Global, Regional, and National Trends of Chagas Disease from 1990 to 2019: Comprehensive Analysis of the Global Burden of Disease Study.

Background Chagas disease (CD) is a neglected tropical disease, endemic in Latin America, but due to migration and environmental changes it has become a global public health issue. Objectives To assess the global prevalence and disability-adjusted life years due to CD using findings from the Global Burden of Disease Study 2019. Methods The Global Burden of Disease data was obtained from the Global Burden of Disease Collaborative Network; results were provided by the Institute for Health Metrics and Evaluation. The prevalence and disability-adjusted life-years (DALYs) were described at a global, regional, and national level, including data from 1990 to 2019. Results Globally, CD prevalence decreased by 11.3% during the study period, from 7,292,889 cases estimated in 1990 to 6,469,283 in 2019. Moreover, the global DALY rate of CD decreased by 23.7% during the evaluated period, from 360,872 in 1990 to 275,377 in 2019. In addition, significant differences in the burden by sex, being men the most affected, age, with the elderly having the highest burden of the disease, and sociodemographic index (SDI), with countries with the lowest SDI values having the highest prevalence of the disease, were observed. Finally, the prevalence trends have followed different patterns according to the region, with a sustained decrease in Latin America, compared to an increasing trend in North America and Europe until 2010. Conclusion The global burden of CD has changed in recent decades, with a sustained decline in the number of cases. Although the majority of cases remain concentrated in Latin America, the increase observed in countries in North America and Europe highlights the importance of screening at-risk populations and raising awareness of this neglected tropical disease

Longitudinal Speckle Tracking Strain Abnormalities in Chagas Disease: A Systematic Review and Meta-Analysis.

BACKGROUND Chronic Chagas cardiomyopathy (CCM) is ranked among heart failure etiologies with the highest mortality rates. CCM is characterized by alterations in left ventricular function with a typical and unique pattern of myocardial involvement. Left ventricle longitudinal speckle tracking strain is emerging as an important additive method for evaluating left ventricular function and risk of future cardiovascular events. This systematic review aimed to characterize the left ventricle (LV) longitudinal strain by speckle tracking patterns in the different stages of Chagas disease, compared to healthy controls. METHODS Searches in Medline, EMBASE, and LILACS databases (from inception to 20 May 2021) were performed. Articles written in any language that assessed patients with Chagas disease and reported any measures derived from the left ventricular strain by speckle tracking were included. Two reviewers independently selected the studies, extracted the data, and assessed the quality of evidence. Standardized mean differences (SMD) were pooled using random-effects meta-analyses. RESULTS Of 1044 references, ten studies, including a total of 1222 participants (CCM: 477; indeterminate form: 444; healthy controls: 301), fulfilled the selection criteria and were included in the final analysis. Patients with CCM had a significantly higher mean global longitudinal strain (GLS) value than indeterminate form (IF) patients (SMD 1.253; 95% CI 0.53, 1.98. I2 = 94%), while no significant difference was observed between IF patients and healthy controls (SMD 0.197; 95% CI -0.19, 0.59. I2 = 80%). Segmental strain analyses revealed that patients with the IF form of CD had significantly worse strain values in the basal-inferoseptal (SMD 0.49; 95% CI 0.24, 0.74. I2: 24%), and mid-inferoseptal (SMD 0.28; 95% CI 0.05, 0.50. I2: 10%) segments compared to healthy controls. CONCLUSIONS Our results suggest different levels of functional derangements in myocardial function across different stages of Chagas disease. Further research is needed to assess the prognostic role of LV longitudinal strain and other measures derived from speckle tracking in CD patients regarding progression to cardiomyopathy and clinical outcomes prediction

Circulating MicroRNAs and myocardial involvement severity in chronic Chagas cardiomyopathy.

