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Papers by Claudia Di Lorenzo Oliveira
Revista do Instituto de Medicina Tropical de São Paulo, 2022
This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License.
Journal of Clinical Immunology, 2021
Cardiomyopathies are an important cause of heart failure and sudden cardiac death. Little is know... more Cardiomyopathies are an important cause of heart failure and sudden cardiac death. Little is known about the role of rare genetic variants in inflammatory cardiomyopathy. Chronic Chagas disease cardiomyopathy (CCC) is an inflammatory cardiomyopathy prevalent in Latin America, developing in 30% of the 6 million patients chronically infected by the protozoan Trypanosoma cruzi, while 60% remain free of heart disease (asymptomatic (ASY)). The cytokine interferon-γ and mitochondrial dysfunction are known to play a major pathogenetic role. Chagas disease provides a unique model to probe for genetic variants involved in inflammatory cardiomyopathy. Methods We used whole exome sequencing to study nuclear families containing multiple cases of Chagas disease. We searched for rare pathogenic variants shared by all family members with CCC but absent in infected ASY siblings and in unrelated ASY. Results We identified heterozygous, pathogenic variants linked to CCC in all tested families on 22 d...
Circulation, 2021
Background: There are few contemporary cohorts of Trypanosoma cruzi –seropositive individuals, an... more Background: There are few contemporary cohorts of Trypanosoma cruzi –seropositive individuals, and the basic clinical epidemiology of Chagas disease is poorly understood. Herein, we report the incidence of cardiomyopathy and death associated with T. cruzi seropositivity. Methods: Participants were selected in blood banks at 2 Brazilian centers. Cases were defined as T. cruzi –seropositive blood donors. T. cruzi –seronegative controls were matched for age, sex, and period of donation. Patients with established Chagas cardiomyopathy were recruited from a tertiary outpatient service. Participants underwent medical examination, blood collection, ECG, and echocardiogram at enrollment (2008–2010) and at follow-up (2018–2019). The primary outcomes were all-cause mortality and development of cardiomyopathy, defined as the presence of a left ventricular ejection fraction <50% or QRS complex duration ≥120 ms, or both. To handle loss to follow-up, a sensitivity analysis was performed using ...
Vox Sanguinis, 2020
Background and objectives-Incidence in first-time and repeat blood donors is an important measure... more Background and objectives-Incidence in first-time and repeat blood donors is an important measure of transfusion-transmitted HIV infection (TT-HIV) risk. This study assessed HIV incidence over time at four large blood centers in Brazil. Materials and methods-Donations were screened and confirmed using serological assays for HIV from 2007-2016, and additionally screened by nucleic acid testing from 2011 forward. Limiting antigen (LAg) avidity testing was conducted on HIV seroreactive samples from first-time donors to classify whether an infection was recently acquired. We calculated incidence in firsttime donors using the mean duration of recent infection and in repeat donors using classical methods. Time and demographic trends were assessed using Poisson regression. Results-Over the 10-year period, HIV incidence in first-time donors was highest in Recife (45.1/100,000 person-years (10 5 py)) followed by São Paulo (32.2/10 5 py) and then Belo Horizonte (23.3/10 5 py), and in repeat donors was highest in Recife (33.2/10
European Heart Journal, 2018
Assessment and intervention in tricuspid, the no longer forgotten valve / Various cardiomyopahies... more Assessment and intervention in tricuspid, the no longer forgotten valve / Various cardiomyopahies 311 years. The indication(s) for TVR were: any TR with an enlarged annulus (n=6), moderate or less TR (n=5), moderate or more (n=5), any TR (n=3). The majority of patients underwent repair with an annuloplasty ring while a minority underwent suture annuloplasty. There was no difference in 30-day/in-hospital mortality between TVR+ and TVR− (RR: 1.31 95% confidence interval (95% CI): 0.85, 2.02, p=0.25). The incidence of new permanent pacemaker implantation was higher in the TVR+ group (RR: 2.73, 95% CI: 2.57, 2.89, p<0.01). TVR+ was protective against late moderate to severe TR (IRR: 0.26, 95% CI: 0.16, 0.43; p<0.01) and severe TR (IRR: 0.32, 95% CI: 0.11, 0.91, p=0.03). There was a trend towards a lower rate of late TV reoperation in a pooled analysis of five studies (IRR: 0.36, 95% CI: 0.13,1.02; p=0.06). Overall, there was no difference in late mortality between TVR+ and TVR− (Figure-IRR: 0.87, 95% CI: 0.63, 1.20 p=0.39).
