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1.
Medicina (B.Aires) ; 81(supl.2): 1-32, dic. 2021. graf
Article in Spanish | LILACS | ID: biblio-1351083

ABSTRACT

Resumen En las últimas décadas ha habido un importante desarrollo de dispositivos inhalados (DI) que permiten aumentar la eficacia de las drogas y disminuir los eventos adversos. Su correcto uso es de fundamental importancia para el control de las enfermedades respiratorias obstructivas. En la Argentina no existen recomendaciones locales sobre el uso de los DI. Se revisó la base biofísica, indicación, ventajas y limitaciones, técnica de correcto uso, errores frecuentes, mantenimiento y limpieza de cada DI. El uso de nebulizaciones ha quedado restringido a la administración de drogas que no están disponibles en otros DI (ejemplo: tratamiento de fibrosis quística), o ante la falla de los otros DI. No deben ser usados durante la pandemia de SARS-CoV2. Los inhaladores de dosis medida (aerosol) deben ser indicados siempre con aerocámaras (AC), las que reducen la incidencia de eventos adversos y aumentan el depósito de la droga en el pulmón. Son los dispositivos de elección junto a los inhaladores de polvo seco. Los aerosoles se deben usar en pacientes que no generan flujos inspiratorios altos. Los inhaladores de polvo seco deben recomendarse en aquellos que pueden realizar flujos inspiratorios enérgicos. Se revisaron los diferentes DI en fibrosis quística y en pacientes con asistencia respiratoria mecánica. La elección del DI dependerá de varios factores: situación clínica, edad, experiencia previa, preferencia del paciente, disponibilidad de la droga y entrenamiento alcanzado con el correcto uso.


Abstract Last decades, a broad spectrum of inhaled devices (ID) had been developed to enhance efficacy and reduce adverse events. The correct use of IDs is a critical issue for controlling obstructive respiratory diseases. There is no recommendation on inhalation therapy in Argentina. This document aims to issue local recommendations about the prescription of IDs. Each device was reviewed regarding biophysical laws, indication, strength, limitations, correct technique of use, frequent mistakes, and device cleaning and maintenance. Nebulization should be restricted to drugs that are not available in other IDs (for example, for treatment of cystic fibrosis) or where other devices fail. Nebulization is not recommended during the SARS-CoV2 pandemic. A metered-dose inhaler must always be used with an aerochamber. Aerochambers reduce the incidence of adverse events and improve lung deposition. Metered-dose inhalers must be prescribed to patients who cannot generate a high inspiratory flow and dry powders to those who can generate an energetic inspiratory flow. We reviewed the use of different IDs in patients with cystic fibrosis and under mechanical ventilation. The individual choice of an ID will be based on several variables like clinical status, age, previous experience, patient preference, drug availability, and correct use of the device.


Subject(s)
Humans , Asthma , COVID-19 , Argentina , RNA, Viral , Pulmonary Disease, Chronic Obstructive , SARS-CoV-2
2.
Rev. ADM ; 78(5): 275-279, sept.-oct. 2021.
Article in Spanish | LILACS | ID: biblio-1348224

ABSTRACT

El SARS-CoV-2, causante de que estemos viviendo una pandemia mundial, tuvo sus orígenes en China, desde donde ha traspasado fronteras rápidamente, llegando a todos los rincones del mundo. Muchos han sido los equipos de investigación que se enfrentan el reto de conseguir una vacuna que logre combatir este mortal virus. Es por este motivo que en esta investigación se pretendió analizar la bibliografía referida a la vacuna Johnson & Johnson (J&J) contra COVID-19: distribución mundial de la vacuna, mecanismo de acción, indicaciones, contraindicaciones y efectos secundarios. Varios estudios demuestran que su eficacia varía de acuerdo con la edad y género de cada individuo; sin embargo, esta vacuna alcanzó un grado de certeza moderada. Los efectos adversos en su mayoría son leves y se resolvieron al cabo de dos días, siendo excepción algunos casos, ya que se registró un efecto adverso poco común denominado trombocitopenia prevalente en mujeres de 18 a 40 años, por este motivo, la FDA (Administración de Alimentos y Medicamentos de EE.UU.) recomienda la precaución en el uso de la vacuna con respecto a este efecto adverso que en algunos casos podría ser mortal (AU)


