2 nd Brazilian Consensus on Chagas Disease, 2015

Abstract Chagas disease is a neglected chronic condition with a high burden of morbidity and mortality. It has considerable psychological, social, and economic impacts. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on the articulation and strategic contribution of renowned Brazilian experts with knowledge and experience on various aspects of the disease. It is the result of a close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. It is hoped that this document will strengthen the development of integrated actions against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research

Epidemiology of mortality related to Chagas' disease in Brazil, 1999-2007

Background: Chagas' disease is an important neglected public health problem in many Latin American countries, but population-based epidemiological data are scarce. Here we present a nationwide analysis on Chagas-associated mortality, and risk factors for death from this disease.\ud \ud Methodology/Principal Findings: We analyzed all death certificates of individuals who died between 1999 and 2007 in Brazil, based on the nationwide Mortality Information System (a total of 243 data sets with about 9 million entries). Chagas' disease was mentioned in 53,930 (0.6%) of death certificates, with 44,537 (82.6%) as an underlying cause and 9,387 (17.4%) as an associated cause of death. Acute Chagas' disease was responsible for 2.8% of deaths. The mean standardized mortality rate was 3.36/100.000 inhabitants/year. Nationwide standardized mortality rates reduced gradually, from 3.78 (1999) to 2.78 (2007) deaths/year per 100,000 inhabitants (-26.4%). Standardized mortality rates were highest in the Central-West region, ranging from 15.23 in 1999 to 9.46 in 2007 (-37.9%), with a significant negative linear trend (p = 0.001; R-2 = 82%). Proportional mortality considering multiple causes of death was 0.60%. The Central-West showed highest proportional mortality among regions (2.17%), with a significant linear negative trend, from 2.28% to 1.90% (-19.5%; p = 0.001; R-2 = 84%). There was a significant increase in the Northeast of 38.5% (p = 0.006; R-2 = 82%). Bivariable analysis on risk factors for death from Chagas' disease showed highest relative risks (RR) in older age groups (RR: 10.03; 95% CI: 9.40-10.70; p<0.001) and those residing in the Central-West region (RR: 15.01; 95% CI: 3.90-16.22; p<0.001). In logistic regression analysis, age >= 30 years (adjusted OR: 10.81; 95% CI: 10.03-10.65; p<0.001) and residence in one of the three high risk states Minas Gerais, Goias or the Federal District (adjusted OR: 5.12; 95% CI: 5.03-5.22, p<0.001) maintained important independent risk factors for death by Chagas' disease.\ud \ud Conclusions/Significance: This is the first nationwide population-based study on Chagas mortality in Brazil, considering multiple causes of death. Despite the decline of mortality associated with Chagas' disease in Brazil, the disease remains a serious public health problem with marked regional differences

Histone Deacetylase Inhibitor Tributyrin and Vitamin A in Cancer

Bioactive food compounds like vitamin A and the butyrate’s prodrug tributyrin have preventive activities against different types of cancer, and their use in association could represent a promising strategy for cancer treatment and che- moprevention. Both compounds can induce cell differentiation and apoptosis of neoplastic and preneoplastic cells by means of modulation of gene transcription, yet they act through different but interconnected mechanisms. Vitamin A acts through nuclear receptors that are tightly regulated by histone modifications such as acetylation and DNA methylation. Tributyrin modulates transcription of genes by HDACs inhibition and histone hyperacetylation. This chapter describes how epigenetics mediates the antineoplastic and chemopreventive activity of vitamin A, tributyrin, and their derivatives and how their combination can be used to help overcome current limitations in cancer treatment and prevention. We also show how the mechanisms of action of vitamin A and tributyrin have aided in the development of synthetic and bioengineered compounds like synthetic retinoids and structured lipids, respectively.UCR::Vicerrectoría de Docencia::Salud::Facultad de Medicina::Escuela de Medicin