European journal of heart failure, 2015
The significance of detection of Trypanosoma cruzi DNA in blood of antibody-positive patients for... more The significance of detection of Trypanosoma cruzi DNA in blood of antibody-positive patients for risk of development of Chagas heart disease is not well established. The objective of this study was to compare detection of T. cruzi DNA with known clinical and laboratory markers of Chagas cardiomyopathy (CC) severity. This is a case-control study nested within a retrospective cohort developed in Brazil to understand the natural history of Chagas disease. The study enrolled 499 T. cruzi seropositive blood donors (SP-BD) and 488 frequency matched seronegative control donors (SN-BD) who had donated between 1996 and 2002, and 101 patients with clinically diagnosed CC. In 2008-2010 all enrolled subjects underwent a health questionnaire, medical examination, electrocardiograms and echocardiograms and polymerase chain reaction (PCR) analyses. A blinded panel of three cardiologists adjudicated the outcome of CC. Trypanosoma cruzi kinetoplast minicircle sequences were amplified by real-time P...
Cadernos de Saúde Pública, 2010
Este estudo teve como objetivo descrever a distribuição espacial e temporal dos candidatos à doaç... more Este estudo teve como objetivo descrever a distribuição espacial e temporal dos candidatos à doação de sangue, do Município de Belo Horizonte, Minas Gerais, Brasil, que se apresentaram no hemocentro da Fundação Hemominas, nos anos de 1994 e 2004. Comparou no espaço e no espaço-tempo as características idade, sexo e aptidão clínica destes candidatos. As informações de 1994, obtidas de estudo transversal, e as de 2004, amostrados entre os candidatos à doação durante o ano. As amostras foram georreferenciadas através dos endereços de residência. As técnicas espaciais utilizadas foram: mapas Kernel, mapas temáticos de taxas Bayesianas empíricas e de taxas brutas e o índice de Moran global. Os resultados indicaram que a distribuição espacial de candidatos não foi aleatória. Os mapas Kernel auxiliaram na detecção de locais com maior ou menor concentração de candidatos. Os mapas temáticos descreveram a concentração de candidatos relativos à população para as diferentes categorias analisada...
Expert opinion on drug delivery, 2015
Nucleic acid delivery is a complex process that requires transport across numerous extracellular ... more Nucleic acid delivery is a complex process that requires transport across numerous extracellular and intracellular barriers, whose impact is often neglected during optimization studies. As such, the development of nonviral vectors for efficient delivery would benefit from an understanding of how these barriers relate to the physicochemical properties of lipoplexes and polyplexes. This review focuses on the evaluation of parameters associated with barriers to delivery such as blood and immune cells compatibility which, as a collective, may serve as a useful prescreening tool for the advancement of nonviral vectors in vivo. An outline of the most relevant rationally developed polyplexes and lipoplexes for clinical application is also given. The evaluation of scientifically recognized parameters enabled the identification of systemic delivered nonviral vectors' behavior while in blood as one of the key determinants of vectors function and activity both in vitro and in vivo. This mu...
Transfusion Medicine, 2014
To identify the demographic characteristics, risk factors and motivations for donating among bloo... more To identify the demographic characteristics, risk factors and motivations for donating among blood donors with reactive serologic tests for syphilis. Post-donation interviews with syphilis seropositive blood donors improve recruitment and screening strategies. This case-control study compares 75 Venereal Disease Research Laboratory (VDRL) &amp;gt; 8, EIA+ (enzyme immunoassay) and FTA-ABS+ (fluorescent treponemal antibody); 80 VDRL-, EIA+ and FTA-ABS+; and 34 VDRL- and EIA- donors between 2004 and 2009. Donors were assessed by their demographic characteristics, sexual behaviour, history of alcohol and illicit drugs use, and motivations to donate. Donors with VDRL &amp;gt; 8 were more likely to be divorced [AOR = 12·53; 95% confidence interval (CI) 1·30-120·81], to have had more than six sexual partners (AOR=7·1; 95% CI 1·12-44·62) and to report male-male-sex in the past 12 months (AOR=8·18; 95% CI 1·78-37·60). Donors with VDRL-, EIA+ and FTA-ABS+ were less likely to be female (AOR=0·26; 95% CI 0·07-0·96), more likely to be older (AOR=10·2; 95% CI 2·45-42·58 ≥ 39 and &amp;lt;60 years old) and to have had more than six sexual partners in the past 12 months (AOR = 8·37; 95% CI 1·49-46·91). There was no significant difference among groups regarding illicit drugs use; 30·7% (VDRL &amp;gt; 8) and 12·5% (VDRL-, EIA+ and FTA-ABS+) of donors reported that they had been at risk for HIV infection (P = 0·004). One-third of donors came to the blood bank to help a friend or a relative who needed blood. Although donors exposed to syphilis reported and recognised some high risk behaviour, most were motivated by direct appeal to donate blood. Monitoring the risk profile of blood donors can benefit public health and improve blood safety.
