Browsing by Autor "Lisbeth Ferrufino"

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    Chagas Cardiomyopathy in the Context of the Chronic Disease Transition
    (Public Library of Science, 2010) Alicia Hidrón; Robert H. Gilman; J Herrera Justiniano; Anna J. Blackstock; Carlos LaFuente; Walter Selum; M I Valderrama Calderón; Manuela Verástegui; Lisbeth Ferrufino; Eduardo Valencia
    Chagas cardiomyopathy remains an important cause of congestive heart failure in this hospital population, and should be evaluated in the context of the epidemiological transition that has increased risk of obesity, hypertension and chronic cardiovascular disease.
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    Pupillary Light Reflexes are Associated with Autonomic Dysfunction in Bolivian Diabetics But Not Chagas Disease Patients
    (American Society of Tropical Medicine and Hygiene, 2016) Anthony Halperin; Mónica J. Pajuelo; Jeffrey A. Tornheim; Nancy Vu; Andrés M. Carnero; Gerson Galdos‐Cardenas; Lisbeth Ferrufino; Marilyn Camacho; J Herrera Justiniano; Rony Colanzi
    Autonomic dysfunction is common in Chagas disease and diabetes. Patients with either condition complicated by cardiac autonomic dysfunction face increased mortality, but no clinical predictors of autonomic dysfunction exist. Pupillary light reflexes (PLRs) may identify such patients early, allowing for intensified treatment. To evaluate the significance of PLRs, adults were recruited from the outpatient endocrine, cardiology, and surgical clinics at a Bolivian teaching hospital. After testing for Chagas disease and diabetes, participants completed conventional autonomic testing (CAT) evaluating their cardiovascular responses to Valsalva, deep breathing, and orthostatic changes. PLRs were measured using specially designed goggles, then CAT and PLRs were compared as measures of autonomic dysfunction. This study analyzed 163 adults, including 96 with Chagas disease, 35 patients with diabetes, and 32 controls. PLRs were not significantly different between Chagas disease patients and controls. Patients with diabetes had longer latency to onset of pupil constriction, slower maximum constriction velocities, and smaller orthostatic ratios than nonpatients with diabetes. PLRs correlated poorly with CAT results. A PLR-based clinical risk score demonstrated a 2.27-fold increased likelihood of diabetes complicated by autonomic dysfunction compared with the combination of blood tests, CAT, and PLRs (sensitivity 87.9%, specificity 61.3%). PLRs represent a promising tool for evaluating subclinical neuropathy in patients with diabetes without symptomatic autonomic dysfunction. Pupillometry does not have a role in the evaluation of Chagas disease patients.