Estudio de Intervención en la evolución natural de la enfermedad de chagas evaluación del tratamiento antiparasitario específico
In this study is presented the comparative terapeutical experience comparing the Allopurinol, Benznidazol y Nifurtimox, in a prospective following in a long term, considering the responses to the parasitemia, specific serology and evolution of the clinic manifestations and complementaries in the 535...
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| Formato: | Artículo revista |
| Lenguaje: | Español |
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Universidad Nacional Córdoba. Facultad de Ciencias Médicas. Secretaria de Ciencia y Tecnología
2002
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/med/article/view/38486 |
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| Sumario: | In this study is presented the comparative terapeutical experience comparing the Allopurinol, Benznidazol y Nifurtimox, in a prospective following in a long term, considering the responses to the parasitemia, specific serology and evolution of the clinic manifestations and complementaries in the 535 chronic chagasic cases (44,5%), instead of 668 patients who did not get any treatment (1203 chagasic cases followed for more than 5 years average). This study was done between April 1984 and April 1994 in patients with and without cardiopathy, in the Córdoba Hospital and the Salud Estudiantil Direccion, Universidad Nacional de Córdoba (U.N.C.); from them,309 patients were given Allopurinol, 130 were given Benznidazol, and 96 were given Nifurtimox, with usual doses of Benznidazoland Nifurtimox, but with Allopurinol it was made an study evaluating the answering-doses, with a following time of posterapeutic average of 55,6 months (D.S.=+ - 57m. ) The comparative parameters were the starting clinic characteristics, the qualitative and quantitative for Chagas, the pre-treatment xerodiagnostic, the treatment fulfilment, the treatment duration, the adverse effects, the treatment abandon, the time of postreatment longitudinal following till the last clinic-complementary evaluation, the clinic characteristics at the end of the following period; quantitative and qualitative serology for Chagas after the treatment, and post-treatment xerodiagnostic. It was observe a prevalence of Electrocardiographic Changes in the ECG in rest, in the first complementary evaluation in76 of the 535 'Treated" and in the 225 "Notreated" patients, being Electrocardiographic abnormality proportion much more in the "No-treated" patients (P = 0.000000). After the end of the following period it was thought to have been found Miocardic Damage Progression in 120 patients "No- treated" and in 31 "Treated" patients (17,9% and 5,8% respectively) (P=0.0000000). The complications in the evolution course were proved in 113 of the "No-treated" and in 19 of the "Treated" patients (16,9% and 3,5%, being this a statistically significant difference (P = 0,0000000). The mortality along the evolution was proved in 37 of the "No- Treated:" patients and in 7 of the "Treated" patients (5,5% and 1,3%), being this a statistically significant difference (P = 0.00019). The most tolerated drug and the one with the least incidence of therapeutic abandons was the Allopurinol. The xerodiagnostic negativization percentages were 72.5% forAllopurinol, 76.4% for Benznidazol and 76.5% for Nifurti mox (non-significant differences). A year and two years after the end of the treatment was made a titied serology with the Inmunofluorescence and Indirect Hemoaglutination Tests, getting significant statistical differences between the three drugs, resulting lower the values obtain after the treatment with Benznidazol and Nifurtimox than with Allopunnol (P=0.0042 and P = 0.00039), respectively). The biggest proportion of Progression in the Cardiopathies, Complications, General Mortality and Attributed Mortality in "No Treated" (specially in older than 30 years) significant both for infected patient and slight cardiopathy, stabilises the possibility of stopping or reducing the morbid course of the Cronic Chagasic Cardiopathy, specially relevant in the formers, where the pathogenic process seems to be accelerated related to thelatters The negativation of the parasitemia and the parasitemia and the tittle disminution of the specific serology like effectiveness treatmentparameters and the stopping in the progression or dissemination of the incidence in new cases of Chronic Chagasic Cardiopathies were considered to be the real benefit of theantiparasitaric therapeutic in the Chagas Disease.As a conclusion, it is thought that the further the instauration of the specific antiparasitaric treatment the more the possibilities of efectiviness , as well as theincrease in the probabilities of preventing orreducing the incidence of cardiopathy in cronic infected, or to stop its evolution and reduce itsmorbimortality in patients with already installed cardiopathy |
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