Revista do Instituto de Medicina Tropical de São Paulo, 2021
This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License.
0 0 1 227 1294 UFSJ 10 3 1518 14.0 Normal 0 false false false PT-BR JA X-NONE Objetivo: Avaliar a... more 0 0 1 227 1294 UFSJ 10 3 1518 14.0 Normal 0 false false false PT-BR JA X-NONE Objetivo: Avaliar a prevalencia da sindrome metabolica (SM) em mulheres com mais de 40 anos, comparando dois criterios internacionais. Metodos: Estudo descritivo transversal, de base populacional, envolvendo 93 mulheres, com idade entre 40 a 59 anos, acompanhadas em Unidades Basicas e Programas de Saude da Familia de Divinopolis-MG. Foram realizadas avaliacoes clinicas, antropometricas e bioquimicas. Para o diagnostico de SM foram empregados dois criterios internacionais: Adult Treatment Panel III of the National Cholesterol Education Program (NCEP/ATP III) e International Diabetes Federation (IDF), que utilizam a presenca de tres ou mais dos seguintes criterios alterados: circunferencia da cintura (CC), triglicerideos (TG), HDL, pressao arterial e glicemia. Resultados: Foram avaliadas 93 pacientes, 54 mulheres entre 40 a 49 anos (58,7%) e 39 entre 50 a 59 anos (41,3%). O parâmetro individual mais alterado...
Revista do Instituto de Medicina Tropical de São Paulo, 2021
Revista do Instituto de Medicina Tropical de São Paulo, 2021
PLOS Neglected Tropical Diseases, 2020
Hygeia - Revista Brasileira de Geografia Médica e da Saúde, 2018
Journal of Electrocardiology, 2018
Chagas cardiomyopathy is the most harmful complication of Chagas disease. The electrocardiogram i... more Chagas cardiomyopathy is the most harmful complication of Chagas disease. The electrocardiogram is a well-studied exam and has been considered an important tool for detection and evaluation of Chagas cardiomyopathy since the first years of its description. Many of its abnormalities have been described as associated with a worse prognosis. Serum BNP levels were described as inversely related to the left ventricular ejection fraction and as an independent predictor of death. It was not reported how electrocardiographic alterations correlate to NT-proBNP and its analog. The present study aims to describe the baseline electrocardiograms of a large cohort of patients with Chagas disease from endemic area and to establish an association between the number of electrocardiogram alterations and high levels of NT-ProBNP in Chagas disease patients. This study selected 1959 Chagas disease patients in 21 municipalities within a limited region in the northern part of the State of Minas Gerais (Brazil), 1084 of them had Chagas cardiomyopathy. NT-proBNP levels were suggestive of heart failure in 11.7% of this population. One or more electrocardiographic alterations have an Odds Ratio of 9.12 (CI 95% 5.62-14.80) to have NT-proBNP elevation. Considering the association between the number of 1, 2, and 3 or more alterations in electrocardiogram and NT-proBNP elevation, the ORs were 7.11 (CI 95% 4.33-11.67); 16.04 (CI 95% 9.27-27.77) and 47.82 (CI 95% 17.98-127.20), respectively. The presence and the number of typical electrocardiographic alterations of Chagas disease are independently associated with the severity of the cardiomyopathy.
PLOS Neglected Tropical Diseases, 2018
Revista do Instituto de Medicina Tropical de São Paulo, 2022
This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License.
