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      II Consenso Brasileiro em Doença de Chagas, 2015 Translated title: Brazilian Consensus on Chagas Disease, 2015

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      Epidemiologia e Serviços de Saúde
      Secretaria de Vigilância em Saúde - Ministério da Saúde do Brasil
      Chagas disease, Epidemiology, Control, Diagnosis, Treatment, Health Care, Consensus, Brazil, Doença de Chagas, Epidemiologia, Controle, Diagnóstico, Tratamento, Assistência à Saúde, Consenso, Brasil

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          Abstract

          RESUMO A doença de Chagas é uma condição crônica negligenciada com elevada carga de morbimortalidade e impacto dos pontos de vista psicológico, social e econômico. Representa um importante problema de saúde pública no Brasil, com diferentes cenários regionais. Este documento traduz a sistematização das evidências que compõe o Consenso Brasileiro de Doença de Chagas. O objetivo foi sistematizar estratégias de diagnóstico, tratamento, prevenção e controle da doença de Chagas no país, de modo a refletir as evidências científicas disponíveis. Sua construção fundamentou-se na articulação e contribuição estratégica de especialistas brasileiros com conhecimento, experiência e atualização sobre diferentes aspectos da doença. Representa o resultado da estreita colaboração entre a Sociedade Brasileira de Medicina Tropical e o Ministério da Saúde. Espera-se com este documento fortalecer o desenvolvimento de ações integradas para enfrentamento da doença no país com foco em epidemiologia, gestão, atenção integral (incluindo famílias e comunidades), comunicação, informação, educação e pesquisas.

          Translated abstract

          ABSTRACT Chagas disease is a neglected chronic condition that presents high morbidity and mortality burden, with considerable psychological, social, and economic impact. The disease represents a significant public health issue in Brazil, with different regional patterns. This document presents the evidence that resulted in the Brazilian Consensus on Chagas Disease. The objective was to review and standardize strategies for diagnosis, treatment, prevention, and control of Chagas disease in the country, based on the available scientific evidence. The consensus is based on collaboration and contribution of renowned Brazilian experts with vast knowledge and experience on various aspects of the disease. It is the result of close collaboration between the Brazilian Society of Tropical Medicine and the Ministry of Health. This document shall strengthen the development of integrated control measures against Chagas disease in the country, focusing on epidemiology, management, comprehensive care (including families and communities), communication, information, education, and research.

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          Clinical and epidemiological aspects of Chagas disease.

          A. Prata (2001)
          Chagas disease is caused by the protozoan parasite Trypanosoma cruzi. During the past decades, after urban migrations, Chagas disease became frequent in cities and a health problem in non-endemic countries, where it can be transmitted vertically and by blood transfusion or organ transplantation. Microepidemics of acute Chagas disease have been reported, probably due to oral transmission. Heart involvement is the major feature of the disease because of its characteristics, frequency, and consequences, and is also the source of most controversies. The indeterminate clinical form, despite its good prognosis on at least a medium-term basis (5-10 years), has acquired increasing importance due to the controversial meaning of the abnormality of some tests and the myocardial focal lesions found in many patients. Simultaneous evaluation of the parasympathetic and of the sympathetic system in the heart has been done by spectral analysis of heart rate. The physiopathological and clinical significance of denervation in Chagas disease is still incompletely understood. There are major divergences of opinion on specific treatment during the chronic phase because of the doubts about cure rates. Changes of Chagas disease prevalence in many countries have been certified by the Pan American Health Organization, and are ascribed to large-scale vector-control programmes with modern pyrethroid insecticides and to improvement in lifestyle.
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            Predictors of mortality in chronic Chagas disease: a systematic review of observational studies.