Background Chronic Chagas Cardiomyopathy (CCM) is characterized by a unique pathophysiology in which inflammatory, microvascular and neuroendocrine processes coalesce in the development of one of the most severe cardiomyopathies affecting humans. Despite significant advances in understanding the molecular mechanisms involved in this disease, scarce information is available regarding microRNAs and clinical parameters of disease severity. We aimed to evaluate the association between circulating levels of six microRNAs with markers of myocardial injury and prognosis in this population. Methods Patients with CCM and reduced ejection fraction were included in a prospective exploratory cohort study. We assessed the association of natural log-transformed values of six circulating microRNAs (miR-34a-5p, miR-208a-5p, miR-185-5p, miR-223-5p, let-7d-5p, and miR-454-5p) with NT-proBNP levels and echocardiographic variables using linear regression models adjusted for potential confounders. By using Cox Proportional Hazard models, we examined whether levels of microRNAs could predict a composite outcome (CO), including all-cause mortality, cardiac transplantation, and implantation of a left ventricular assist device (LVAD). Finally, for mRNAs showing significant associations, we predicted the target genes and performed pathway analyses using Targetscan and Reactome Pathway Browser. Results Seventy-four patients were included (59% males, median age: 64 years). After adjustment for age, sex, body mass index, and heart failure medications, only increasing miR-223-5p relative expression levels were significantly associated with better myocardial function markers, including left atrium area (Coef. -10.2; 95% CI -16.35; -4.09), end-systolic (Coef. -45.3; 95% CI -74.06; -16.61) and end-diastolic volumes (Coef. -46.1; 95% CI -81.99; -10.26) of the left ventricle. Moreover, we observed that higher miR-223-5p levels were associated with better left-ventricle ejection fraction and lower NT-proBNP levels. No associations were observed between the six microRNAs and the composite outcome. A total of 123 target genes for miR-223-5p were obtained. From these, several target pathways mainly related to signaling by receptor tyrosine kinases were identified. Conclusions The present study found an association between miR-223-5p and clinical parameters of CCM, with signaling pathways related to receptor tyrosine kinases as a potential mechanism linking low levels of miR-223-5p with CCM worsening

Arquitectura centrada en la web para el control y monitoreo de funcionalidad domótica

En el presente paper se ilustra una arquitectura para el desarrollo de sistemas en ambientes distribuidos homogéneos centrados en la Web, que a efectos de ser llevado a la práctica, se discute el diseño e implementación de una aplicación para el control y monitoreo con funcionalidad domótica. La arquitectura empleada se basa en el patrón arquitectural denominado Web Delivery. Se presentan consideraciones finales y futuros avances en el empleo de arquitecturas de software con potencial repercusión para el campo de la DomóticaÁrea: Ingeniería de Software - Bases de DatosRed de Universidades con Carreras en Informática (RedUNCI

Manejo de suelos en cultivos intensivos

En el manejo del suelo en cultivos intensivos se aplican diversas técnicas en función de variados factores, las cuales pueden afectar la calidad física, química y biológica del mismo. Por un lado esto depende de la intensidad del sistema productivo, que puede ir desde rotaciones más cortas que las habituales en cultivos extensivos, a los monocultivos (e.g. cultivo de tomate bajo cubierta). Por otro lado, es difícil hacer generalizaciones debido al amplio rango de especies cultivadas, desde plantas herbáceas hortícolas con ciclos de algunas semanas de duración (e.g. espinaca), hasta frutícolas leñosas con varios años de permanencia en los lotes cultivados. A todo esto se le deben sumar otras variables como el tipo de suelo, el clima y la calidad del agua disponible en el caso de cultivos bajo riego. En general la situación más extrema de degradación se encuentra en los suelos que se cultivan bajo cobertura plástica que, en escasas temporadas, ven deteriorada su estructura a causa del intenso laboreo; se salinizan y alcalinizan como consecuencia de la sobrefertilización y el riego con aguas salinas y/o bicarbonatadas sódicas. El proceso se agrava debido a que no contemplan los requerimientos de lixiviación o por velocidades de infiltración muy bajas que anulan la percolación profunda natural. La disminución de los niveles de materia orgánica como consecuencia del incremento de la velocidad de su mineralización por el laboreo frecuente, y por último, el vacío biológico producido por el uso de agroquímicos fumigantes de amplio espectro que alteran el equilibrio ecológico, son las principales consecuencias sobre el suelo en este tipo de producción. En estos ambientes, la degradación se intenta morigerar a través de técnicas de laboreo como el subsolado, que incrementa la lixiviación y el alomado, que junto al aporte de materia orgánica con alto contenido de lignina, permiten mejorar la infiltración, el agua útil y la concentración de oxígeno en el suelo. Para contrarrestar la sodificación se aplican enmiendas cálcicas que, al mantener el estado de floculación del complejo arcillo-húmico, favorecen la estructura, confiriendo friabilidad a los suelos arcillosos y agregación a los arenosos. Por otro lado, el empleo de este tipo de enmiendas estimula la actividad biológica debido a que el calcio también es un elemento esencial para los microorganismos benéficos. En casos extremos de alcalinización y sodificación se instalan drenajes artificiales y se realiza un lavado de los suelos mediante la aplicación de abundantes láminas de riego. En el caso del cultivo de papa en el SE bonaerense, como ejemplo de otra situación de cultivo intensivo, el tipo y frecuencia de las labranzas empleadas, las numerosas fumigaciones, la intensa aplicación de fertilizantes y pesticidas, el laboreo a favor de la pendiente que favorece el proceso de erosión hídrica, sumado a la baja calidad del agua de riego, describen una situación que deriva en un impacto ambiental sumamente desfavorable. En estas situaciones, con el fin de evitar la erosión hídrica se aconseja escoger lotes sin pendiente o con pendientes menores al 1% orientando los surcos en sentido contrario a la pendiente (máximo 4-5%). Se deben disminuir las labranzas, aplicar agroquímicos de acuerdo al resultado de monitoreos, así como fertilizantes, previo diagnóstico edáfico y/o foliar. En los cultivos intensivos cuyanos las prácticas habituales son la rotación con abonos verdes compuestos por leguminosas y gramíneas que se incorporan cuando estas últimas emiten la espiga floral, la realización de verdeos invernales y la incorporación de guanos en dosis de 5 a 20 t ha-1 que mejoran las condiciones físicas del suelo como la aireación y la retención de agua, además de aportar nutrientes.Facultad de Ciencias Agrarias y Forestale