The SARS-CoV-2, which caused us to be experiencing a global pandemic, had its origins in China, from where it has crossed borders rapidly, reaching all corners of the world. Many research teams have faced the challenge of getting a vaccine to fight this deadly virus. For this reason, this research aimed to analyze the literature on the Johnson & Johnson COVID-19 vaccine: global distribution of the vaccine, mechanism of action, indications, contraindications and side effects. Several studies show that its effectiveness varies according to the age and gender of each individual, but this vaccine reached a moderate degree of certainty. The adverse effects are mostly mild and resolved within two days, with some exceptions being a rare adverse effect called prevalent thrombocytopenia in women aged 18 to 40 years. For this reason, the FDA recommends caution in the use of the vaccine with respect to this potentially fatal adverse effect in some cases (AU)


Subject(s)
Humans , Male , Female , Contraindications, Drug , COVID-19 Vaccines/adverse effects , COVID-19 Vaccines/supply & distribution , COVID-19 Vaccines/therapeutic use , COVID-19 Vaccines/pharmacology , SARS-CoV-2 , COVID-19/prevention & control , United States Food and Drug Administration , Viral Proteins , Effectiveness , RNA, Viral , Sex Factors , Age Factors , Virus Inactivation
3.
Medicina (B.Aires) ; 81(2): 135-142, June 2021. graf
Article in English | LILACS | ID: biblio-1287262

ABSTRACT

Abstract Most countries in Latin America have already reported thousands of confirmed cases and vulnerable populations are the most affected by the coronavirus disease 2019 (COVID-19) pandemic. Preventive measures such as hygiene, social distancing, and isolation, essential to stop the spread of coronavirus, are difficult to accomplish for vulnerable populations due to their living conditions. Seroepidemiological surveys are assets to measure the transmission for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Until July 1st, the incidence rate of SARS-CoV-2 infection in Barrio Padre Mugica, one of the largest slums in Buenos Aires City, was 5.9%. This study aimed to establish the prevalence of SARS-CoV-2 antibodies immunoglobulin G (IgG) immediately after the outbreak, and to identify neighbourhood, household and individual factors associated with seroconversion. The prevalence based on IgG was 53.4% (95% CI 52.8% to 54.1%). For each polymerase chain reaction (RT-qPCR) confirmed case, nine people tested IgG positive, indicating a high rate of undetected (probably asymptomatic) infections. Hence, the high rate of undiagnosed people suggests that clinical criteria and epidemiological nexus should be considered. The high seroprevalence observed in the context of an intense epidemic in a vulnerable area might serve as a reference to other countries. This study contributes to future decision making by understanding population immunity against SARS-CoV2 and its relation to living conditions and foccus that comprehensive biosocial, household-level interventions are needed.


Resumen Muchos países de América Latina han informado miles de casos confirmados y las poblaciones vulnerables son las más afectadas por la pandemia de la enfermedad por coronavirus 2019 (COVID-19). Las medidas preventivas como la higiene, el distanciamiento social y el aislamiento, fundamentales para frenar la propagación del coronavirus, son difíciles de lograr en estas poblaciones debido a sus condiciones de vida. Los estudios seroepidemiológicos son de gran utilidad para medir la transmisión del síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2). Hasta el 1 de julio, la tasa de incidencia de la infección por SARS-CoV-2 en el Barrio Padre Mugica, uno de los barrios marginales más grandes de la ciudad de Buenos Aires, era del 5.9%. Este estudio tuvo como objetivo estimar la prevalencia de anticuerpos inmunoglobulina G (IgG) para SARS-CoV-2 inmediatamente después del brote, e identificar factores del barrio, hogar e individuales asociados con la seroconversión. La prevalencia basada en IgG fue del 53.4% (IC del 95%: 52.8% a 54.1%). Para cada caso confirmado por reacción en cadena de la polimerasa (RT-qPCR), nueve personas dieron positivo en IgG, lo que indica una alta tasa de infecciones no detectadas y probablemente asintomáticas. La alta tasa de personas no diagnosticadas sugiere que se deben considerar los criterios clínicos y el nexo epidemiológico. La alta seroprevalencia observada en el contexto de una intensa epidemia en una zona vulnerable podría servir de referencia a otros países. Este estudio contribuye a la toma de decisiones futuras al comprender la inmunidad de la población contra el SARS-CoV2 en su relación con las condiciones de vida y por su enfoque en la necesidad de intervenciones integrales a nivel del hogar.


