Towards a Paradigm Shift in the Treatment of Chronic Chagas Disease

Submitted by sandra infurna ([email protected]) on 2015-10-13T16:46:13Z No. of bitstreams: 1 taraujo_jorge_etal_IOC_2014.pdf: 471708 bytes, checksum: 462a85377d75fba287922349d9ecb37e (MD5)Approved for entry into archive by sandra infurna ([email protected]) on 2015-10-13T16:46:29Z (GMT) No. of bitstreams: 1 taraujo_jorge_etal_IOC_2014.pdf: 471708 bytes, checksum: 462a85377d75fba287922349d9ecb37e (MD5)Approved for entry into archive by sandra infurna ([email protected]) on 2015-10-13T17:03:55Z (GMT) No. of bitstreams: 1 taraujo_jorge_etal_IOC_2014.pdf: 471708 bytes, checksum: 462a85377d75fba287922349d9ecb37e (MD5)Made available in DSpace on 2015-10-13T17:04:13Z (GMT). No. of bitstreams: 1 taraujo_jorge_etal_IOC_2014.pdf: 471708 bytes, checksum: 462a85377d75fba287922349d9ecb37e (MD5) Previous issue date: 2014Hospital Interzonal General de Agudos (HIGA) Eva Perón. Sección Chagas. Servicio de Cardiología. Buenos Aires, Argentina.Universidad Central de Venezuela (IMT-UCV). Instituto de Medicina Tropical. Caracas, Venezuela.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Programa Integrado de Doença de Chagas. Laboratório de Inovações em Terapias, Ensino e Bioprodutos. Rio de Janeiro, RJ, Brasil.Universidad Católica del Ecuador (CIEI-PUCE). Centro de Investigación de Enfermedades Infecciosas. Quito, Ecuador / Ohio University. Tropical Disease Institut. Athens, Ohio, USA.Universidad de los Andes (UA-CIMPAT). Centro de Investigaciones en Microbiología y Parasitología Tropical. Bogotá, Colombia.Consejo Superior de Investigaciones Científicas (IPBLN-CSIC). Instituto de Parasitología y Biomedicina Lopez-Neyra. Granada, Spain.Instituto Nacional de Salud Pública (CRISP-INSP).Centro Regional de Investigación en Salud Pública. Tapachula, Chiapas, Mexico.Drugs for Neglected Diseases Initiative (DNDi). Geneva, Switzerland.Instituto de Investigaciones en Ingeniería Genética y Biología Molecular (INGEBI).CONICET. Buenos Aires, Argentina.Instituto Nacional de Parasitología Dr. Mario Fatala Chaben (INP)-ANLIS Dr. Carlos G. Malbran, Buenos Aires, Argentina.Universidad Mayor de San Simón (UMSS). Cochabamba, Bolivia.Barcelona Center for International Health Research (CRESIB). Hospital Clinic/IDIBAPS. Barcelona, Spain.Treatment for Chagas disease with currently available medications is recommended universally only for acute cases (all ages) and for children up to 14 years old. The World Health Organization, however, also recommends specific antiparasite treatment for all chronic-phase Trypanosoma cruzi-infected individuals, even though in current medical practice this remains controversial, and most physicians only prescribe palliative treatment for adult Chagas patients with dilated cardiomyopathy. The present opinion, prepared by members of the NHEPACHA network (Nuevas Herramientas para el Diagnóstico y la Evaluación del Paciente con Enfermedad de Chagas/New Tools for the Diagnosis and Evaluation of Chagas Disease Patients), reviews the paradigm shift based on clinical and immunological evidence and argues in favor of antiparasitic treatment for all chronic patients. We review the tools needed to monitor therapeutic efficacy and the potential criteria for evaluation of treatment efficacy beyond parasitological cure. Etiological treatment should now be mandatory for all adult chronic Chagas disease patients

Oclusión espontánea de malformación arteriovenosa cerebral parcialmente embolizada: reporte de dos casos Spontaneous occlusion of previously cerebral embolized residual arteriovenous malformation: report of two cases

OBJETIVO: Mostrar dos casos de oclusión espontánea de remanente malformativo previamente embolizado y analizar sus probables causas. MÉTODO: Revisión retrospectiva de pacientes con malformaciones arteriovenosas cerebrales (MAV) embolizadas entre Enero de 1999 y Agosto de 2005 en nuestra institución y análisis de dos casos de oclusión de MAV remanentes. RESULTADOS: Se presentan dos casos de MAV tratadas por vía endovascular, con remanentes del nido malformativo post-embolización, que posteriormente en controles angiográficos presentan desaparición completa de las lesiones sin mediar otro tratamiento. CONCLUSIÓN: La oclusión espontánea de un remanente arteriovenoso es un hecho infrecuente. Se discuten diversos mecanismos relacionados.<br>OBJECTIVE: To report two cases of spontaneous occlusion of residual malformations that had previously been embolized and to analyze their probable causes. METHOD: Retrospective review of patients with embolized arteriovenous malformations (AVMs) between January 1999 and August 2005 in our institution and analysis of two cases of occlusion in residual AVMs. RESULTS: Two cases of AVMs that received endovascular treatment and had post-embolization residual nidus malformation, which in later angiographic controls showed a complete disappearance of the lesions without other treatment. CONCLUSION: The spontaneous occlusion of residual arteriovenous malformations is an infrequent occurrence. Several related mechanisms are discussed