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The art of medicine Carlos Chagas: science, health, and national debate in Brazil
... Once he had earned renown for his discovery of American trypanosomiasis and his related research and had become acknowledged as the prestigious heir to Oswaldo Cruz, Chagas was able to rally a network of collaborators and allies, not only in the laboratories where the disease was investigated but also in the social and political spaces that were stage to debates over the challenges facing the Brazilian nation and the directions it should follow. (11,13,17,18) According to Bruno Latour, (19,20) science is formed by a network of "heterogeneous associations" wherein scientists fulfill their parts alongside a wide array of other actors, human and non-human alike. What at first glance might appear to be a rather straightforward statement is actually an invitation for us to demystify the heroic notion of the "genius scientist", not with the purpose of negating anyone's merits or unique qualities but of impelling us to contemplate the complexity of the groups these scientists belong to and marshal. ...
... (1,2,3,4,5,6,7,8,19,20) In the case of Carlos Chagas's research, the entwining of cognitive and social aspects is appreciable in the very way he produced and communicated the ideas through which he characterised the disease. (11,17,18) From his earliest work, Chagas considered the disease to be medicalbiological and social at once. Framed by the theoretical and methodological repertoires of tropical medicine and by the IOC's institutional project, (9,10) the new trypanosomiasis (whose African counterpart was a priority for European colonialism) was from the very beginning defined as a major public health issue and was increasingly cast as a concern critical to the expansion and interiorisation of republican modernisation in Brazil. ...
Approaching from the perspective of the history and social studies of science, the article analyses some aspects of the early history of Chagas disease, from its discovery through initial research. It is our goal to show that historians of science can explore this topic as a way not only of remembering and narrating past events but also of examining the processes through which science is produced. To this end, we present five basic precepts that have guided historical and sociological studies of “science in action”: science as a collective endeavor, as a social activity, as a set of practices, as a process that involves controversies, and as a formative process. By examining the topic in the light of these five points, we demonstrate how the history of this successful research tradition can lead us to broader reflections about the complex dynamics interweaving science and society.
... Carlos Chagas would not tire of saying that disease and poverty were two sides of the same coin, a problem for which the solution depended on the State's firm action in the implementation of public health policies, aiming to serve Berenice and so many others affected by what he called "diseases of Brazil" [3,5,10,12]. When assuming the leadership of the federal health services ten years later, the scientist from the Oswaldo Cruz Institute would put these ideas into practice by bringing health services and policies to remote corners of Brazil, serving populations that had never seen any sign of public authorities [13]. ...
... When assuming the leadership of the federal health services ten years later, the scientist from the Oswaldo Cruz Institute would put these ideas into practice by bringing health services and policies to remote corners of Brazil, serving populations that had never seen any sign of public authorities [13]. Therefore, remembering the 14th of April has a political meaning, defending a conception of health as a right of the people and a duty of the State [12]. ...
In May 2019, the World Health Organization established the “World Chagas Disease Day”, to be celebrated on the 14th of April [...]
... Su nombre hace referencia al médico e infectólogo brasileño Carlos Ribeiro Justiniano Chagas, quien en 1909 la describió por primera vez en el pueblo de Lassance en Brasil (2). ...
... Su nombre hace referencia al médico e infectólogo brasileño Carlos Ribeiro Justiniano Chagas, quien en 1909 la describió por primera vez en el pueblo de Lassance en Brasil (2). ...
Aunque España es el país con mayor carga de enfermedad de Chagas de Europa, no cuenta con un programa nacional de control de la enfermedad. El objetivo de este estudio fue evaluar la eficiencia de distintas estrategias para el cribado de la enfermedad de Chagas entre la población inmigrante latinoamericana residente en España.
En concreto se han comparado las siguientes cuatro estrategias:
A. “No cribar”
B. “Madre y recién nacido”. En esta estrategia se propone el cribado de todas las mujeres latinoamericanas embarazadas residentes en España y de sus recién nacidos en caso de que el test resulte positivo en la embarazada.
C. “Familiares madre positiva”. En esta estrategia se propone añadir a la estrategia anterior el cribado de los familiares de 1º y 2º grado de la madre positiva.
D. “Familiares madre negativa”. En esta estrategia se propone añadir a la estrategia anterior el cribado de los familiares de 1º y 2º grado de la madre negativa, pero únicamente de los adultos. Se asume que los menores de madre negativa tienen una probabilidad de contagio muy baja al residir en España y no estar expuestos a la picadura del insecto.
Se ha realizado una evaluación económica en la que se ha comparado el coste y la utilidad de la aplicación de esas cuatro estrategias a la población de latinoamericanos residentes en España. La evaluación se ha realizado desde dos perspectivas: la social y la del Sistema Nacional de Salud (SNS).