Subject(s)
Humans , Poverty Areas , COVID-19 , RNA, Viral , Seroepidemiologic Studies , SARS-CoV-2 , Antibodies, Viral
4.
An. bras. dermatol ; 96(2): 184-187, Mar.-Apr. 2021. graf
Article in English | LILACS | ID: biblio-1248747

ABSTRACT

Abstract Epstein Barr virus-associated smooth muscle tumors are an uncommon neoplasm that occurs in immunosuppressed patients of any age. Usually, it presents as multifocal tumors mainly in the spinal cord, epidural region, gastrointestinal tract and liver, upper respiratory tract and skin, the latest with few cases reported in the literature and related with human immunodeficiency virus infection and acquired immune deficiency syndrome. The authors present the first case of a Colombian adult patient with human immunodeficiency virus infection and multifocal Epstein Barr virus-associated smooth muscle tumors in the skin and epidural region, confirmed by histopathology, immunohistochemistry and in situ hybridization studies.


Subject(s)
Humans , Adult , HIV Infections/complications , Smooth Muscle Tumor , Epstein-Barr Virus Infections/complications , RNA, Viral , Herpesvirus 4, Human/genetics
5.
Arq. gastroenterol ; 58(1): 1-4, Jan.-Mar. 2021. tab
Article in English | LILACS | ID: biblio-1248991

ABSTRACT

ABSTRACT Mass vaccination offers the best strategy to fight against COVID-19 pandemic, and SARS-CoV2 vaccines are being approved in several countries for emergency use. In Brazil, vaccine approval is expected in the next few days, however potential concerns exist regarding vaccine recommendations for specific populations, such as patients with inflammatory bowel disease (IBD). To address these questions, the Brazilian IBD Study Group (GEDIIB) provides this practical advice with key recommendations about the COVID-19 vaccines in IBD population.


RESUMO A vacinação em massa oferece a melhor estratégia para enfrentamento da pandemia de COVID-19, e as vacinas contra SARS-CoV2 estão sendo aprovadas em vários países para uso emergencial. No Brasil, a aprovação da vacina é esperada em breve, no entanto, existem potenciais preocupações em relação às recomendações de vacinas para populações específicas, como pacientes com doença inflamatória intestinal (DII). Para responder essas questões, o Grupo Brasileiro de Estudos IBD (GEDIIB) fornece conselhos práticos com recomendações importantes sobre as vacinas para COVID-19 na população com DII.


Subject(s)
Humans , Inflammatory Bowel Diseases , COVID-19 , Brazil , RNA, Viral , Vaccination , Pandemics , COVID-19 Vaccines , SARS-CoV-2
6.
Article in Chinese | WPRIM | ID: wpr-877518

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection is the key link for the precise epidemic prevention and control, and the urban detection bases have been proved to be achieved great successes in increasing the regional nucleic acid detection ability and efficiency. This expert advice contains ten aspects: environment and facilities management, personnel management and training, equipment management, materials management, quality management, bio-safety management, medical waste management, information system management, result report, supervision and continuous improvement. This manual aims to provide standards and suggestions for the SARS-CoV-2 RNA detection base management for ensuring the standardized, safe and orderly operation of the base to complete large-scale nucleic acid screening with high efficiency and quality. It also could be used by other SARS-CoV-2 RNA detection laboratory as reference.


Subject(s)
COVID-19 , Humans , Mass Screening , RNA, Viral , Reference Standards , SARS-CoV-2
7.
Chinese Medical Journal ; (24): 2048-2053, 2021.
Article in English | WPRIM | ID: wpr-887657

