Nayara Dornela Quintino

BACKGROUND: Chagas disease (ChD), a neglected cardiovascular condition, affects 7.5 to 10.5 million people worldwide. Opportunistic screening during routine electrocardiography may allow earlier detection of unrecognized infections, enabling timely antiparasitic therapy or optimized cardiac care. This study prospectively evaluated the feasibility and diagnostic accuracy of an artificial intelligence (AI)–enabled ECG model enriched with 3 epidemiological questions (AI-ECG-EPI model) as an opportunistic screening for ChD in endemic regions of Brazil. METHODS: We conducted a prospective study embedded in the Telehealth Network of Minas Gerais, Brazil, across 107 municipalities in hyperendemic and endemic regions. From October 2023 to September 2024, adults undergoing routine tele-ECGs were eligible. The primary exposure was the output of the AI-ECG-EPI model: all positive individuals and a 3:1 sample of negative individuals were invited for serology (index test–dependent sampling), the reference standard. Weighted analyses (inverse probability) accounted for this sampling design. Diagnostic metrics included sensitivity, specificity, predictive values, likelihood ratios, area under the receiver operating characteristics curve, and area under the precision recall curve. The AI-ECG-EPI model was compared with both an epidemiological questions model and an AI ECG–only model. RESULTS: Among 75 779 eligible ECGs, the AI-ECG-EPI model was available for 59 154 individuals; 6812 (11.5%) screened positive. A total of 7804 selected were invited for serology, and 3509 completed testing (2517 positive; 992 negative). ChD was confirmed in 36.8% of positive and 9.3% of negative individuals. The weighted prevalence of ChD was 12.2%. Sensitivity was 34.3%, specificity 91.6%, harmonic mean of precision and recall score 0.52, and diagnostic odds ratio 5.69. The AI-ECG-EPI model showed higher discrimination than both the epidemiological questions model and AI ECG–only model (area under the receiver operating characteristics curve, 77.6% versus 70.0% and 64.5%, respectively; P <0.001). Precision recall curves showed higher precision across most recall levels. Exploratory analysis suggested improved risk reclassification (net reclassification improvement, 0.503). Performance was higher in women and in individuals with Chagas cardiomyopathy. CONCLUSIONS: In this community-based study, an AI-ECG-EPI model integrated into a public telecardiology network enabled feasible opportunistic screening for ChD in primary care. It showed acceptable diagnostic accuracy, with higher discrimination than epidemiological questions and AI ECG–only models, and identified many previously undiagnosed patients in endemic regions, supporting its potential role in scalable screening strategies. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02646943.

Background: Chagas disease (CD) is a neglected endemic infectious disease. Primary health care (PHC) is responsible for delivering care to patients with CD in an integrated manner with other levels of the health system. We aimed to describe the use of implementation science (IS) as a tool for developing a care pathway for patients with CD from the perspective of the Brazilian Chronic Care Model (BCCM). Methods: This study was conducted in the large municipality of Minas Gerais, Brazil. A diagnostic phase was conducted to identify barriers and facilitators related to CD care. The findings from this stage were analyzed using IS frameworks. Subsequently, the BCCM was adapted as a logical model to guide the creation of a care pathway. Health managers and professionals from the municipalities were trained to implement the proposed actions. After implementation, process and outcome indicators were monitored over a 12-month period. Results: IS proved to be an effective strategy for applying BCCM to patients with CD in PHC settings. A total of 267 health professionals were trained. After the intervention, the following indicators increased: risk factor screening, serological testing, diagnosis, and antiparasitic treatment for CD. Conclusion: The development of a CD care pathway using IS tools integrated with the BCCM enabled the incorporation of processes into PHC and suggested that this model may be replicated in other contexts as well as for other chronic conditions requiring longitudinal care.

Resumo Objetivo Avaliar se as internações por acidente vascular cerebral (AVC) apresentaram relação com a doença de Chagas e com o índice de vulnerabilidade da doença de Chagas em Minas Gerais. Métodos Tratou-se de estudo observacional analítico de base populacional. Utilizaram-se registros do Sistema de Informações Hospitalares do Sistema Único de Saúde de Minas Gerais de 2022. A seleção dos dados de internações hospitalares foi baseada na Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde, na qual o AVC foi registrado como causa primária e a doença de Chagas/sentinelas, como causa secundária. Taxas de internações por AVC foram estimadas e conduziu-se análise de correlação do índice de vulnerabilidade da doença de Chagas e da prevalência de internações por AVC para Minas Gerais e suas macrorregiões. Resultados Em 2022, foram registradas 25.813 internações por AVC como causa primária, e destas, somente 18 apresentaram registro da doença de Chagas/sentinelas como causa secundária, sendo a maioria registrada na macrorregião Centro (n=10). A correlação entre internações por AVC e o índice de vulnerabilidade da doença de Chagas foi fraca (r=0,145) e não significativa, apesar da coincidência entre macrorregiões com maiores taxas de internação por AVC e maiores índices de vulnerabilidade da doença de Chagas (Vale do Jequitinhonha e Norte). Conclusões Embora haja alto número de internações por AVC no Sistema Único de Saúde em Minas Gerais, somente 18 desses registros foram relacionados à doença de Chagas/sentinelas, o que pode sugerir subnotificação relativa à doença de Chagas e incerteza quanto à qualidade de tais registros.

