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Background and purpose: The carotid stent placement as a therapeutic option for carotid stenosis has been increasing among years; therefore, studies are required to evaluate the security and efficacy of its materials. The purpose of this study was to evaluate the distal filter and the proximal balloon-guided catheter with flow inversion as protection devices during carotid angioplasty and stenting. Methods: This is a retrospective, observational study of patients diagnosed with carotid stenosis treated with angioplasty between January 1, 2014, and June 30, 2020; we analyzed a radiology service database to compare the distal filter and the proximal balloon-guided catheter as protection devices during angioplasty. Results: One hundred seventy-five angioplasties were performed, the distal filter was the most prevalent embolic protection device used (66%), patients baseline characteristics did not differ between groups with different embolic protection devices, except for history of dyslipidemia (p < 0.000). As well, we did not find any significant differences between the groups in the device related complications, intervention time (p = 0.140), unrelated complications (p = 0.693) and functional independence at 90 days (p = 0.096). Conclusions: In our study the proximal balloon-guided catheter and the distal filter protection device as protection devices during the carotid stenting didn't show significant differences regarding complications related to the system. [ABSTRACT FROM AUTHOR]

Nifurtimox is indicated in Chagas disease but determining its effectiveness in chronic disease is hindered by the length of time needed to demonstrate negative serological conversion. We manually reviewed long-term follow-up data from hospital records of patients with chronic Chagas disease (N = 1,497) in Argentina diagnosed during 1967-1980. All patients were aged ≥18 years at diagnosis and were either treated with nifurtimox (n = 968) or received no antitrypanosomal treatment (n = 529). The primary endpoint was negative seroconversion (the "event"), defined as a change from positive to negative in the serological or parasitological laboratory test used at diagnosis. Time to event was from baseline visit to date of endpoint event or censoring. The effectiveness of nifurtimox versus no treatment was estimated with Cox proportional hazard regression using propensity scores with overlap weights to calculate the hazard ratio and 95% confidence interval. The nifurtimox group was younger than the untreated group (mean, 32.4 vs. 40.3 years), with proportionally fewer females (47.9% vs. 60.1%), and proportionally more of the nifurtimox group than the untreated group had clinical signs and symptoms of Chagas disease at diagnosis (28.9% vs. 14.0%). Median maximum daily dose of nifurtimox was 8.0 mg/kg/day (interquartile range [IQR]: 8.0-9.0) and median treatment duration was 44 days (IQR: 1-90). Median time to event was 2.1 years (IQR: 1.0-4.5) for nifurtimox-treated and 2.4 years (IQR: 1.0-4.2) for untreated patients. Accounting for potential confounders, the estimated hazard ratio (95% confidence interval) for negative seroconversion was 2.22 (1.61-3.07) favoring nifurtimox. Variable treatment regimens and follow-up duration, and an uncommonly high rate of spontaneous negative seroconversion, complicate interpretation of this epidemiological study, but with the longest follow-up and largest cohort analyzed to date it lends weight to the benefit of nifurtimox in adults with chronic Chagas disease. Trial registration: The study protocol was registered at ClinicalTrials.gov: NCT03784391., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: David Vizcaya, Ulrike Grossmann, Frank Kleinjung, Ruiping Zhang and Kiliana Suzart-Woischnik are employees of Bayer. Leylen Colmegna is an employee of LAT Research, Argentina. Sandra Seu, Teresa Ramirez and Oscar Ledesma have nothing to disclose.

No studies exist on sister-chromatid exchange (SCE) formation in chagasic patients therapeutically exposed to nifurtimox (NFX) or benznidazol (BZ). In the present study SCE was analyzed in cultures of peripheral lymphocytes of patients aged 11 months to 11 years treated with NFX 12-15 mg/kg/d for 60 days or with BZ 5 mg/kg/d for 30 days. Chagasic patients before treatment constituted a control group. A mean of 30 metaphases were examined for each individual. All treated patients compared with untreated controls did not show a significant increase in SCE frequency. Compared with the percentage of chromosomal aberrations in these patients and others belonging to the same epidemic protocol, SCE seems to be less sensitive in the detection of lymphocyte chromosomal damage caused by NFX or BZ.

Chromosomal aberrations were analyzed from cultures of peripheral lymphocytes in 2 groups of chagasic children, before and after treatment with nifurtimox. The mean incidence of chromosomal aberrations increased from control values of 1.75 +/- 1.39 (8 patients) to 23.55 +/- 9.55 (6 patients) at a significance of P less than 0.0001. G-banding analysis of chromosomal aberration sites revealed that treated patients present coincidence in the chromosome regions affected: 1p11, 1q11-12, 9q11-13, 17q11-21, 2p21, 2q23, 2q31, 2q33, 6p21, 6p21, 7q32, 13q14, 13q22, 15q22. These data indicate a non-random distribution of chromosomal aberrations induced by nifurtimox therapeutic treatment.

A serologic and electrocardiographic study was carried out in people living in 18 households in La Invernada (LI), Departamento Figueroa, and in 20 houses in Amamá (A), Departamento Moreno, both in the province of Santiago del Estero, Argentina. Serological tests performed were indirect hemagglutination (IHAT) and indirect immunofluorescence antibody tests (IFAT). Complement fixation, direct agglutination and ELISA tests were also done for those sera, showing discordant results for either IHAT or IFAT. All people in LI and children up to 12 years old in A were studied by xenodiagnosis. Approximately 50% of the whole population was infected (50% in LI and 50.9% in A) and a similar prevalence rate was already recorded in children below 10 years. A moderate increase of infection rates was observed in successively older age groups, indicating that most of the people became infected in the first decade of life. Comparison of serological profiles of both populations suggests a protective effect of insecticidal control campaigns in those individuals born between 1961 and 1971. New surveys carried out in both populations 2 years later rendered a 4 times greater annual incidence rate in A as compared with LI (7.9% vs 1.8% respectively). No differences were found in the percentages of abnormal electrocardiograms among seropositive and seronegative individuals from both settlements. The prevalence of complete right bundle branch block (RBBB) was higher in seropositive than in seronegative people (4.8% vs 2.3%) but lower than those figures recorded for other parts of the country and the continent. This suggests that in spite of its high prevalence, Chagas' disease has low morbidity in both localities.

Chromosomal aberrations and induction of micronuclei were analyzed from cultures of peripheral lymphocytes in 2 groups of chagasic children, before and after treatment with benznidazole. The median incidence of micronucleated interphase lymphocytes (20 patients) and chromosomal aberrations (10 patients) increased from control values of 5/1000 and 3% to 11.5/1000 and 6%, respectively, at a significance of P = 0.05.