Journal of Clinical Immunology, 2021
Cardiomyopathies are an important cause of heart failure and sudden cardiac death. Little is know... more Cardiomyopathies are an important cause of heart failure and sudden cardiac death. Little is known about the role of rare genetic variants in inflammatory cardiomyopathy. Chronic Chagas disease cardiomyopathy (CCC) is an inflammatory cardiomyopathy prevalent in Latin America, developing in 30% of the 6 million patients chronically infected by the protozoan Trypanosoma cruzi, while 60% remain free of heart disease (asymptomatic (ASY)). The cytokine interferon-γ and mitochondrial dysfunction are known to play a major pathogenetic role. Chagas disease provides a unique model to probe for genetic variants involved in inflammatory cardiomyopathy. Methods We used whole exome sequencing to study nuclear families containing multiple cases of Chagas disease. We searched for rare pathogenic variants shared by all family members with CCC but absent in infected ASY siblings and in unrelated ASY. Results We identified heterozygous, pathogenic variants linked to CCC in all tested families on 22 d...
Circulation, 2021
Background: There are few contemporary cohorts of Trypanosoma cruzi –seropositive individuals, an... more Background: There are few contemporary cohorts of Trypanosoma cruzi –seropositive individuals, and the basic clinical epidemiology of Chagas disease is poorly understood. Herein, we report the incidence of cardiomyopathy and death associated with T. cruzi seropositivity. Methods: Participants were selected in blood banks at 2 Brazilian centers. Cases were defined as T. cruzi –seropositive blood donors. T. cruzi –seronegative controls were matched for age, sex, and period of donation. Patients with established Chagas cardiomyopathy were recruited from a tertiary outpatient service. Participants underwent medical examination, blood collection, ECG, and echocardiogram at enrollment (2008–2010) and at follow-up (2018–2019). The primary outcomes were all-cause mortality and development of cardiomyopathy, defined as the presence of a left ventricular ejection fraction <50% or QRS complex duration ≥120 ms, or both. To handle loss to follow-up, a sensitivity analysis was performed using ...
Vox Sanguinis, 2020
Background and objectives-Incidence in first-time and repeat blood donors is an important measure... more Background and objectives-Incidence in first-time and repeat blood donors is an important measure of transfusion-transmitted HIV infection (TT-HIV) risk. This study assessed HIV incidence over time at four large blood centers in Brazil. Materials and methods-Donations were screened and confirmed using serological assays for HIV from 2007-2016, and additionally screened by nucleic acid testing from 2011 forward. Limiting antigen (LAg) avidity testing was conducted on HIV seroreactive samples from first-time donors to classify whether an infection was recently acquired. We calculated incidence in firsttime donors using the mean duration of recent infection and in repeat donors using classical methods. Time and demographic trends were assessed using Poisson regression. Results-Over the 10-year period, HIV incidence in first-time donors was highest in Recife (45.1/100,000 person-years (10 5 py)) followed by São Paulo (32.2/10 5 py) and then Belo Horizonte (23.3/10 5 py), and in repeat donors was highest in Recife (33.2/10
European Heart Journal, 2018
Assessment and intervention in tricuspid, the no longer forgotten valve / Various cardiomyopahies... more Assessment and intervention in tricuspid, the no longer forgotten valve / Various cardiomyopahies 311 years. The indication(s) for TVR were: any TR with an enlarged annulus (n=6), moderate or less TR (n=5), moderate or more (n=5), any TR (n=3). The majority of patients underwent repair with an annuloplasty ring while a minority underwent suture annuloplasty. There was no difference in 30-day/in-hospital mortality between TVR+ and TVR− (RR: 1.31 95% confidence interval (95% CI): 0.85, 2.02, p=0.25). The incidence of new permanent pacemaker implantation was higher in the TVR+ group (RR: 2.73, 95% CI: 2.57, 2.89, p<0.01). TVR+ was protective against late moderate to severe TR (IRR: 0.26, 95% CI: 0.16, 0.43; p<0.01) and severe TR (IRR: 0.32, 95% CI: 0.11, 0.91, p=0.03). There was a trend towards a lower rate of late TV reoperation in a pooled analysis of five studies (IRR: 0.36, 95% CI: 0.13,1.02; p=0.06). Overall, there was no difference in late mortality between TVR+ and TVR− (Figure-IRR: 0.87, 95% CI: 0.63, 1.20 p=0.39).