Electrocardiographic abnormalities in Chagas disease in the general population: A systematic review and meta-analysis.

BACKGROUND: Chagas disease (CD) is a major public health concern in Latin America and a potentially serious emerging threat in non-endemic countries. Although the association between CD and cardiac abnormalities is widely reported, study design diversity, sample size and quality challenge the information, calling for its update and synthesis, which would be very useful and relevant for physicians in non-endemic countries where health care implications of CD are real and neglected. We performed to systematically review and meta-analyze population-based studies that compared prevalence of overall and specific ECG abnormalities between CD and non-CD participants in the general population. METHODS: Six databases (EMBASE, Ovid Medline, Web of Science, Cochrane Central, Google Scholar and Lilacs) were searched systematically. Observational studies were included. Odds ratios (OR) were computed using random-effects model. RESULTS: Forty-nine studies were selected, including 34,023(12,276 CD and 21,747 non-CD). Prevalence of overall ECG abnormalities was higher in participants with CD (40.1%; 95%CIs=39.2-41.0) compared to non-CD (24.1%; 95%CIs=23.5-24.7) (OR=2.78; 95%CIs=2.37-3.26). Among specific ECG abnormalities, prevalence of complete right bundle branch block (RBBB) (OR=4.60; 95%CIs=2.97-7.11), left anterior fascicular block (LAFB) (OR=1.60; 95%CIs=1.21-2.13), combination of complete RBBB/LAFB (OR=3.34; 95%CIs=1.76-6.35), first-degree atrioventricular block (A-V B) (OR=1.71; 95%CIs=1.25-2.33), atrial fibrillation (AF) or flutter (OR=2.11; 95%CIs=1.40-3.19) and ventricular extrasystoles (VE) (OR=1.62; 95%CIs=1.14-2.30) was higher in CD compared to non-CD participants. CONCLUSIONS: This systematic review and meta-analysis provides an update and synthesis in this field. This research of observational studies indicates a significant excess in prevalence of ECG abnormalities (40.1%) related to T. cruzi infection in the general population from Chagas endemic regions, being the most common ventricular (RBBB and LAFB), and A-V B (first-degree) node conduction abnormalities as well as arrhythmias (AF or flutter and VE). Also, prevalence of ECG alterations in children was similar to that in adults and suggests earlier onset of cardiac disease