Objective To assess whether hospitalizations due to stroke were associated with Chagas disease and the Chagas disease vulnerability index in the state of Minas Gerais. Methods This was a population-based analytical observational study. Data were obtained from the Hospital Information System of the Brazilian National Health System in Minas Gerais for the year 2022. Hospitalization records were selected based on the International Statistical Classification of Diseases and Related Health Problems, in which stroke was recorded as the primary cause and Chagas disease/sentinels as the secondary cause. Stroke-related hospitalization rates were estimated, and a correlation analysis was conducted between the Chagas disease vulnerability index and stroke hospitalization prevalence in Minas Gerais and its health macro-regions. Results In 2022, a total of 25,813 hospitalizations due to stroke as the primary cause were recorded, of which only 18 included Chagas disease/sentinels as the secondary cause, most of them in the Central macro-region (n=10). The correlation between stroke-related hospitalizations and the Chagas disease vulnerability index was weak (r=0.145) and not statistically significant, despite the overlap of macro-regions with higher stroke-related hospitalization rates and higher Chagas disease vulnerability index scores (Jequitinhonha Valley and North). Conclusion Although there was a high number of stroke-related hospitalizations in the Brazilian National Health System in Minas Gerais, only 18 of these records were associated with Chagas disease/sentinels, which may suggest underreporting of Chagas disease and uncertainty regarding the quality of such records.

Chagas disease (ChD) remains a significant public health concern in the Americas, with challenges to accurately assessing its mortality burden due to under-reporting and misclassification. This study aimed to analyze mortality patterns of two cohorts of individuals with ChD—one comprising asymptomatic individuals with positive serology (REDS) and another with patients showing Chagas cardiomyopathy (SaMi-Trop)—to propose a method for estimating the potential under-registration of Chagas-related deaths and to find the factors influencing the identification of ChD as the underlying cause of death. We carried out a retrospective analysis of mortality data from these cohorts together with data on the Brazilian Mortality Information System. Causes of death were classified according to ICD-10 codes, and an expert review was used to find possible Chagas-related deaths. Logistic regression was used to explore predictors of ChD identification considering demographic and clinical variables. Of 2,488 patients, 381 died, 28.9% attributed to ChD, predominantly chronic ChD with cardiac involvement (B57.2). Using our method, we estimated a 53.8% potential under-registration rate for possible Chagas deaths. Males were negatively associated with Chagas disease identification, with an odds ratio of 0.52 (95%CI 0.24–1.1). No other significant associations were found, and the overall significance of the model was low. Our findings provide a potential measurement of under-registration, indicating that it may be substantial. These results underscore the need for improved identification and accurate reporting on death certificates. Strengthening the quality of mortality data is essential to understand Chagas-related mortality and guide public health strategies to reduce its impact.

: The aims of this study were to estimate the prevalence of gastrointestinal manifestations among individuals with positive serology for Chagas disease (ChD) and to describe the clinical gastrointestinal manifestations of the disease. A systematic review with meta-analysis was conducted based on the criteria and recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PubMed, Scopus, Virtual Health Library, Web of Science, and Embase databases were used to search for evidence. Two reviewers independently selected eligible articles and extracted data. RStudio^® software was used for the meta-analysis. For subgroup analysis, the studies were divided according to the origin of the individuals included: 1) individuals from health units were included in the health care service prevalence analysis, and 2) individuals from the general population were included in the population prevalence analysis. A total of 2,570 articles were identified, but after removal of duplicates and application of inclusion criteria, 24 articles were included and 21 were part of the meta-analysis. Most of the studies were conducted in Brazil. Radiological diagnosis was the most frequent method used to identify the gastrointestinal clinical form. The combined effect of meta-analysis studies showed a prevalence of gastrointestinal manifestations in individuals with ChD of 12% (95% CI, 8.0–17.0%). In subgroup analysis, the prevalence for studies involving health care services was 16% (95% CI, 11.0–23.0%), while the prevalence for population-based studies was 9% (95% CI, 5.0–15.0%). Megaesophagus and megacolon were the main forms of ChD presentation in the gastrointestinal form. The prevalence of gastrointestinal manifestations of ChD was 12%. Knowing the prevalence of ChD in its gastrointestinal form is an important step in planning health actions for these patients.

