RESUMO
Achalasia is a primary esophageal motor disorder with a variety of causes. It is most common in Central and South America, where Chagas disease is endemic. In addition to the infectious etiology, achalasia can be idiopathic, autoimmune, or drug induced. It is an incurable, progressive condition that destroys the intramural nerve plexus, causing aperistalsis of the esophageal body and impaired relaxation of the lower esophageal sphincter. The literature on the treatment of achalasia comparing pneumatic dilation (PD) and laparoscopic Heller's myotomy (LHM) shows conflicting results. Therefore, a systemic review and meta-analysis are needed. A systematic review and meta-analysis of randomized controlled trials of PD and LHM, based on the preferred reporting items for systematic reviews and meta-analyses recommendations, was presented. The primary outcome was symptom remission based on the Eckardt score. Secondary outcomes were lower esophageal sphincter pressure (LESP), gastroesophageal reflux (GER), and perforation. A total of four studies were included in this analysis. The total number of patients was 404. Posttreatment symptom remission rates did not differ significantly between LHM and PD at 2 years (RD = 0.03, 95% CI [-0.05, 0.12], P = 0.62), or 5 years (RD = 0.13, 95% CI [-0.12, 0.39], P = 0.32). The posttreatment perforation rate was lower for LHM (RD = 0.04, 95% CI [-0.08, -0.01], P = 0.03). There was no significant difference in terms of LESP or GER. For the treatment of esophageal achalasia, LHM and PD were found to be similar in terms of their long-term efficacy, as well as in terms of the posttreatment GER rates. However, the perforation rate appears to be lower when LHM is employed.
Assuntos
Dilatação/métodos , Acalasia Esofágica/cirurgia , Miotomia de Heller/métodos , Laparoscopia/métodos , Adulto , Esfíncter Esofágico Inferior/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do TratamentoRESUMO
Field tests were carried out during the rainy season of 2001/2002 in São Luís de Montes Belos, Goiás, Brazil, to evaluate the potential of the entomopathogenic fungus, Beauveria bassiana, against peridomestic Triatoma sordida. An oil-water formulation of the isolate CG 14 (Embrapa) was applied in triatomine infested hen houses of four farms at a final concentration of 10(6) conidia/cm2. Numbers of T. sordida decreased over the next 25 days, after application of the fungus, and B. bassiana developed on dead insects in one hen house. A high number of B. bassiana colonies was detected in substrates collected in treated hen houses 24 h after application of CG 14. In the following three months the presence of B. bassiana declined to values found before treatment.
Assuntos
Ascomicetos , Óleos , Controle Biológico de Vetores , Triatoma/microbiologia , Animais , Brasil , Estações do Ano , Fatores de TempoRESUMO
Field tests were carried out during the rainy season of 2001/2002 in São Luís de Montes Belos, Goiás, Brazil, to evaluate the potential of the entomopathogenic fungus, Beauveria bassiana, against peridomestic Triatoma sordida. An oil-water formulation of the isolate CG 14 (Embrapa) was applied in triatomine infested hen houses of four farms at a final concentration of 10(6) conidia/cm². Numbers of T. sordida decreased over the next 25 days, after application of the fungus, and B. bassiana developed on dead insects in one hen house. A high number of B. bassiana colonies was detected in substrates collected in treated hen houses 24 h after application of CG 14. In the following three months the presenceof B. bassiana declined to values found before treatment.
Assuntos
Animais , Ascomicetos , Óleos , Controle Biológico de Vetores , Triatoma , Brasil , Estações do Ano , Fatores de TempoRESUMO
Entomological surveillance of Chagas' disease in São Paulo State has adopted a scheme that uses the locality as a unit for field work. Actions are prioritized according to infestation levels obtained by systematic search of triatomine (routine actions), bugs in areas with high infestation levels and in houses whose inhabitants report the presence of the bugs (reply to notification). The most prevalent triatominic species in Sao Paulo State at present are Triatoma sordida and Panstrongylus megistus. A comparative study of infestation levels obtained in houses and surroundings in routine search and replies to notification in the two-year periods of 90/91, 92/93 and 94/95, has shown average percentage positivity of 1.3 indoors in routine activity and 6.2 in the reply to notification. For the house surroundings the values were 8.6 and 18.2 respectively, no differences being found between the two-year periods. Replies to notification showed average percentage positivity (focus) in 26% of the houses. It was verified that the notifications had come from localities with prior infestation levels equal to zero (I = O), intermediary infestation levels (I < 5) and high infestation levels (I > 5), although the percentages of positive replies to notification were higher in those localities with high prior infestation levels. These results reinforce the importance of notification in the surveillance of vector species of the invasive type like those currently prevalent in Sao Paulo State.