Browsing by Autor "Jorge Flores"

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Abstract 16978: Use of 2-D Speckle Tracking Strain to Predict Onset of Cardiomyopathy in Chagas Disease
(Lippincott Williams & Wilkins, 2018) Monica Miranda Schaeubinger; Sithu Win; Lola Camila Telleria; Freddy Tinajeros; Jorge Flores; Paula P. Carballo-Jimenez; Caryn Bern; Ronald Gustavo Durán Saucedo; Robert H. Gilman; Monica Mukherjee
Introduction: Chagas disease is a major cause of morbidity in Latin America where it affects approximately 8 million people, with highest prevalence in Bolivia. An estimated 20-30% of those infected develop Chagas cardiomyopathy (CC) and clinical heart failure. There is currently a lack of reliable predictors of CC, hindering early identification and treatment of patients at highest risk of progression. Methods: This prospective observational study was conducted at the Hospital San Juan de Dios in Santa Cruz, Bolivia. Between 2016 and 2018, participants with Chagas disease underwent a focused history and physical exam, 12-lead ECG and echocardiogram at baseline and at 1-year follow-up. Participants were assigned cardiac disease severity stages according to ECG findings and systolic function as done by Okamoto et al. Those classified as stage A or B at baseline were selected from the overall cohort, and considered to have developed cardiomyopathy (stage C or D) by structural abnormalities on their follow-up echo. Echocardiograms were analyzed for peak averaged and regional left ventricular global longitudinal systolic strain (GLS) using TomTec Image-Arena software. Baseline GLS was compared between those who progressed and those who did not using two-sample t-tests. Results: Of the 113 participants with stage A or B at baseline, 10 had progressed to stage C or D at follow-up 1 year later. Mean age was similar in the two groups, however those who progressed were more likely to be male (see table). At baseline, mean LVEF was lower and peak GLS was less negative among those who progressed compared to those who did not. These differences were similar at the follow-up visit. Conclusion: Mild abnormalities in GLS identify patients with Chagas disease with a higher risk of developing cardiomyopathy within 1 year. Screening for these changes may provide a non-invasive and cost-effective approach to identify patients who could benefit from timely management.
Early identification of patients with Chagas disease at risk of developing cardiomyopathy using 2-D speckle tracking strain
(Elsevier BV, 2022) Sithu Win; Monica Miranda‐Schaeubinger; Ronald Gustavo Durán Saucedo; Paula P. Carballo-Jimenez; Jorge Flores; Brandon N. Mercado-Saavedra; Lola Camila Telleria; Anne G. Raafs; Manuela Verástegui; Caryn Bern
Baseline LV GLS in participants with CCC stage A or B was predictive of progression within 1-year and may guide timing of clinical follow-up and promote early detection or treatment.
Genetic association study of NLRP1, CARD, and CASP1 inflammasome genes with chronic Chagas cardiomyopathy among Trypanosoma cruzi seropositive patients in Bolivia
(Public Library of Science, 2018) Steven J. Clipman; Josephine Henderson-Frost; Katherine Y. Fu; Caryn Bern; Jorge Flores; Robert H. Gilman
About 20-30% of people infected with Chagas disease present with chronic Chagas cardiomyopathy (CCC), the most serious and frequent manifestation of the disease, while others remain asymptomatic and often do not experience Chagas-specific mortality. It is not currently well understood what causes these differential disease outcomes, but a genetic predisposition within the host could play an important role. This study examined variants in the NLRP1, CARD, and CASP1 inflammasome genes among 62 T. cruzi seropositive patients from Bolivia (38 cases with CCC and 24 asymptomatic controls) to uncover associations with CCC. All subjects underwent a complete medical examination including electrocardiogram (EKG) and echocardiogram. After genotype calling and quality control filtering with exclusion of 3 cases and 3 controls, association analysis was performed across 76 directly genotyped SNPs in NLRP1, CARD, and CASP1 genes, adjusting for age, sex, and population stratification. One SNP (rs11651270; Bonferroni-corrected p = 0.036) corresponding to a missense mutation in NLPR1 was found to be significant after adjustment for multiple testing, and a suggestive association was seen in CARD11 (rs6953573; Bonferroni-corrected p = 0.060). Although limited by sample size, the study results suggest variations in the inflammasome, particularly in NLRP1 and CARD11, may be associated with CCC.