ABSTRACT

BACKGROUND@#With the ongoing worldwide coronavirus disease 2019 (COVID-19) pandemic, an increasing number of viral variants are being identified, which poses a challenge for nucleic acid-based diagnostic tests. Rapid tests, such as real-time reverse transcription-polymerase chain reaction (rRT-PCR), play an important role in monitoring COVID-19 infection and controlling its spread. However, the changes in the genotypes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants may result in decreased sensitivity of the rRT-PCR assay and it is necessary to monitor the mutations in primers and probes of SARS-CoV-2 detection over time.@*METHODS@#We developed two rRT-PCR assays to detect the RNA-dependent RNA polymerase (RdRp) and nucleocapsid (N) genes of SARS-CoV-2. We evaluated these assays together with our previously published assays targeting the ORF1ab and N genes for the detection and confirmation of SARS-CoV-2 and its variants of concern (VOCs). In addition, we also developed two rRT-PCR assays (S484K and S501Y) targeting the spike gene, which when combined with the open reading frames (ORF)1ab assay, respectively, to form duplex rRT-PCR assays, were able to detect SARS-CoV-2 VOCs (lineages B.1.351 and B.1.1.7).@*RESULTS@#Using a SARS-CoV-2 stock with predetermined genomic copies as a standard, the detection limit of both assays targeting RdRp and N was five copies/reaction. Furthermore, no cross-reactions with six others human CoVs (229E, OC43, NL63, HKU1, severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome coronavirus) were observed using these assays. In addition, the S484K and S501Y assays were combined with the ORF1ab assay, respectively.@*CONCLUSIONS@#Four rRT-PCR assays (RdRp, N, S484K, and S501Y) were used to detect SARS-CoV-2 variants, and these assays were shown to be effective in screening for multiple virus strains.


Subject(s)
COVID-19 , Humans , RNA, Viral/genetics , Real-Time Polymerase Chain Reaction , Reverse Transcription , SARS-CoV-2 , Sensitivity and Specificity
8.
Article in English | WPRIM | ID: wpr-922209

ABSTRACT

BACKGROUND@#We investigated factors associated with prolonged viral clearance of SARS-CoV-2 among non-severe adult patients in Osaka, Japan. A total of 706 laboratory-confirmed COVID-19 patients were enrolled in this longitudinal observational study between 29 January 2020 and 31 May 2020, across 62 hospitals and three non-hospital recuperation facilities.@*METHODS@#Logistic regression analysis was performed to investigate the factors associated with prolonged (29 days: upper 25% in duration) viral clearance of SARS-CoV-2. Linear regression analysis was conducted to assess these factors 14 days after symptom onset.@*RESULTS@#The median duration of viral clearance was 22 days from symptom onset. After adjustment for sex, age, symptoms, comorbidity, and location of recuperation, comorbidities were associated with prolonged duration: (OR, 1.77 [95% CI, 1.11-2.82]) for one, (OR, 2.47 [95% CI, 1.32-4.61]) for two or more comorbidities. Viral clearance 14 days after symptom onset was 3 days longer for one comorbidity and 4 days longer for two or more comorbidities compared to clearance when there was no comorbidity.@*CONCLUSION@#The presence of comorbidity was a robust factor associated with a longer duration of viral clearance, extending by 3 to 4 days compared to patients with no comorbidity.


Subject(s)
Adult , COVID-19 , Humans , Japan/epidemiology , RNA, Viral , SARS-CoV-2 , Virus Shedding
9.
Protein & Cell ; (12): 717-733, 2021.
Article in English | WPRIM | ID: wpr-888715

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is spread primary via respiratory droplets and infects the lungs. Currently widely used cell lines and animals are unable to accurately mimic human physiological conditions because of the abnormal status of cell lines (transformed or cancer cells) and species differences between animals and humans. Organoids are stem cell-derived self-organized three-dimensional culture in vitro and model the physiological conditions of natural organs. Here we showed that SARS-CoV-2 infected and extensively replicated in human embryonic stem cells (hESCs)-derived lung organoids, including airway and alveolar organoids which covered the complete infection and spread route for SARS-CoV-2 within lungs. The infected cells were ciliated, club, and alveolar type 2 (AT2) cells, which were sequentially located from the proximal to the distal airway and terminal alveoli, respectively. Additionally, RNA-seq revealed early cell response to virus infection including an unexpected downregulation of the metabolic processes, especially lipid metabolism, in addition to the well-known upregulation of immune response. Further, Remdesivir and a human neutralizing antibody potently inhibited SARS-CoV-2 replication in lung organoids. Therefore, human lung organoids can serve as a pathophysiological model to investigate the underlying mechanism of SARS-CoV-2 infection and to discover and test therapeutic drugs for COVID-19.


