A Field Trial of Alternative Targeted Screening Strategies for Chagas Disease in Arequipa, Peru

In the wake of emerging T. cruzi infection in children of periurban Arequipa, Peru, we conducted a prospective field trial to evaluate alternative targeted screening strategies for Chagas disease across the city. Using insect vector data that is routinely collected during Ministry of Health insecticide application campaigns in 3 periurban districts of Arequipa, we separated into 4 categories those households with 1) infected vectors; 2) high vector densities; 3) low vector densities; and 4) no vectors. Residents of all infected-vector households and a random sample of those in the other 3 categories were invited for serological screening for T. cruzi infection. Subsequently, all residents of households within a 15-meter radius of detected seropositive individuals were invited to be screened in a ring case-detection scheme. Of 923 participants, 21 (2.28%) were seropositive. There were no significant differences in prevalence across the 4 screening strategies, indicating that household entomologic factors alone could not predict the risk of infection. Indeed, the most predictive variable of infection was the number of years a person lived in a location with triatomine insects. Therefore, a simple residence history questionnaire may be a useful screening tool in large, diverse urban environments with emerging Chagas disease

Regression of an abdominal aortic aneurysm after endograft exclusion.

We describe the regression of a 6.5 cm diameter abdominal aortic aneurysm in a 71-year-old patient within 1 year of aortic endograft placement. The aneurysm decreased in size to 4 cm at 3 months and was 3.3 cm at 8 months on duplex examination. By 1 year a spiral computed tomographic study confirmed complete regression of the aneurysm, with mild shortening and angulation of the unsupported body of the aortoiliac endoluminal prosthesis. The case demonstrates a potential of endograft treatment of aortic aneurysms and decribes the changes in prosthesis configuration and position that occurred after implantation

Reacción de Guerreiro-Machado. Estudio en 1010 personas procedentes de diversos departamentos del Perú

He has practiced Guerreiro - Machado reaction in 1010 specimens from the same number of people , following the technique of 50% hemolysis of antigen using Bozicevich and total aqueous extract of T. cruzi ( forms of culture in medium Senekjie ) prepared Peruvian strains isolated from people and Trialoma infestans. In the study group , 551 Lima residents who had long previous residence in another department and 459 residents Samegua and Moquegua, locations known for their high endemicity for Chagas included . Reactions in 1010 , he found , 98 ( 9.70 %) were positive , 20 ( 1.98 %) suspicious and 31 ( 3.07 %) anticomplementary . The incidence was higher in females , 12.33 '% , and in the following age groups: 60 and older, 24.42 % ; 50 to 59 years , 13.86 % ; 40 to 49, 13.64 '% and 30 to 39, 9.16 % positive cases . De Lima 551 residents , 34 ( 6.17 % ) presented positive serology ; 1 ( 0.18 %) , suspicious and 7 ( 1.27 %) , anticomplementary . In 15 of the 34 positive subjects , xenodiagnosis was performed , resulting 7 positive . RFC 459 residents conducted in the department of Moquegua, was obtained , 64 (13.94 %) were positive , 19 ( 4.14 %) suspicious and 24 ( 5.23 %) anticomplementary . In this group RFC , 448 xenodiagnosis was performed the same number of people , finding 29 positive ( 6.47 %). Among the 34 positive residents of Lima , 6 had had several years of previous residence in chagasic areas of the department of Arequipa , 10 Moquegua, 8 in Tacna, 4 in San Martin, 2 in Cajamarca, 2 in Loreto, 1 in La Libertad and 1 in Iquique ( Chile) . More than 50% of the 1010 subjects studied were referred by clinical specialists , having considered Chagas disease among its diagnostic possibilities . Of the 98 positive cases reported in this study , 95 have been reported in previous publications (16, 20, 32 , 33) And three first reported . The three new cases , subjects are residents of Lima, one of them had had previous residency chogásicas areas of Arequipa, Moquegua in the second and third in San Martin. It is hoped that in the future ; diagnostic methods in uniformen surveys for the presence of American Trypanosomiasis , and thus determine the incidence of this disease in our country.Se ha practicado la reacción de Guerreiro-Machado en 1010 sueros correspondientes a igual número de personas, siguiendo la técnica del 50% de Hemólisis de Bozicevich y empleando antígeno de extracto acuoso total de T. cruzi (formas de cultivo en medio Senekjie ) preparado a partir de cepas peruanas aisladas de personas y de Trialoma infestans. En el grupo estudiado, se incluye 551 residentes de Lima que habían tenido prolongada residencia anterior en otros departamento y 459 residentes de Samegua y Moquegua, localidades conocidas por su elevada endemicidad en enfermedad de Chagas. De 1010 reacciones realizadas, se encontró, 98 (9.70%) positivas, 20 (1.98%) sospechosas y 31 (3.07%) anticomplementarias. La mayor incidencia fue en el sexo femenino, 12.33'%, y, en los siguientes grupos de edad: de 60 y más años, 24.42%; de 50 a: 59 años, 13.86%; de 40 a 49 años, 13.64'% y de 30 a 39 años, 9.16% de casos positivos. De 551 residentes de Lima, 34 (6.17 %), presentaron serología positiva; 1 (0.18%), sospechosa y 7 (1.27%), anticomplementaria. A 15 de los 34 sujetos positivos, se le practicó xenodiagnóstico, resultando 7 positivos. De 459 R. F. C. realizadas en residentes del departamento de Moquegua, se obtuvo, 64 (13.94%) positivas, 19 (4.14%) sospechosas y 24 (5.23%) anticomplementarias. En este grupo con R. F. C., se practicó 448 xenodiagnósticos a igual número de personas, encontrándose 29 positivos (6.47%). Entre los 34 positivos residentes de Lima, 6 habían tenido varios años de residencia anterior en zonas chagásicas del departamento de Arequipa, 10 en Moquegua, 8 en Tacna, 4 en San Martín, 2 en Cajamarca,2 en Loreto, 1 en La Libertad y 1 en Iquique (Chile). Más del 50% de los 1010 sujetos estudiados fueron remitidos por clínicos y especialistas, por haber considerado la enfermedad de Chagas entre sus posibilidades diagnósticas. De los 98 casos positivos señalados en el presente trabajo, 95 han sido comunicados en publicaciones anteriores (16, 20, 32, 33) Y tres informados por primera vez. Los tres nuevos casos, son sujetos residentes de Lima, uno de ellos había tenido residencia anterior en zonas chogásicas de Arequipa, el segundo en Moquegua y el tercero en San Martín. Es de esperar que en el futuro; se uniformen los métodos de diagnóstico en las encuestas para investigar la presencia de Trypanosomiasis Americana, y así conocer la incidencia de esta enfermedad en nuestro país

Vascular imaging before, during, and after endovascular repair.

Endovascular techniques for repair of vascular lesions are developing rapidly. Imaging modalities are critical in this evolution from several perspectives. Device development and evaluation rely on precise imaging to ensure fixation of devices, isolation of lesions, and assessment of healing at various intervals. Clinical implementation of endovascular techniques requires a spectrum of imaging methods to choose patients appropriately for procedures, to deploy devices expediently and precisely, and to evaluate long-term efficacy in a minimally invasive manner. This paper reviews the utility of available imaging methods for performing these assessments