The American journal of medicine
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Proven cases of vector-transmitted acute autochthonous Chagas disease in the United States are rare (<10 cases). Possible or probable cases of unknown duration determined by serology are uncommon as well (<100). In Latin America it is widely accepted that after feeding, the kissing bug defecates and Trypanosoma cruzi in the feces is rubbed into the bite punctum. ⋯ The average infected individual in Latin America suffers more than 1000 bites, but more importantly, there are often thousands of kissing bugs in a household dropping feces on the inhabitants and living quarters. Today in Brazil the most common form of acute Chagas is secondary to oral ingestion of the parasite in food and drink. We present our experience with many hundreds of individuals bitten by kissing bugs and the possibility of oral ingestion occurring in the United States.
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Thromboelastography (TEG) provides a global assessment of hemostasis and may have value for patients with cirrhosis who have multiple hemostatic defects. We sought to examine the characteristics of TEG in hospitalized patients with cirrhosis and its relationship with outcomes. ⋯ TEG provides insight into the hemostatic state of patients with cirrhosis beyond that of standard measures of hemostasis. It is associated with liver disease severity and outcomes and may play a role complementary to standard measures of hemostasis in this population.
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Infection may be an acute precipitant of cardiovascular events. However, the relationships between different types of infection and cardiovascular events are less known. Our objective was to determine if exposure to infections of different organ systems in different time periods increases risk of myocardial infarction or venous thromboembolism. ⋯ We found a gradient of decreasing magnitudes of association with longer time periods, across the majority of infection types and cardiovascular events. This warrants potential interventions to prevent infection or cardiovascular disease prophylaxis in individuals with infection.