Subject(s)
Adenosine Monophosphate/therapeutic use , Alanine/therapeutic use , Alveolar Epithelial Cells/virology , Antibodies, Neutralizing/therapeutic use , COVID-19/virology , Down-Regulation , Drug Discovery , Human Embryonic Stem Cells/metabolism , Humans , Immunity , Lipid Metabolism , Lung/virology , RNA, Viral/metabolism , SARS-CoV-2/physiology , Virus Replication/drug effects
10.
Chinese Journal of Biotechnology ; (12): 1237-1248, 2021.
Article in Chinese | WPRIM | ID: wpr-878627

ABSTRACT

RNA interference (RNAi) is one of the important mechanisms to regulate gene expression in eukaryotes. One of the original functions of RNAi is to facilitate the antiviral strategy of host. Early studies reveal that invertebrates can use RNAi to resist viruses. However, if this mechanism exists in mammals is still controversial. The latest studies confirm that mammals do have the RNAi-based immunity, and researchers believe that RNAi-based antiviral immunity is a brand-new immunological mechanism that was neglected in the past. It is worthy to note that virus can also use RNAi to enhance its infectivity and immune escape in host cells. This review introduces the research history of RNAi-based antiviral immunity in animals and summarizes the main findings in this field. Last but not least, we indicate a series of unresolved questions about RNAi-based antiviral immunity, and explore the relationship between RNAi-based antiviral immunity and other innate immunological pathways. The virus-mediated RNAi pathway in animal is not only an interesting basic biology question, but also has important guiding roles in the development of antiviral drugs.


Subject(s)
Animals , Antiviral Agents , Immunity, Innate/genetics , Mammals , RNA Interference , RNA, Small Interfering/genetics , RNA, Viral
11.
Article in English | WPRIM | ID: wpr-878357

ABSTRACT

Objective@#The aim of the present study was to evaluate the performance of the simultaneous detection of HIV-1 RNA, HIV-1 DNA, and HCV RNA using one dried blood spot (DBS) as an alternative sample to plasma.@*Method@#A total of 571 paired DBS/plasma samples were collected from men who have sex with men (MSM) and injection drug users (IDUs), and serological and molecular assays were performed. Using plasma results as the reference standard, the performance of DBS tests for HIV-1 RNA, HIV-1 DNA, and HCV RNA was evaluated. Pearson's correlation coefficients and Bland-Altman analysis were performed to assess the correlation and concordance between DBS and plasma.@*Results@#Among paired plasma/DBS samples with detectable HIV-1 RNA and HCV RNA, five samples (5/32) were not detectable in DBS, while measurable HIV-1 RNA levels were present in plasma (1.44 to 3.99 log @*Conclusion@#The performance of the simultaneous detection of HIV-1 RNA, HIV-1 DNA, and HCV RNA using one DBS was acceptable. DBS, as an alternative sample to plasma, may be a viable option for the simultaneous detection of HIV-1 RNA, HIV-1 DNA, and HCV RNA in resource-limited settings or for individuals living in areas that are difficult to access.


Subject(s)
DNA, Viral/analysis , Diagnostic Tests, Routine/methods , Dried Blood Spot Testing/methods , HIV Infections/diagnosis , HIV-1/isolation & purification , Hepacivirus/isolation & purification , Hepatitis C/diagnosis , RNA, Viral/analysis , Sensitivity and Specificity , Specimen Handling/methods , Syphilis/diagnosis , Treponema pallidum/isolation & purification
12.
Rev. Soc. Bras. Med. Trop ; 54: e02532020, 2021. tab
Article in English | LILACS | ID: biblio-1155541