Improved DNA extraction technique from clot for the diagnosis of Chagas disease
(Public Library of Science, 2019) Holger Mayta; Yomara K. Romero; Alejandra Pando-Caciano; Manuela Verástegui; Freddy Tinajeros; Ricardo Bozo; Josephine Henderson-Frost; Rony Colanzi; Jorge Flores; Richard M. Lerner
The new methodology for DNA extraction from clot samples improves the molecular diagnosis of Chagas disease.
Use of a Chagas Urine Nanoparticle Test (Chunap) to Correlate with Parasitemia Levels in T. cruzi/HIV Co-infected Patients
(Public Library of Science, 2016) Yagahira E. Castro-Sesquen; Robert H. Gilman; Carolina Mejía; Daniel E. Clark; Jeong Won Choi; Melissa Reimer-McAtee; Rosario Castro; Edward Valencia Ayala; Jorge Flores; Natalie M. Bowman
Chunap shows potential for early detection of Chagas reactivation. With appropriate adaptation, this diagnostic test can be used to monitor Chagas disease status in T. cruzi/HIV co-infected patients.
Use of a Chagas Urine Nanoparticle Test (Chunap) to Correlate with Parasitemia Levels in T. cruzi/HIV Co-infected Patients
(University of North Carolina at Chapel Hill, 2016) Yagahira E. Castro-Sesquen; Robert H. Gilman; Carolina Mejía; Daniel E. Clark; Jeong Won Choi; Melissa Reimer-McAtee; Rocío Requena Castro; Jorge Flores; Edward Valencia-Ayala; Faustino Torrico
Background Early diagnosis of reactivated Chagas disease in HIV patients could be lifesaving. In Latin America, the diagnosis is made by microscopical detection of the T. cruzi parasite in the blood; a diagnostic test that lacks sensitivity. This study evaluates if levels of T. cruzi antigens in urine, determined by Chunap (Chagas urine nanoparticle test), are correlated with parasitemia levels in T. cruzi/HIV co-infected patients. Methodology/Principal Findings T. cruzi antigens in urine of HIV patients (N = 55: 31 T. cruzi infected and 24 T. cruzi serology negative) were concentrated using hydrogel particles and quantified by Western Blot and a calibration curve. Reactivation of Chagas disease was defined by the observation of parasites in blood by microscopy. Parasitemia levels in patients with serology positive for Chagas disease were classified as follows: High parasitemia or reactivation of Chagas disease (detectable parasitemia by microscopy), moderate parasitemia (undetectable by microscopy but detectable by qPCR), and negative parasitemia (undetectable by microscopy and qPCR). The percentage of positive results detected by Chunap was: 100% (7/7) in cases of reactivation, 91.7% (11/12) in cases of moderate parasitemia, and 41.7% (5/12) in cases of negative parasitemia. Chunap specificity was found to be 91.7%. Linear regression analysis demonstrated a direct relationship between parasitemia levels and urine T. cruzi antigen concentrations (p<0.001). A cut-off of > 105 pg was chosen to determine patients with reactivation of Chagas disease (7/7). Antigenuria levels were 36.08 times (95% CI: 7.28 to 64.88) higher in patients with CD4+ lymphocyte counts below 200/mL (p = 0.016). No significant differences were found in HIV loads and CD8+ lymphocyte counts. Conclusion Chunap shows potential for early detection of Chagas reactivation. With appropriate adaptation, this diagnostic test can be used to monitor Chagas disease status in T. cruzi/HIV co-infected patients.