The identification of the magnitude of chronic Chagas disease in Brazil requires linking activities in health surveillance, seeking to develop a wide, hierarchically organized and geographically distributed network of services to provide care to thousands of individuals with Trypanosoma cruzi infection. The study aimed to elaborate a model for prioritization of municipalities for chronic Chagas disease, to offer comprehensive care for persons with the disease. A multicriteria analysis was thus performed using the PROMETHEÉ II algorithm, implemented in the Pradin software. The criteria for assessing the model consisted of three indices built from the following indicators: (a) epidemiological, directly related to chronic Chagas disease, (b) related to the evolution in chronic Chagas disease, and (c) related to access to health services. Saaty's Fundamental Scale was used to define the indicators' weights, with greater importance assigned to those directly related to chronic Chagas disease and to those with greater reliability and respective quality of information. Assessment of the models' consistency was based on comparison of the available data in historically endemic areas with the distribution of acute cases, besides other sensitivity analyses. The best model was defined by 1,345 municipalities with medium priority, 1,003 high priority, and 601 with very high priority for chronic Chagas disease, with the highest proportions in the Southeast and Northeast regions. Prioritization allows the administration to rationalize and channel resources, and it is essential to identify the territories where persons with chronic Chagas disease are living, to promote comprehensive care and improve quality of life.
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http://dx.doi.org/10.1590/0102-311X00175920 | DOI Listing |
Rofo
January 2025
Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Acta Parasitol
January 2025
Edificio D, Facultad de Ciencias Químicas, LADISER Inmunología y Biología Molecular, Universidad Veracruzana, Orizaba, Veracruz, México.
Despite being the most relevant and critical option for managing Chagas disease, pharmacological therapy is currently limited by the availability of only two drugs, benznidazole and nifurtimox. Their effectiveness is further restricted in the chronic phase of the infection, as they induce severe side effects and require prolonged treatment. Additionally, the use of these drugs can lead to the emergence of substantial resistance problems, compounded by the potential natural resistance of some parasite isolates.
View Article and Find Full Text PDFJCI Insight
January 2025
Department of Tropical Medicine and Infectious Disease, Tulane University, New Orleans, United States of America.
Chagas disease is a neglected tropical disease caused by Trypanosoma cruzi with clinical presentations ranging from asymptomatic to cardiac and/or gastrointestinal complications. The mechanisms of pathogenesis are still poorly understood, but T. cruzi strain diversity may be associated with disease progression.
View Article and Find Full Text PDFPathogens
December 2024
Departamento de Inmunología, Instituto Nacional de Cardiología Ignacio Chávez (INCICH), Mexico City 14080, Mexico.
Chronic chagasic cardiomyopathy is the most severe clinical manifestation of Chagas disease, which affects approximately seven million people worldwide. Latin American countries bear the highest burden, with the greatest morbidity and mortality rates. Currently, diagnostic methods do not provide information on the risk of progression to severe stages of the disease.
View Article and Find Full Text PDFLife (Basel)
November 2024
Division of Nephrology, Hospital Universitário Clementino Fraga Filho, Federal University of Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco, 255-Cidade Universitária, Rio de Janeiro 21941-617, RJ, Brazil.
Renal osteodystrophy (ROD) represents histological bone changes in patients with chronic kidney disease and is classified according to turnover and mineralization. This cross-sectional study evaluates several bone biomarkers and their ability to discriminate turnover and mineralization defects in hemodialysis (HD) patients. Bone-specific [BSAP] and total [tAP] alkaline phosphatase, procollagen-1 N-terminal propeptide [P1NP], C-terminal cross-linking telopeptide [CTX], intact [iPTH] and whole [wPTH] parathyroid hormone, sclerostin [SOST], fibroblast growth factor 23 [FGF-23], vitamin D, osteoprotegerin [OPG], and receptor activator of nuclear factor κB ligand [RANKL] were collected before the bone biopsy.
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