ABSTRACT

Abstract INTRODUCTION: We compared the hepatitis C virus (HCV) core antigen test with the HCV RNA assay to confirm anti-HCV results to determine whether the HCV core antigen test could be used as an alternative confirmatory test to the HCV RNA test. METHODS: Sera from 156 patients were analyzed for anti-HCV and HCV core antigen using a chemiluminescent microparticle immunoassay (Architect i2000SR) and for HCV RNA using the artus HCV RG RT-PCR Kit (QIAGEN) in a Rotor-Gene Q instrument. RESULTS: The diagnostic sensitivity, specificity, and positive and negative predictive values of the HCV core antigen assay compared to the HCV RNA test were 77.35%, 100%, 100%, and 89.38%, respectively. HCV core antigen levels showed a good correlation with those from HCV RNA quantification (r =0.872). However, 13 samples with a viral load of less than 4000 IU/mL were negative in the HCV core antigen assay. All gray-zone reactive samples were also RNA positive and were positive on repeat testing. CONCLUSIONS: The Architect HCV core antigen assay is highly specific and has an excellent positive predictive value. At the present level of sensitivity (77%), the study is still relevant in a low-income setting in which most of the HCV-positive patients would go undiagnosed, since HCV RNA testing is not available and/or not affordable. HCV core antigen testing can also help determine the true burden of infection in a population, considering the fact that almost 50% of the anti-HCV positive cases are negative for HCV RNA.


Subject(s)
Humans , Hepatitis C/diagnosis , Hepacivirus/genetics , RNA, Viral , Sensitivity and Specificity , Hepatitis C Antigens , Hepatitis C Antibodies
14.
Braz. j. med. biol. res ; 54(5): e10725, 2021. graf
Article in English | LILACS | ID: biblio-1153554

ABSTRACT

Phylogenetic and pathogenesis studies of the severe acute respiratory syndrome-related coronaviruses (SARS-CoVs) strains have highlighted some specific mutations that could confer the RNA genome fitness advantages and immunological resistance for their rapid spread in the human population. The analyses of 30 kb RNA SARS-CoVs genome sequences, protein structures, and functions have provided us a perspective of how host-virus protein-protein complexes act to mediate virus infection. The open reading frame (ORF)1a and ORF1b translation yields 16 non-structural (nsp1-16) and 6 accessory proteins (p6, p7a, p8ab, p9b) with multiple functional domains. Viral proteins recruit over 300 host partners forming hetero-oligomeric complexes enabling the viral RNA synthesis, packing, and virion release. Many cellular host factors and the innate immune cells through pattern-recognition receptors and intracellular RNA sensor molecules act to inhibit virus entry and intracellular replication. However, non-structural ORF proteins hijack them and suppress interferon synthesis and its antiviral effects. Pro-inflammatory chemokines and cytokines storm leads to dysfunctional inflammation, lung injury, and several clinical symptoms in patients. During the global pandemic, COVID-19 patients were identified with non-synonymous substitution of G614D in the spike protein, indicating virus co-evolution in host cells. We review findings that suggest that host RNA editing and DNA repair systems, while carrying on recombination, mutation, and repair of viral RNA intermediates, may facilitate virus evolution. Understanding how the host cell RNA replication process may be driven by SARS-CoV-2 RNA genome fitness will help the testing of vaccines effectiveness to multiple independent mutated coronavirus strains that will emerge.


Subject(s)
Humans , SARS-CoV-2 , COVID-19 , Phylogeny , RNA, Viral/genetics , COVID-19 Vaccines
15.
Mem. Inst. Oswaldo Cruz ; 116: e210018, 2021. tab, graf
Article in English | LILACS | ID: biblio-1287340

ABSTRACT

BACKGROUND Coronavirus disease 2019 (COVID-19) is highly infectious causing millions of deaths worldwide. Nasopharyngeal swabs are the primary sample of choice for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), thus, to decrease the exposure to potentially infected samples through the collection is a key point to reduce the risk of infection in healthcare workers. OBJECTIVES This study aimed to evaluate the sensitivity and viral load of saliva specimens by days of symptoms onset comparing to nasopharyngeal swabs in subjects with mild symptoms. METHODS Saliva and nasopharyngeal swabs samples were collected from São Paulo Hospital workers presenting mild symptoms, such as fever, cough, sore throat, rhinorrhea, myalgia, headaches, anosmia, ageusia, and fatigue. To understand the positivity and viral load, reverse transcription-polymerase chain reaction (RT-PCR) was performed. FINDINGS Saliva specimens presented a sensitivity of 98.6% compared to nasopharyngeal swabs. Overall, saliva showed lower viral load compared to nasopharyngeal swabs, regarding days of symptoms onset on diagnosis, the first four days had significant changes in viral load and no significant difference was reported in the days five to nine. MAIN CONCLUSIONS Although RT-PCR of saliva has presented a lower viral load compared to nasopharyngeal swabs, saliva specimens are a potential and reliable candidate for COVID-19 diagnosis through RT-PCR.