            Chagas disease is a major cause of morbidity and mortality in Latin America. Knowledge of the predictors of prognosis can help clinical decision making by identifying patients' level of risk. We reviewed the published literature on prognostic factors in patients with Chagas disease by performing a PubMed search for articles published in any language between 1985 and February 2006 and hand searches of the reference lists of retrieved articles. Studies were selected if they included patients in the chronic phase of Chagas disease, analyzed a clearly defined outcome (all-cause mortality, sudden cardiac deaths, and/or cardiovascular deaths), and used multivariable regression models of prognosis. From 606 potentially relevant studies, 12 met the inclusion criteria: 8 clinic-based studies including 3928 patients and 4 hospital-based studies including 349 patients. Impaired left ventricular function by echocardiogram or cineventriculogram was found to be the most common and consistent independent predictor of death. New York Heart Association functional class III/IV and cardiomegaly on the chest radiography also were independently associated with higher mortality. More recently, strong evidence was found that nonsustained ventricular tachycardia on 24-hour Holter monitoring indicated an adverse prognosis. The typical ECG abnormalities showed limited additional prognostic value. Other often-mentioned risk factors, advanced age and male sex, showed inconsistent results. A formal meta-analysis was not feasible because of the heterogeneity of published studies and the lack of minimal standards in reporting results. A systematic review of published studies indicates that impaired left ventricular function, New York Heart Association class III/IV, cardiomegaly, and nonsustained ventricular tachycardia indicate a poor prognosis in patients with chronic Chagas disease.
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              Southern Cone Initiative for the elimination of domestic populations of Triatoma infestans and the interruption of transfusion Chagas disease: historical aspects, present situation, and perspectives

              João Dias (2007)
              Created in 1991 by the governments of Argentina, Bolivia, Brazil, Chile, Paraguay, and Uruguay, the Southern Cone Initiative (SCI) has been extremely important for Chagas disease control in this region. Its basic objective was to reach the interruption of this disease, chiefly by means of the elimination of the principal vector Triatoma infestans and by the selection of safe donors in the regional blood banks. After a summarized historic of SCI, the text shows the advance of technical and operative activities, emphasizing some factors for the initiative success, as well as some difficulties and constraints. The future of SCI will depend of the continuity of the actions and of political priority. Scientific community has been highly responsible for this initiative and its maintenance. At the side of this, national and international efforts must be involved and reinforced to assure the accomplishment of the final targets of SCI. Very specially, the Pan American Health Organization has cooperated with the Initiative in all its moments and activities,being the most important catalytic and technical factor for SCI success.
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                Journal
                ress
                Epidemiologia e Serviços de Saúde
                Epidemiol. Serv. Saúde
                Secretaria de Vigilância em Saúde - Ministério da Saúde do Brasil
                2237-9622
                June 2016
                : 25
                : spe
                : 7-86
                Affiliations
                [1 ] Fundação Oswaldo Cruz Brazil
                [2 ] Universidade Federal do Ceará Brazil
                [3 ] Universidade Federal de Minas Gerais Brazil
                [4 ] Universidade Federal de Goiás Brazil
                [5 ] Universidade de São Paulo Brazil
                [6 ] Fundação Oswaldo Cruz Brazil
                [7 ] Universidade Estadual de Campinas Brazil
                [8 ] Universidade de Pernambuco Brazil
                [9 ] Organização Pan-Americana da Saúde Brasil
                [10 ] Universidade Federal de Goiás Brazil
                [11 ] Universidade Federal de Minas Gerais Brazil
                [12 ] Universidade de São Paulo Brazil
                [13 ] Hospital do Coração Anis Rassi Brasil
                [14 ] Instituto Dante Pazzanese de Cardiologia Brazil
                [15 ] Fundação Oswaldo Cruz Brazil
                [16 ] Universidade Federal do Triângulo Mineiro Brazil
                [17 ] Ministério da Saúde Brazil
                [18 ] Universidade Federal de Goiás Brazil
                [19 ] Universidade Federal de Minas Gerais Brazil
                [20 ] Secretaria do Estado de Saúde de Minas Gerais Brasil
                [21 ] Universidade Estadual de Londrina Brazil
                [22 ] Universidade Federal do Triângulo Mineiro Brazil
                [23 ] Universidade de São Paulo Brazil
                [24 ] Universidade Federal do Rio de Janeiro Brazil
                [25 ] Universidade de São Paulo Brazil
                [26 ] Ministério da Saúde Brazil
                [27 ] Ministério da Saúde Brazil
                Article
                S2237-96222016000500007
                10.5123/s1679-49742016000500002
                27869914
                13ff9de0-fd4b-4577-b58e-9025b96313aa

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

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                SciELO Brazil

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=2237-9622&lng=en
                Categories
                Health Care Sciences & Services
                Health Policy & Services

                Health & Social care,Public health
                Chagas disease,Epidemiology,Control,Diagnosis,Treatment,Health Care,Consensus,Brazil,Doença de Chagas,Epidemiologia,Controle,Diagnóstico,Tratamento,Assistência à Saúde,Consenso,Brasil

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