The multidimensional comprehension of Chagas disease. Contributions, approaches, challenges and opportunities from and beyond the information, education and communication field

Chagas is a complex, multidimensional phenomenon in which political, economic, environmental, biomedical, epidemiological, psychological, and sociocultural factors intersect. Nonetheless, the hegemonic conceptualisation has long envisioned Chagas as primarily a biomedical question, while ignoring or downplaying the other dimensions, and this limited view has reinforced the disease's long neglect. Integrating the multiple dimensions of the problem into a coherent approach adapted to field realities and needs represents an immense challenge, but the payoff is more effective and sustainable experiences, with higher social awareness, increased case detection and follow-up, improved adherence to care, and integrated participation of various actors from multiple action levels. Information, Education, and Communication (IEC) initiatives have great potential for impact in the implementation of multidimensional programs of prevention and control successfully customised to the diverse and complex contexts where Chagas disease persists

Proyecto de sensibilización y visualización de las personas afectadas por la enfermedad de Chagas: encuestas, spots y un largo camino por delante

Según estimaciones de la Organización Mundial de la Salud, actualmente existen -al menos8 millones de personas infectadas con el parásito que causa la enfermedad de Chagas (el Trypanosoma cruzi). La mayor parte de estas personas se encuentra desde Estados Unidos hasta Argentina y Chile (WHO, 2013; 2010), principalmente en los 21 países de Latinoamérica incluidos en la zona considerada tradicionalmente endémica. La infección por T. cruzi se transmite principalmente por vía vectorial, a través de insectos conocidos como “vinchucas”, “chinches”, “barbeiros”, “chipos”, entre otros nombres, dependiendo de la región. Este parásito también puede transmitirse por transfusiones de sangre o trasplantes de algunos órganos de donantes infectados; por vía congénita, durante el embarazo o el parto de mujeres infectadas; o a través de la ingestión de bebidas o alimentos contaminados con deyecciones de vinchucas infectadas. Se estima que una tercera parte de las personas que presentan serología positiva para Chagas desarrollará la enfermedad propiamente dicha a partir de afectaciones cardiacas, digestivas (habitualmente con dilatación del esófago y/o del colon), neurológicas o mixtas; 20 ó 30 años después de haberse infectado.Instituto de Física de Líquidos y Sistemas Biológico

Neuromyopathy with congenital cataracts and glaucoma: A distinct syndrome caused by POLG variants

We identified three non-related patients manifesting a childhood-onset progressive neuromyopathy with congenital cataracts, delayed walking, distal weakness and wasting, glaucoma and swallowing difficulties. Electrophysiology and nerve biopsies showed a mixed axonal and demyelinating neuropathy, while muscle biopsy disclosed both neurogenic and myopathic changes with ragged red fibers, and muscle MRI showed consistent features across patients, with a peculiar concentric disto-proximal gradient of fatty replacement. We used targeted next generation sequencing and candidate gene approach to study these families. Compound biallelic heterozygous variants, p.[(Pro648Arg)]; [(His932Tyr)] and p.[(Thr251Ile),(Pro587Leu)]; [(Arg943Cys)], were found in the three patients causing this homogeneous phenotype. Our report on a subset of unrelated patients, that showed a distinct autosomal recessive childhood-onset neuromyopathy with congenital cataracts and glaucoma, expands the clinical spectrum of POLG-related disorders. It also confirms the association between cataracts and neuropathy with variants in POLG. Early onset cataract is otherwise rare in POLG-related disorders and so far reported only in a few patients with the clinical pattern of distal myopathy or neuromyopathy

Body Size Evolution in Extant Oryzomyini Rodents: Cope's Rule or Miniaturization?

At the macroevolutionary level, one of the first and most important hypotheses that proposes an evolutionary tendency in the evolution of body sizes is “Cope's rule". This rule has considerable empirical support in the fossil record and predicts that the size of species within a lineage increases over evolutionary time. Nevertheless, there is also a large amount of evidence indicating the opposite pattern of miniaturization over evolutionary time. A recent analysis using a single phylogenetic tree approach and a Bayesian based model of evolution found no evidence for Cope's rule in extant mammal species. Here we utilize a likelihood-based phylogenetic method, to test the evolutionary trend in body size, which considers phylogenetic uncertainty, to discern between Cope's rule and miniaturization, using extant Oryzomyini rodents as a study model. We evaluated body size trends using two principal predictions: (a) phylogenetically related species are more similar in their body size, than expected by chance; (b) body size increased (Cope's rule)/decreased (miniaturization) over time. Consequently the distribution of forces and/or constraints that affect the tendency are homogenous and generate this directional process from a small/large sized ancestor. Results showed that body size in the Oryzomyini tribe evolved according to phylogenetic relationships, with a positive trend, from a small sized ancestor. Our results support that the high diversity and specialization currently observed in the Oryzomyini tribe is a consequence of the evolutionary trend of increased body size, following and supporting Cope's rule