Subject(s)
Humans , RNA, Viral , COVID-19 , Saliva , Nasopharynx , Viral Load , COVID-19 Testing , SARS-CoV-2
16.
Brasília, DF; OPAS; 11 Jun. 2020. 42 p. ilus. (OPAS-W/BRA/COVID-19/20-079).
Non-conventional in Portuguese | LILACS, BIGG | ID: biblio-1147331

ABSTRACT

Desde sua identificação na China em dezembro de 2019, o novo coronavírus responsável pela COVID-19 evoluiu rapidamente para uma pandemia. A COVID-19 se manifesta com sintomas respiratórios inespecíficos de gravidade variável e pode exigir suporte respiratório avançado. Atualmente, o diagnóstico de COVID- 19 é confirmado por testes laboratoriais através da identificação de RNA viral na reação em cadeia da polimerase com transcriptase reversa (RT-PCR). Os exames de imagem de tórax foram considerados como parte da investigação diagnóstica de pacientes com suspeita ou probabilidade de COVID-19, nos lugares em que a RT-PCR não está disponível ou em que os resultados demoram ou são inicialmente negativos na presença de sintomas sugestivos de COVID-19. Os exames de imagem também foram considerados na complementação da avaliação clínica e dos parâmetros laboratoriais no tratamento de pacientes já diagnosticados com COVID-19. Antes de iniciar o desenvolvimento deste guia, vários estados-membros solicitaram um parecer da OMS sobre o papel dos exames de imagem do tórax em pacientes com suspeita ou confirmação de COVID-19. Uma revisão das práticas de exames de imagem em pacientes com suspeita ou confirmação de COVID-19 em todo o mundo encontrou grandes variações. Isso motivou o desenvolvimento de diretrizes globais sobre o uso de exames de imagem de tórax para apoiar os estados membros na resposta à pandemia da COVID-19. Este guia de aconselhamento rápido examina as evidências e faz recomendações para o uso de exames de imagem do tórax em pacientes agudos com suspeita, probabilidade ou confirmação de COVID-19, incluindo radiografia de tórax, tomografia computadorizada (TC) e ultrassonografia pulmonar. Destina-se a ser um guia prático para os profissionais de saúde envolvidos na evolução da atenção à COVID-19, desde o momento de chegada a um estabelecimento de saúde até a alta hospitalar. A orientação é relevante para pacientes com diferentes níveis de gravidade da doença, desde indivíduos assintomáticos a pacientes críticos...


Subject(s)
Humans , Pneumonia, Viral/diagnostic imaging , Thorax/diagnostic imaging , Coronavirus Infections/diagnostic imaging , RNA, Viral/isolation & purification , Reverse Transcriptase Polymerase Chain Reaction/standards , Betacoronavirus/isolation & purification
17.
Rev. chil. infectol ; 37(3): 276-280, jun. 2020. tab, graf
Article in English | LILACS | ID: biblio-1126120

ABSTRACT

Abstract The global shortage of reagents and kits for nucleic acid extraction and molecular detection of SARS-CoV-2 requires new cost-effective strategies for the diagnosis of suspected COVID-19 cases, especially in countries that need to increase detection capacity. Pooled nucleic acid testing has been extensively used as a cost-effective strategy for HIV, HepB, HepC and influenza. Also, protocols dispensing of RNA extraction appears as an attractive option for detection of SARS-CoV-2. In this study, we found that pooling of 5 samples showed that CT variations were in the range of 1.0-4,5 units, with less likelihood of a false negative result. Results of the sample without nucleic acid ex-traction, was unsatisfactory, with a significant increase in CT values, and thus for risk of a false negative result. In conclusion, pooling nasopharyngeal samples with both automated and manual extraction proved reliable, and thus a potential efficient alternative for the diagnosis of suspected COVID-19 in developing countries.