Chagas disease (ChD) is a neglected tropical disease that is caused by the protozoan parasite Trypanosoma cruzi and can negatively impact quality of life (QoL). This study aimed to assess and compare QoL between individuals with and without ChD.

Chagas disease (CD) is a neglected disease caused by the protozoan Trypanosoma cruzi. It has high morbidity and mortality rates and mainly affects socially vulnerable populations. This is a cross-sectional study, with retrospective and prospective data collection. Using questionnaires applied to environmental surveillance coordinators, we characterized the status of CD surveillance activities in municipalities endemic for the disease in Northern Minas Gerais State (MG) and Jequitinhonha Valley (Vale do Jequitinhonha). Moreover, we spatialized the vulnerability index for chronic CD in the study area. The population consisted of 22 environmental surveillance coordinators, active in 2020, from Northern MG and Jequitinhonha Valley, 21 municipalities included in the SaMi-Trop research project, and Montes Claros municipality. After applying the questionnaires to the coordinators, a descriptive analysis of the variables was performed. To characterize the active municipalities, the explanatory variables collected in the questionnaire were compared with the dichotomous variable. Bivariate descriptive analysis was performed. Finally, geoprocessing techniques were used to spatialize the data and prepare maps. Regarding the team of endemic combat agents (ECA), 90.9% reported the lack of a specific team for CD vector control actions. Of the 22 municipalities participating in this study, nine were active (41.1%). Only 25% (n=2) of active municipalities (9% of the municipalities studied) met the target of visiting 50% of households per year. Finally, 81.1% of the coordinators stated that in their municipality, they developed actions linked to primary health care (PHC). The implementation of CD surveillance activities weakened in the endemic region. Few municipalities have a surveillance team, with low regularity of active surveillance and noncompliance with the program’s goal. The results suggest insufficient recording of activities in the information system, considering that there are municipalities that report performing the activities, but no production record was observed in the system.

Numerous tests employed to predict cardiac and functional status are expensive and not widely accessible for a considerable number of patients, particularly those diagnosed with Chagas disease (CD) residing in remote and endemic regions. To date, there is no knowledge of studies that have validated instruments that address functionality in an expanded way, including the biopsychosocial factors in patients with CD. This study aims to evaluate the psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS 2.0), in its 12-item shortened version (WHODAS-12) when applied to patients with CD. This is a cross-sectional study of a prospective cohort that follows individuals with CD (SaMi-Trop). Data collection took place between October 2019 and March 2020. In the interviews, sociodemographic information, life habits, clinical information, and indicators of disability measured by WHODAS-12 were collected. Descriptive analysis, internal consistency and construct validity of the instrument were performed. A total of 628 patients with CD were interviewed, most were women (69.5%), their mean age was of 57 years, and most declared an average self-perception of health (43.4%). The 12 items of WHODAS-12 were distributed into three factors, which together account for 61% of the variance. The Kaiser–Meyer–Olkin (KMO) index was 0.90, indicating adequacy of the sample for factor analysis. The internal consistency of the global scale showed alpha = 0.87. The percentage of incapacity was 16.05%, indicating mild incapacity for the evaluated patients. WHODAS-12 is a valid and reliable measure to assess the disability of the Brazilian population with CD.

Resumo Objetivo Descrever a vigilância ativa dos eventos adversos pós-vacinação, sua incidência e fatores associados, em um município de Minas Gerais, Brasil. Métodos Coorte prospectiva realizada na Atenção Primária à Saúde, entre 2017 e 2018. Foram acompanhados 384 indivíduos que receberam vacinas, excluindo-se aqueles que tiveram eventos adversos prévios. Na linha de base, foram coletadas informações sociodemográficas, de saúde e histórico de vacinação e, no seguimento, as características do evento adverso e das ações de vigilância epidemiológica. Estimou-se taxa de [...] Resumo Objetivo Descrever a vigilância ativa dos eventos adversos pós-vacinação, sua incidência e fatores associados, em um município de Minas Gerais, Brasil. Métodos Coorte prospectiva realizada na Atenção Primária à Saúde, entre 2017 e 2018. Foram acompanhados 384 indivíduos que receberam vacinas, excluindo-se aqueles que tiveram eventos adversos prévios. Na linha de base, foram coletadas informações sociodemográficas, de saúde e histórico de vacinação e, no seguimento, as características do evento adverso e das ações de vigilância epidemiológica. Estimou-se taxa de