Brote de enfermedad aguda de Chagas adquirida oralmente en Sucre, 2019-2020

Background: In the last two decades, several Latin American countries have experienced multiple outbreaks of oral Chagas disease. The study: Retrospective study analyzing an outbreak of acute oral Chagas disease in Sucre, Colombia during December-January 2020. The cases were confirmed by different diagnostic methods. Finding: During two weeks, 16 cases were confirmed, where the mean age was 14 years and 12 were male. Of the total, 14 patients were hospitalized and 2 died. Clinical manifestations include: fever, facial edema, hepatosplenomegaly, In 13 of the patients Trypanosoma cruzi trypomastigotes were observed in the thin and thick smears. Oral transmission is established as the most likely route in 14 of the patients. Conclusions: Acute orally transmitted Chagas disease can be life-threatening or even fatal, therefore, it is urgent to improve epidemiological control measures at the national level and in other Latin American countries.Introducción: En las dos últimas décadas, varios países de América Latina han experimentado múltiples brotes de la enfermedad de Chagas oral. El estudio: Estudio retrospectivo que analiza un brote de enfermedad de Chagas oral aguda en Sucre, Colombia durante diciembre-enero de 2020. Los casos fueron confirmados por diferentes métodos diagnósticos. Hallazgos: Durante dos semanas se confirmaron 16 casos, donde la edad media fue de 14 años. Del total, 14 pacientes fueron hospitalizados y 2 fallecieron. Las manifestaciones clínicas incluyeron: fiebre, edema facial, hepatoesplenomegalia. En 13 de los pacientes se observaron tripomastigotes de Trypanosoma cruzi en los frotis fino y grueso. La transmisión oral se estableció como la vía más probable. Conclusiones: La enfermedad de Chagas aguda transmitida por vía oral puede poner en peligro la vida o incluso ser mortal, por tanto, es urgente mejorar las medidas de control epidemiológico a nivel nacional y en otros países de América Latina

Are Nested Networks More Robust to Disturbance? A Test Using Epiphyte-Tree, Comensalistic Networks

Recent research on ecological networks suggests that mutualistic networks are more nested than antagonistic ones and, as a result, they are more robust against chains of extinctions caused by disturbances. We evaluate whether mutualistic networks are more nested than comensalistic and antagonistic networks, and whether highly nested, host-epiphyte comensalistic networks fit the prediction of high robustness against disturbance. A review of 59 networks including mutualistic, antagonistic and comensalistic relationships showed that comensalistic networks are significantly more nested than antagonistic and mutualistic networks, which did not differ between themselves. Epiphyte-host networks from old-growth forests differed from those from disturbed forest in several topological parameters based on both qualitative and quantitative matrices. Network robustness increased with network size, but the slope of this relationship varied with nestedness and connectance. Our results indicate that interaction networks show complex responses to disturbances, which influence their topology and indirectly affect their robustness against species extinctions

Effects of serelaxin in patients with acute heart failure

Background: Serelaxin is a recombinant form of human relaxin-2, a vasodilator hormone that contributes to cardiovascular and renal adaptations during pregnancy. Previous studies have suggested that treatment with serelaxin may result in relief of symptoms and in better outcomes in patients with acute heart failure. Methods: In this multicenter, double-blind, placebo-controlled, event-driven trial, we enrolled patients who were hospitalized for acute heart failure and had dyspnea, vascular congestion on chest radiography, increased plasma concentrations of natriuretic peptides, mild-to-moderate renal insufficiency, and a systolic blood pressure of at least 125 mm Hg, and we randomly assigned them within 16 hours after presentation to receive either a 48-hour intravenous infusion of serelaxin (30 μg per kilogram of body weight per day) or placebo, in addition to standard care. The two primary end points were death from cardiovascular causes at 180 days and worsening heart failure at 5 days. Results: A total of 6545 patients were included in the intention-to-treat analysis. At day 180, death from cardiovascular causes had occurred in 285 of the 3274 patients (8.7%) in the serelaxin group and in 290 of the 3271 patients (8.9%) in the placebo group (hazard ratio, 0.98; 95% confidence interval [CI], 0.83 to 1.15; P=0.77). At day 5, worsening heart failure had occurred in 227 patients (6.9%) in the serelaxin group and in 252 (7.7%) in the placebo group (hazard ratio, 0.89; 95% CI, 0.75 to 1.07; P=0.19). There were no significant differences between the groups in the incidence of death from any cause at 180 days, the incidence of death from cardiovascular causes or rehospitalization for heart failure or renal failure at 180 days, or the length of the index hospital stay. The incidence of adverse events was similar in the two groups. Conclusions: In this trial involving patients who were hospitalized for acute heart failure, an infusion of serelaxin did not result in a lower incidence of death from cardiovascular causes at 180 days or worsening heart failure at 5 days than placebo. (Funded by Novartis Pharma; RELAX-AHF-2 ClinicalTrials.gov number, NCT01870778. opens in new tab.