Chagas prevention and control in an endemic area from the Argentinian Gran Chaco Region: Data from 14 years of uninterrupted intervention.

BackgroundChagas Disease (ChD) is a Neglected Tropical Disease (NTD) affecting 6 to 7 million people worldwide, mostly from Latin America. In Argentina, a national control program has been implemented since 1962, yet there are still an estimated 1.6 million infected individuals. Control programs were based almost exclusively on entomological surveillance and chemical control of households and were not continuous given a lack of coordination and resources. Argentina´s ChD program was originally vertical and centralized; later, it was partially and, in general, unsuccessfully transferred to the provinces. Herein, we describe the implementation of a control program for ChD with an ecohealth approach in rural settlements around the city of Añatuya, Santiago del Estero.MethodsThe program included yearly household visits for entomological surveillance and control, health promotion workshops, and structural house improvements. Improved structures included internal and external walls and roofs, as well as the construction of water wells and latrines, and the organization and improvement of peri-domestic structures. Activities were carried out by specifically trained personnel except for house improvements, which were performed by the community, under technical guidance and provision of materials. Data was collected using standardized questionnaires for household characterization, entomological infestation status and chemical control activities.ResultsThis program was continuously implemented since 2005 with high community participation and adherence, incorporating 13 settlements and 502 households. During the surveillance phase, 4,193 domiciliary inspections were performed, and both the intra- and peri-domestic infestation rate were reduced from 17.9% to 0.2% (P ConclusionThe program is still ongoing and, after 14 years of implementation, has built social networks and collaboration between implementers and beneficiaries with a reduction of T. infestans infestation in the intra- and peri-domicile. This reduction, especially inside the household, has enabled access to diagnosis and treatment of the population, with minimal risk of re-infection

PET-adapted therapy after three cycles of ABVD for all stages of Hodgkin lymphoma: results of the GATLA LH-05 trial

The role of Ann Arbor staging in determining treatment intensity after achieving a negative positron emission tomography (PET) has not been established in classical Hodgkin lymphoma (cHL). Patients with stage I–IV cHL, received three cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and an interim PET scan (PET3). PET3-negative patients received no further therapy. PET3-positive patients received three additional cycles of ABVD plus involved-field radiation therapy or salvage chemotherapy, if refractory to ABVD, and were re-evaluated by PET scan (PET6). Study endpoints were 3-year progression-free survival (PFS) and overall survival (OS) rates. Two hundred and thirty-nine patients with early-stage and 138 with advanced-stage were evaluable. Overall, 260 patients (70%) were PET3-negative and had higher 3-year PFS (90% vs. 65%; P < 0 0001) and OS (98% vs. 92%; P = 0 007) rates than PET3-positive patients. All PET3-negative patients, regardless of disease stage at diagnosis, achieved similarly good PFS (90–91%; P = 0 76) and OS (97–99%). The only independent prognostic factor for PFS was PET3-negativity (Hazard ratio 3 8; 95% confidence interval 2 4–6 3; P < 0 0001). This study suggests that cHL patients who achieve a negative PET3 following ABVD have an excellent outcome, regardless of stage at diagnosis. An appropriately powered, phase III trial will be necessary to confirm these findings.Fil: Pavlovsky, Astrid. Fundación Para Combatir la Leucemia; Argentina. Centro de Hematología Pavlovsky; ArgentinaFil: Fernández, Isolda. Fundación Para Combatir la Leucemia; Argentina. Centro de Hematología Pavlovsky; ArgentinaFil: Kurgansky, Nicolas. Doctus; ArgentinaFil: Prates, Virginia. Hospital Italiano de La Plata; ArgentinaFil: Zoppegno, Lucia. Hospital General San Martín; ArgentinaFil: Negri, Pedro. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Privado de Hematología y Hemoterapia; ArgentinaFil: Milone, Gustavo. Fundación Para Combatir la Leucemia; ArgentinaFil: Cerutti, Ider. Idhea Clinica Hematologica Dr Cerutti Ider; ArgentinaFil: Zabaljauregui, Soledad. Academia Nacional de Medicina de Buenos Aires; ArgentinaFil: Mariano, Romina. Provincia de Entre Rios. Hospital San Martin; ArgentinaFil: Grecco, Horacio F.. Sanatorio Dr. Julio Méndez; ArgentinaFil: Basquiera, Ana Lisa. Hospital Privado Universitario de Cordoba.; ArgentinaFil: Saba, Silvia. Hospital Rodolfo Rossi; ArgentinaFil: Rudoy, Silvia. Clínica Modelo de Morón; ArgentinaFil: Sackmann, Federico. Fundación Para Combatir la Leucemia; ArgentinaFil: Castano, Vanesa. Idhea Clinica Hematologica Dr Cerutti Ider; ArgentinaFil: Remaggi, Guillermina. Fundación Para Combatir la Leucemia; ArgentinaFil: Cabrejo, María del Rosario. Sanatorio Dr. Julio Méndez; ArgentinaFil: Roveri, Eriberto. Idhea Clinica Hematologica Dr Cerutti Ider; ArgentinaFil: Casale, María Florencia. Instituto Privado de Hematología y Hemoterapia; Argentina. Hospital General Centeno; ArgentinaFil: Cabane, Vanina. Clínica Dr. Roberto Raña; ArgentinaFil: Taus, Rossana. Hospital Rodolfo Rossi; ArgentinaFil: Venturini, Claudia. Instituto Privado de Hematología y Hemoterapia; ArgentinaFil: Sakamoto, Francisco. Instituto Privado de Hematología y Hemoterapia; ArgentinaFil: Varela, Ana I.. Sanatorio Las Lomas Sociedad Anonima.; ArgentinaFil: Riddick, Maximiliano Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentina. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Departamento de Matemáticas; ArgentinaFil: Pavlovsky, Santiago. Fundación Para Combatir la Leucemia; Argentin