and 25 articles were finally included. The peak oxygen uptake (VO2peak) was correlated with demographic and echocardiographic variables. Echocardiographic features of the left ventricular diastolic function and right ventricular systolic function appeared to be determinants of functional capacity, in addition to age and sex. VO2peak was associated with higher mortality, especially in patients with dilated ChC. The minute ventilation/carbon dioxide production slope (VE/VCO2 slope) was a strong predictor of survival; however, more studies are needed to verify this observation. Field tests showed moderate to strong correlation with VO2peak and thus may be inexpensive tools for the functional evaluation of patients with ChC. However, few studies have verified their prognostic significance. While exercise tests are useful tools for functional assessment, information is scarce regarding further considerations, and many of the criteria are based on guidelines for other heart diseases.

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Section: Current Challengesmentioning

confidence: 99%

Exercise tests in Chagas cardiomyopathy: an overview of functional evaluation, prognostic significance, and current challenges

Costa

Lima

et al. 2020

Rev. Soc. Bras. Med. Trop.

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“…[1][2][3] According to the World Health Organization, about eight million people worldwide are affected by this pathology, and the majority of individuals live in Latin America. 1,4,5 The disease occurs in two phases: the acute and chronic phases. The early phase of the pathology can be lethal in many cases, with intense parasite multiplication and cell invasion.…”

Section: Introductionmentioning

confidence: 99%

Stability Indicating Method for Determination of Benznidazole and Its Degradation Products in Active Pharmaceutical Ingredient

Kawaguchi¹,

Fachi²,

Cerqueira³

et al. 2020

J. Braz. Chem. Soc.

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Currently, treatment of Chagas disease is restricted to the use of benznidazole and nifurtimox; however, nifurtimox was temporarily suspended in some countries. Based on the limitations in pharmacological treatments, it is essential to guarantee the quality of benznidazole. Therefore, this work aimed to identify the degradation products of benznidazole and to validate a stability indicating method. The stability test was performed through a forced degradation study, exposing benznidazole under a range of conditions. Benznidazole proved to be unstable under acidic and alkaline conditions, and three products were identified by liquid chromatography coupled to a hybrid quadrupole time-of-flight mass spectrometer (UPLC-QTOF-MS). Furthermore, a stability indicating method by high performance liquid chromatography with a diode array detector (HPLC-DAD) for benznidazole was developed and validated according to ICH (International Conference on Harmonisation) and ANVISA (Agência Nacional de Vigilância Sanitária) guidelines. The method was linear (180-420 µg mL-1 range), selective in the presence of degradation products, precise (relative standard deviation (RSD) < 0.6%), accurate (recovery > 99.2%), robust, and free of matrix effects. The method was successfully able to quantify the benznidazole in pharmaceutical formulations.

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“…Chagas disease is a tropical neglected infection caused by the protozoan parasite Trypanosoma cruzi (Lara et al ., 2018; Ribeiro et al ., 2018). About 6–7 million people are infected by T. cruzi worldwide, mainly in Latin American countries, where the disease is a public health problem and at least 25 million people are at risk of infection (WHO, 2018).…”

Section: Introductionmentioning

confidence: 99%

Could angiotensin-modulating drugs be relevant for the treatment of Trypanosoma cruzi infection? A systematic review of preclinical and clinical evidence

et al. 2019

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Although leucocytes are targets of renin-angiotensin system (RAS) effector molecules and RAS-modulating drugs exert immunomodulatory effects, their impact on Trypanosoma cruzi infection remains poorly understood. By using the framework of a systematic review, we integrated the preclinical and clinical evidence to investigate the relevance of angiotensin-inhibiting drugs on T. cruzi infections. From a comprehensive and structured search in biomedical databases, only original studies were analysed. In preclinical and clinical studies, captopril, enalapril and losartan were RAS-modulating drugs used. The main in vitro findings indicated that these drugs increased parasite uptake per host cells, IL-12 expression by infected dendritic cells and IFN-γ by T lymphocytes, in addition to attenuating IL-10 and IL-17 production by CD8 + T cells. In animal models, reduced parasitaemia, tissue parasitism, leucocytes infiltration and mortality were often observed in T. cruzi-infected animals receiving RAS-modulating drugs. In patients with Chagas’ disease, these drugs exerted a controversial impact on cytokine and hormone levels, and a limited effect on cardiovascular function. Considering a detailed evaluation of reporting and methodological quality, the current preclinical and clinical evidence is at high risk of bias, and we hope that our critical analysis will be useful in mitigating the risk of bias in further studies.

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Functional capacity in Chagas disease

Cited by 3 publications

References 19 publications

Exercise tests in Chagas cardiomyopathy: an overview of functional evaluation, prognostic significance, and current challenges

Exercise tests in Chagas cardiomyopathy: an overview of functional evaluation, prognostic significance, and current challenges

Stability Indicating Method for Determination of Benznidazole and Its Degradation Products in Active Pharmaceutical Ingredient

Could angiotensin-modulating drugs be relevant for the treatment of Trypanosoma cruzi infection? A systematic review of preclinical and clinical evidence

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