European journal of heart failure, 2015
The significance of detection of Trypanosoma cruzi DNA in blood of antibody-positive patients for... more The significance of detection of Trypanosoma cruzi DNA in blood of antibody-positive patients for risk of development of Chagas heart disease is not well established. The objective of this study was to compare detection of T. cruzi DNA with known clinical and laboratory markers of Chagas cardiomyopathy (CC) severity. This is a case-control study nested within a retrospective cohort developed in Brazil to understand the natural history of Chagas disease. The study enrolled 499 T. cruzi seropositive blood donors (SP-BD) and 488 frequency matched seronegative control donors (SN-BD) who had donated between 1996 and 2002, and 101 patients with clinically diagnosed CC. In 2008-2010 all enrolled subjects underwent a health questionnaire, medical examination, electrocardiograms and echocardiograms and polymerase chain reaction (PCR) analyses. A blinded panel of three cardiologists adjudicated the outcome of CC. Trypanosoma cruzi kinetoplast minicircle sequences were amplified by real-time P...
Cadernos de Saúde Pública, 2010
Este estudo teve como objetivo descrever a distribuição espacial e temporal dos candidatos à doaç... more Este estudo teve como objetivo descrever a distribuição espacial e temporal dos candidatos à doação de sangue, do Município de Belo Horizonte, Minas Gerais, Brasil, que se apresentaram no hemocentro da Fundação Hemominas, nos anos de 1994 e 2004. Comparou no espaço e no espaço-tempo as características idade, sexo e aptidão clínica destes candidatos. As informações de 1994, obtidas de estudo transversal, e as de 2004, amostrados entre os candidatos à doação durante o ano. As amostras foram georreferenciadas através dos endereços de residência. As técnicas espaciais utilizadas foram: mapas Kernel, mapas temáticos de taxas Bayesianas empíricas e de taxas brutas e o índice de Moran global. Os resultados indicaram que a distribuição espacial de candidatos não foi aleatória. Os mapas Kernel auxiliaram na detecção de locais com maior ou menor concentração de candidatos. Os mapas temáticos descreveram a concentração de candidatos relativos à população para as diferentes categorias analisada...
Expert opinion on drug delivery, 2015
Nucleic acid delivery is a complex process that requires transport across numerous extracellular ... more Nucleic acid delivery is a complex process that requires transport across numerous extracellular and intracellular barriers, whose impact is often neglected during optimization studies. As such, the development of nonviral vectors for efficient delivery would benefit from an understanding of how these barriers relate to the physicochemical properties of lipoplexes and polyplexes. This review focuses on the evaluation of parameters associated with barriers to delivery such as blood and immune cells compatibility which, as a collective, may serve as a useful prescreening tool for the advancement of nonviral vectors in vivo. An outline of the most relevant rationally developed polyplexes and lipoplexes for clinical application is also given. The evaluation of scientifically recognized parameters enabled the identification of systemic delivered nonviral vectors' behavior while in blood as one of the key determinants of vectors function and activity both in vitro and in vivo. This mu...
Transfusion Medicine, 2014
To identify the demographic characteristics, risk factors and motivations for donating among bloo... more To identify the demographic characteristics, risk factors and motivations for donating among blood donors with reactive serologic tests for syphilis. Post-donation interviews with syphilis seropositive blood donors improve recruitment and screening strategies. This case-control study compares 75 Venereal Disease Research Laboratory (VDRL) &amp;gt; 8, EIA+ (enzyme immunoassay) and FTA-ABS+ (fluorescent treponemal antibody); 80 VDRL-, EIA+ and FTA-ABS+; and 34 VDRL- and EIA- donors between 2004 and 2009. Donors were assessed by their demographic characteristics, sexual behaviour, history of alcohol and illicit drugs use, and motivations to donate. Donors with VDRL &amp;gt; 8 were more likely to be divorced [AOR = 12·53; 95% confidence interval (CI) 1·30-120·81], to have had more than six sexual partners (AOR=7·1; 95% CI 1·12-44·62) and to report male-male-sex in the past 12 months (AOR=8·18; 95% CI 1·78-37·60). Donors with VDRL-, EIA+ and FTA-ABS+ were less likely to be female (AOR=0·26; 95% CI 0·07-0·96), more likely to be older (AOR=10·2; 95% CI 2·45-42·58 ≥ 39 and &amp;lt;60 years old) and to have had more than six sexual partners in the past 12 months (AOR = 8·37; 95% CI 1·49-46·91). There was no significant difference among groups regarding illicit drugs use; 30·7% (VDRL &amp;gt; 8) and 12·5% (VDRL-, EIA+ and FTA-ABS+) of donors reported that they had been at risk for HIV infection (P = 0·004). One-third of donors came to the blood bank to help a friend or a relative who needed blood. Although donors exposed to syphilis reported and recognised some high risk behaviour, most were motivated by direct appeal to donate blood. Monitoring the risk profile of blood donors can benefit public health and improve blood safety.