Se ha construido un árbol de decisión representando la evaluación clínica de la enfermedad a lo largo de toda la vida del paciente. Se ha comparado el coste medido en euros (actualizados al año 2013) y la utilidad medida en Años de Vida Ajustados por Calidad (AVAC). Se ha realizado un análisis de sensibilidad para estudiar la influencia que puedan tener sobre los resultados los distintos parámetros introducidos en el modelo.
El resultado ha sido que la estrategia “No cribar” es la más cara y menos efectiva quedando dominada por las otras estrategias desde las dos perspectivas, la social y la del Sistema Nacional de Salud. Entre las estrategias de cribado la más eficiente desde ambas perspectivas fue el cribado de las mujeres embarazadas, sus recién nacidos y los familiares de primer y segundo grado de las madres positivas.
Los parámetros, cuya modificación, tuvo más repercusión en los resultados fueron la eficacia del tratamiento de la enfermedad crónica y la prevalencia de la enfermedad. Se observa que podría ser eficiente extender un programa de este tipo a los familiares de las madres negativas si aumentara la eficacia del tratamiento o si los programas se dirigieran a población con mayor riesgo.
The most fundamental level at which the genome information gives rise to the phenotype is by the expression of its genes. Multi-omics technologies have been employed over the years to analyze gene expression on a genome-wide level to understand biological systems and disease. Analysis of the genome’s protein-coding genes and how they are posttranscriptionally regulated and the importance of the noncoding part of the genome have been producing large scale data from various human cell types, tissues, and organs in health and disease. The rate of datasets depositions in public repositories is increasing in the same rate as the complexity and challenges researchers are facing in analyzing, integrating, and interpreting the results. Transcriptomics integration analysis by using a systems biology approach is key in identifying metabolic and signaling pathways involved in the pathogenesis of a given disease. Commercial and/or freely available web-based tools with efficient algorithms containing manually curated networks and casual relationships have been used to overcome the bottleneck of these type of analyses which is the need of computational biology programming background knowledge. This approach has helped scientists to understand biological mechanisms of complex diseases, such as Chagas disease or American trypanosomiasis, caused by an intracellular parasite, Trypanosoma cruzi (T. cruzi), and it is a leading cause of heart failure in Latin America. In this chapter, we will explore the basic aspects of Chagas disease and how research based on transcriptomics and systems biology data exploration has been helping our understanding about different aspects of the pathogenesis and the clinical outcomes of the disease.KeywordsAmerican trypanosomiasisChagas disease
Trypanosoma cruzi
Carlos ChagasBlood-sucking insectParasitaemiaFeverAnemiaLymphadenopathySplenomegalyChronic phaseHaematophagus bugOral transmissionReduviidaeTriatomines
Triatoma infestans
Triatoma sordida
Panstrongylus megistus
TrypomastigotesAmastigotesProinflammatory cytokinesMacrophageNeglected diseaseMyocardiumMicroarraysRNA sequencing (RNAseq)MicroRNATranscriptomeProteomeGene expressioncDNADifferentially expressed genesGene expression profilingmicroRNA (miRNA)mRNATranslation inhibitionCardiovascular system
The most fundamental level at which the genome information gives rise to the phenotype is by the expression of its genes. Recent results from the ENCODE project, a 10-year effort by hundreds of scientists to characterize the human genome in depth, have indicated that a much larger proportion of our DNA is likely to be expressed and functional than previously estimated. This has put the focus back on RNA as a key component of organism development, meaning that the measurement of gene expression continues to be a critical tool employed across drug discovery, and life science research. Microarray technology has yielded much important information about the ‘transcriptome’ (or the entire profile of transcripts in a species) and as such has been invaluable in providing the link between information encoded in the genome and phenotype. The great benefit of this approach is that it allows a researcher to investigate the expression of every gene in the genome in a single experiment. This technology has helped scientists to understand biological mechanisms of complex diseases, as Chagas disease or American trypanosomiasis, caused by an intracellular parasite, Trypanosoma cruzi, and it is a leading cause of heart failure in Latin America. In this chapter, we will explore the basic aspects of Chagas disease and how research based on genome and trasncriptome exploration has been helping our understanding about different aspects and clinical outcomes of the disease.
This article analyzes the discovery of Chagas disease and the parasite that causes it (Trypanosoma cruzi) by Carlos Chagas in 1908/1909, with a special focus on the scientific and social context in which this occurred. Its inclusion in the international debate on European tropical medicine--especially with researchers from the German school of protozoology--and its connection with discussions on the modernization of the recently established Brazilian Republic are also examined. The discovery of Chagas disease became a decisive aspect in the scientific project that Oswaldo Cruz sought to establish at the institute that bears his name. It was extolled as a symbol of Brazil's scientific ability t produce knowledge in line with the international scientific agenda, while simultaneously being attuned to the specific problems of the country.