Rotura forniceal y urinoma secundario a fibrosis retroperitoneal: caso clínico y revisión de la literatura

ResumenEl sitio de rotura secundaria a obstrucción más frecuente del sistema excretor es el fórnix renal, habitualmente de origen litiásico. La rotura forniceal y la formación de colecciones líquidas retroperitoneales son formas de presentación muy infrecuentes de la fibrosis retroperitoneal. Se presenta el caso de un hombre en su quinta década de vida, que consulta por dolor abdominal en el Servicio de Urgencias. Se realiza tomografía computarizada de abdomen y pelvis, que demuestra una lesión de partes blandas retroperitoneal, con discreto realce, que envuelve y comprime extrínsecamente al uréter derecho. Se asocia a una segunda imagen de menor densidad, que en fase de eliminación se constató que correspondía a un urinoma, por rotura de un fórnix renal ipsilateral. Se trató con un catéter doble J para la descompresión del sistema excretor y terapia esteroidea sistémica, con buena respuesta. La fibrosis retroperitoneal es una enfermedad infrecuente, caracterizada por el desarrollo de inflamación y fibrosis en el espacio retroperitoneal. Se describe una variante idiopática y otra secundaria, siendo más frecuente la primera. Existe actualmente evidencia que relaciona la variante idiopática con las enfermedades ligadas a IgG4.AbstractThe most frequent site of excretory system rupture that is secondary to obstruction, usually arising from stone disease, is the renal fornix. Forniceal rupture and the formation of retroperitoneal fluid collections are rare forms of retroperitoneal fibrosis. Presented herein is the case of a man in the fith decade of life that came to the Emergency Service because of abdominal pain. Computed tomography scan of the abdomen and pelvis revealed a slightly enhanced retroperitoneal soft tissue lesion that extrinsically enveloped and compressed the right ureter. A second image of lower density was observed in the excretory phase that proved to be a urinoma secondary to rupture of the ipsilateral renal fornix. A double-J catheter was placed to decompress the excretory system and systemic steroid therapy was given, with good response. Retroperitoneal fibrosis is an uncommon disease characterized by the development of inflammation and fibrosis in the retroperitoneal space. We describe herein 2 forms, idiopathic and secondary, the former being more frequent. Current evidence has associated the idiopathic variant with IgG4-related diseases

An analysis of the latent demand for low-cost air transport services in South America

The goal of the present paper is to assess the potential role that low cost air transport services could play in South America. We will briefly review the characteristics of the low cost air transport model, in order to check to which extent existing South American airlines conform to it. The outcome is that this industry generally does not present many of the characteristics of low cost airlines located in North America and Europe. Therefore, there appears to be a substantial market development potential for these services, provided that a more favourable regulatory framework is set up. Such potential market is assessed through a geographical analysis aimed at discovering the main production and attraction points for trips that could be served by low-cost air mobility services in South America. A production index for a given area is then defined on the basis of (1) the size of the population that can afford such a service, (2) the percentage of immigrants within the basin, that are more likely to use low cost services to visit friends and relatives, and (3) the number of urbanites, as a proxy of those people more conveniently located near the airport. A complementary attraction index is defined by looking at the number of tourists that visits the different regions. By combining the two indexes through a simplified gravitational trip distribution model, we individuate the routes that should have the highest market potential for low cost air travel services. The ten most promising routes are all located in the southern part of this subcontinen

Fantoma para punción tiroidea ecoguiada, de elaboración casera y bajo costo

Los procedimientos intervencionistas guiados por imágenes han adquirido importancia en la práctica médica, particularmente para el radiólogo que debe estar familiarizado con estas técnicas para obtener diagnósticos precisos, sin someter al paciente a grandes procedimientos con mayores riesgos asociados. Uno de estos métodos es la punción aspiración con aguja fina (PAAF), que requiere de entrenamiento para adquirir destreza en la obtención de buenas imágenes y una adecuada muestra para la evaluación citológica precisa. Por ello, nos planteamos el desafío de elaborar un fantoma tiroideo, de bajo costo y fácil preparación, que simule contener una glándula tiroides multinodular, además de la tráquea, la vena yugular interna y la arteria carótida común como puntos de referencia anatómicos internos, y que sirva de herramienta de entrenamiento para la práctica de punciones tiroideas en residentes de Radiología