Revista do Instituto de Medicina Tropical de São Paulo, 2021
This is an open-access article distributed under the terms of the Creative Commons Attribution Li... more This is an open-access article distributed under the terms of the Creative Commons Attribution License.
0 0 1 227 1294 UFSJ 10 3 1518 14.0 Normal 0 false false false PT-BR JA X-NONE Objetivo: Avaliar a... more 0 0 1 227 1294 UFSJ 10 3 1518 14.0 Normal 0 false false false PT-BR JA X-NONE Objetivo: Avaliar a prevalencia da sindrome metabolica (SM) em mulheres com mais de 40 anos, comparando dois criterios internacionais. Metodos: Estudo descritivo transversal, de base populacional, envolvendo 93 mulheres, com idade entre 40 a 59 anos, acompanhadas em Unidades Basicas e Programas de Saude da Familia de Divinopolis-MG. Foram realizadas avaliacoes clinicas, antropometricas e bioquimicas. Para o diagnostico de SM foram empregados dois criterios internacionais: Adult Treatment Panel III of the National Cholesterol Education Program (NCEP/ATP III) e International Diabetes Federation (IDF), que utilizam a presenca de tres ou mais dos seguintes criterios alterados: circunferencia da cintura (CC), triglicerideos (TG), HDL, pressao arterial e glicemia. Resultados: Foram avaliadas 93 pacientes, 54 mulheres entre 40 a 49 anos (58,7%) e 39 entre 50 a 59 anos (41,3%). O parâmetro individual mais alterado...
Revista do Instituto de Medicina Tropical de São Paulo, 2021
Revista do Instituto de Medicina Tropical de São Paulo, 2021
PLOS Neglected Tropical Diseases, 2020
Hygeia - Revista Brasileira de Geografia Médica e da Saúde, 2018
Journal of Electrocardiology, 2018
Chagas cardiomyopathy is the most harmful complication of Chagas disease. The electrocardiogram i... more Chagas cardiomyopathy is the most harmful complication of Chagas disease. The electrocardiogram is a well-studied exam and has been considered an important tool for detection and evaluation of Chagas cardiomyopathy since the first years of its description. Many of its abnormalities have been described as associated with a worse prognosis. Serum BNP levels were described as inversely related to the left ventricular ejection fraction and as an independent predictor of death. It was not reported how electrocardiographic alterations correlate to NT-proBNP and its analog. The present study aims to describe the baseline electrocardiograms of a large cohort of patients with Chagas disease from endemic area and to establish an association between the number of electrocardiogram alterations and high levels of NT-ProBNP in Chagas disease patients. This study selected 1959 Chagas disease patients in 21 municipalities within a limited region in the northern part of the State of Minas Gerais (Brazil), 1084 of them had Chagas cardiomyopathy. NT-proBNP levels were suggestive of heart failure in 11.7% of this population. One or more electrocardiographic alterations have an Odds Ratio of 9.12 (CI 95% 5.62-14.80) to have NT-proBNP elevation. Considering the association between the number of 1, 2, and 3 or more alterations in electrocardiogram and NT-proBNP elevation, the ORs were 7.11 (CI 95% 4.33-11.67); 16.04 (CI 95% 9.27-27.77) and 47.82 (CI 95% 17.98-127.20), respectively. The presence and the number of typical electrocardiographic alterations of Chagas disease are independently associated with the severity of the cardiomyopathy.
PLOS Neglected Tropical Diseases, 2018