The Southern Cone Initiative against Chagas Disease

Schofield, Christopher J.; Dias, João Carlos Pinto

doi:10.1016/s0065-308x(08)60147-5

Cited by 242 publications

(159 citation statements)

References 29 publications

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“…Although the incidence of new cases of Chagas' disease has fallen close to zero after the successful control of the vector transmission (Schofield and Dias, 1998), it remains a large group of chronically infected individuals, the majority in the indeterminate form of the disease, which is emerging as one of the great focuses of interest (Oliveira et al, 1986;Dias, 1989;Ribeiro and Rocha, 1998;Macêdo, 1999). This form ever shows intriguing pathological, functional, clinical, and epidemiological aspects, incorporating several unsolved or controversial questions, one of which is concerned with the cardiac sinus node autonomic modulation.…”

Section: Discussionmentioning

confidence: 99%

Impaired autonomic control of heart interval changes to Valsalva manoeuvre in Chagas' disease without overt manifestation

Soares

2002

Autonomic Neuroscience

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Background: In the apparent indeterminate form of Chagas' disease, which lacks any overt clinical, electrocardiographic, and radiological manifestations of organ damage, lesions of the intrinsic autonomic innervation of heart are not striking features and evidences for cardiac autonomic dysfunction are elusive and conflicting. Objective: To evaluate the cardiac autonomic modulation based on Valsalva manoeuvreassociated heart interval variation in Chagas' disease subjects with apparent indeterminate form. Subjects and methods: We examined 36 outpatient volunteers aged 15 -51 years old (median: 36.5), in comparison with 52 healthy control individuals aged 17 -49 years old (median: 29) ( p < 0.001). Each subject sequentially performed in the supine position three to four manoeuvres at an intra-oral pressure of 40 mm Hg during 20 s, under continuous DII lead electrocardiographic registration, and rate-and time-dependent indices of Valsalva manoeuvre-associated R -R interval variation were obtained. The t-test or the Mann -Whitney test was employed to compare the data between the groups. Results: No correlation was found between every index and age for the control group ( p = 0.39 -0.71). The chagasic group presented similar basal to phase IV median increment (relative bradycardia) (23.7% vs. 22.7%; p = 0.63) and smaller basal to phase III median decrement of R -R interval (relative tachycardia) ( À 31.7% vs. À 35%; p = 0.02) in comparison to the control group, respectively. The median Valsalva ratio showed a tendency for reduction in chagasics (1.78 vs. 1.90; p = 0.08). Prolonged median time (14.2 vs. 10.3 s; p < 0.001) and slowed median velocity (5.1%/s vs. 8.9%/s; p < 0.001) of the phases III -IV bradycardia were also observed in chagasic group. The majority (58.3%) of the chagasics presented exclusively at least one depressed, and 8.3% presented at least one enhanced index of rateand/or time-dependent heart interval responses beyond the 25th or 75th control percentiles, and 27.8% presented at least one depressed and other enhanced index, while 5.6% showed all indices within the control interquartile range. All the indices outside the 25th or 75th control percentiles were noted in 13.9% of chagasics. Conclusion: Chagas' disease subjects without overt manifestations presented variable and subtle depression and less frequent enhancement or normality of the rate-and time-dependent tachycardia and bradycardia reflex responses related to Valsalva manoeuvre, which demonstrates distinct patterns of finely disturbed cardiac sinus parasympathetic and sympathetic modulation, probably due to inflammatory or autoimmunological damage of intrinsic innervation and/or to autoantibodies-induced derangement in neurotransmitter receptors. D

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Section: Discussionmentioning

confidence: 99%

Impaired autonomic control of heart interval changes to Valsalva manoeuvre in Chagas' disease without overt manifestation

Soares

2002

Autonomic Neuroscience

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“…Entretanto, a análise dos relatórios de atividade da Fundação Nacional de Saúde expressa que, nesta região, o trabalho não alcançou os índices de continuidade e contigüidade que definiram este programa em outras áreas, nas quais se logrou a interrupção da transmissão vetorial e a dramática redução na distribuição do Triatoma infestans, que correspondia ao principal vetor nestas áreas (Dias & Schofield, 1999). Por conseguinte, ao iniciarmos uma avaliação acerca de aspectos operacionais no controle do T. brasiliensis, é fundamental a extrapolação para um contexto que transcende os fenômenos biológicos, podendo ser bastante limitado por aspectos políticos e de distribuição dos recursos na área de saúde.…”

Section: Discussionunclassified

Aspectos operacionais do controle do Triatoma brasiliensis

et al. 2000

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“…In addition, the prevalence of T. cruzi infection is also decreasing amongst blood donors and women of child-bearing age, bringing corresponding reductions in the risk of transfusional and congenital transmission (Dias 1997). Table III, from the official reports of Southern Cone Initiative, shows the reduction of seropositivity over the last few years (WHO 1997, Schofield & Dias 1999.…”

Section: Vector Controlmentioning

confidence: 99%

“…Nevertheless four other challenges emerge for the new century: (a) to maintain political decision (and naturally the necessary resources) in those regions where the disease impact fallen down; (b) to face objectively the irreversible tendency to centralization. In other words, to maintain minimum central and regional reference structures in order to improve the efficacy and continuity of finalistic activities at the peripheral level; (c) to control secondary and ubiquitous species at the peri-domestic level, and, (d) to maintain a high and permanent degree of community participation in order to improve a continuous epidemiological surveillance (Dias 1987, Schofield & Dias 1999). …”

Section: Vector Controlmentioning

confidence: 99%

“…In order to have a general and chronologic comprehension of the facts appointed above, the following picture was prepared, showing the considered most relevant facts concerning to the control of human Chagas disease, since its discovery and according to the consensus of the majority of the authors (Dias 1988, Coura 1997, Schofield & Dias 1999 …”

Section: Summary Of the Principal Events Related To Human Chagas Disementioning

confidence: 99%

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The evolution of Chagas disease (American Trypanosomiasis) control after 90 years since Carlos Chagas discovery

Dias

Schofield

1999

Mem. Inst. Oswaldo Cruz

136

123

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The Southern Cone Initiative against Chagas Disease

Cited by 242 publications

References 29 publications

Impaired autonomic control of heart interval changes to Valsalva manoeuvre in Chagas' disease without overt manifestation

Impaired autonomic control of heart interval changes to Valsalva manoeuvre in Chagas' disease without overt manifestation

Aspectos operacionais do controle do Triatoma brasiliensis

The evolution of Chagas disease (American Trypanosomiasis) control after 90 years since Carlos Chagas discovery

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