Chagas' disease in the United States

Article Abstract:

There are several species of trypanosomes, which are single-celled organisms. Some affect primarily animals, but some are a significant cause of human illness. In Africa, sleeping sickness is caused by Trypanosoma gambiense. In the western hemisphere, Chagas' disease is caused by Trypanosoma cruzi. Trypanosomes are transmitted by insect bites; Chagas' disease is transmitted by bites of the reduviid bug. It is estimated that 16 to 18 million people are infected with T. cruzi and that 30 to 40 percent will develop heart symptoms as a result of their infection. In parts of the world where Chagas' disease is endemic, most notably South America, the disease is the largest single cause of cardiovascular death. Chagas' disease is very rare in the United States; only eight cases have been reported, and all of these in Latin American immigrants. However, with the large number of Latin American immigrants, the number infected with the trypanosome may be as high as 100,000 in this country. American physicians are unfamiliar with Chagas' disease, however. A review of the cases of 25 patients with Chagas' disease was conducted not only to demonstrate the fundamental characteristics of the disease, but to illustrate that the disease is likely to be misdiagnosed by North American physicians. The symptoms of Chagas' disease include chest pain, rapid beating of the heart (tachycardia), and heart failure. Conditions resulting from Chagas' disease also include atrioventricular block, which is a failure of the normal conduction of the electrical impulses which control the heartbeat. Eighteen of the 25 patients with Chagas' disease were under treatment for heart disease prior to their proper diagnosis. In one case, a patient had been treated for 108 months prior to the diagnosis. Survival calculations showed that the four-year survival of patients with Chagas' disease was 56 percent, but fatal complications occurred only in the patients with heart failure or aneurysms. These cases illustrate that the symptoms of Chagas' disease mimic those of other forms of heart disease and that the true cause of illness in such patients is likely to be misdiagnosed by physicians with little experience with Chagas' disease. It seems likely that Chagas' disease is underdiagnosed in the United States. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Demographic aspects, Heart diseases, Chagas' disease, Chagas disease, Trypanosomiasis

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Collection and transfusion of blood in the United States, 1982-1988

Article Abstract:

The supply of donated blood in the United States has been affected by the human immunodeficiency virus (HIV, the virus associated with AIDS). To evaluate these effects, blood collection and transfusion practices were studied during the years 1982 through 1988. Data were acquired from the American Association of Blood Banks (AABB), the American Red Cross, and the council of Community Blood Centers. Information from a 1980 survey of transfusions by the National Heart, Lung, and Blood Institute was used for comparison with the more recent data. Results indicated that the numbers of units of whole blood (excluding plasma) and of red cells transfused in 1982 were 15 percent greater than in 1980. The number peaked to 12,159,000 units in 1986, from which point it began to decline. Plasma transfusions also declined from a peak in 1984. Platelet transfusions (blood cells essential for clotting) grew rapidly until 1986, then at a much slower rate until 1987. Use of platelets from a single donor, however, increased steadily between 1980 and 1988, increasing by 21 percent between 1987 and 1988. Autologous blood donations (donations of one's own blood for later use) increased considerably after 1984, reaching a level equal to three percent of homologous donations (for use by other people). Importation of European blood increased during the period studied. Since the conditions necessitating transfusions have not changed appreciably, physicians are probably using transfusions more conservatively. Pressure to reduce transfusion number is undoubtedly generated by the public's fear of receiving HIV-contaminated blood. Blood-sparing techniques in surgery appear to have been adopted, as does the use of platelets from single donors. The trend toward reducing reliance on transfusions is evaluated. Analysis of these results indicates that shortages of blood have been prevented in recent years largely by lowering the transfusion rate and increasing the autologous donation rate. European blood has also contributed to maintaining our supply. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Blood collection and preservation, Reports, Statistics, Surveys, AIDS (Disease), Blood transfusion, Donation of organs, tissues, etc., Tissue donation, Blood banks

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Nonaccredited medical education in the United States

Article Abstract:

Several foreign medical schools are setting up a campus in the US. This presents a problem for two reasons. Foreign medical schools do not have to be accredited, leading to concerns that the training may not pass American educational standards. Also, many of the students are US citizens and will remain and practice in the US. They may not be as well trained as students educated in accredited schools.

United States, Medical education

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