Resumen La escasez mundial de reactivos para la extracción de ácidos nucleicos y la detección molecular de SARS-CoV-2 requiere de nuevas estrategias de mayor rendimiento para el diagnóstico de casos sospechosos de COVID-19, especialmente en países que necesitan aumentar su capacidad diagnóstica. La detección de ácidos nucleicos en muestras agrupadas o pool testing se ha utilizado ampliamente como una estrategia costo-efectiva para el VIH, hepatitis B, hepatitis C e influenza. Adicionalmente, los protocolos que no requieren extracción de ARN aparecen como una opción para la detección de SARS-CoV-2. En este trabajo, presentamos los resultados de una estrategia detección de SARS-CoV-2 en muestras agrupadas, que incluye diferentes métodos de extracción de ARN que puede ser una estrategia atractiva para los países en desarrollo. La agrupación de 5 muestras mostró variaciones CT en el rango de 1,0 a 4,5 unidades, con una baja probabilidad de obtener falsos negativos, a diferencias de los resultados agregando muestras agrupadas directamente en la reacción de amplificación de SARS-CoV-2. En conclusión, la agrupación de muestras nasofaríngeas, demostró ser un método confiable y, por lo tanto, una alternativa para aumentar el rendimiento en el diagnóstico de COVID-19 para países en desarrollo.


Subject(s)
Humans , Pneumonia, Viral/diagnosis , Coronavirus Infections/diagnosis , Pandemics , RNA, Viral , Clinical Laboratory Techniques , Reverse Transcriptase Polymerase Chain Reaction , Developing Countries
18.
Braz. j. infect. dis ; 24(1): 13-24, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1089334

ABSTRACT

ABSTRACT Dengue has been a significant public health problem in Colombia since the simultaneous circulation of the four dengue virus serotypes. The replicative fitness of dengue is a biological feature important for virus evolution and contributes to elucidating the behavior of virus populations and viral pathogenesis. However, it has not yet been studied in Colombian isolates. This study aimed to compare the replicative fitness of the four dengue virus serotypes and understand the association between the serotypes, their in vitro infection ability, and their replication in target cells. We used three isolates of each DENV serotype to infect Huh-7 cells at an MOI of 0.5. The percentage of infected cells was evaluated by flow cytometry, cell viability was evaluated by MTT assay, and the pathogenicity index was calculated as a ratio of both parameters. The replicative fitness was measured by the number of viral genome copies produced using quantitative PCR and the production of infectious viral progeny was measured by plaque assay. We showed that Huh-7 cells were susceptible to infection with all the different strain isolates. Nevertheless, the biological characteristics, such as infectious ability and cell viability, were strain-dependent. We also found different degrees of pathogenicity between strains of the four serotypes, representative of the heterogeneity displayed in the circulating population. When we analyzed the replicative fitness using the mean values obtained from RT-qPCR and plaque assay for the different strains, we found serotype-dependent behavior. The highest mean values of replicative fitness were obtained for DENV-1 (log 4.9 PFU/ml) and DENV-4 (log 5.28 PFU/ml), followed by DENV-2 (log 3.9 PFU/ml) and DENV-3 (log 4.31 PFU/ml). The internal heterogeneity of the replicative fitness within each serotype could explain the simultaneous circulation of the four DENV serotypes in Colombia.


Subject(s)
Humans , Virus Replication/genetics , Dengue Virus/genetics , Dengue Virus/pathogenicity , Serogroup , Viral Plaque Assay , Reference Values , Tetrazolium Salts , Time Factors , RNA, Viral/genetics , Cell Line , Cell Survival , Cells, Cultured , Colombia , Reverse Transcriptase Polymerase Chain Reaction , Flow Cytometry , Formazans , Liver/cytology
19.
Arq. gastroenterol ; 57(1): 39-44, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1098056

ABSTRACT

ABSTRACT BACKGROUND: Hepatitis C virus (HCV) infection is the most common hepatotropic viral infection affecting the patients on maintenance hemodialysis. Treatment of chronic HCV infection in stage 4 and 5 CKD includes a combination of elbasvir/grazoprevir and glecaprevir/pibrentasvir, which are not available in many countries. OBJECTIVE: Hence, we have conducted this study to look for the safety and efficacy of sofosbuvir combination therapy in this difficult to treat population. METHODS: We conducted a single-center, prospective, open-label study in which Stage 5 CKD patients on maintenance hemodialysis with HCV infection. Total of 18 patients was included. sofosbuvir with daclatasvir or ledipasvir was used according to genotype for 12 weeks. HCV RNA, genotype, transient elastography (TE) was considered for every patient. HCV RNA was quantified at 4th week, 12th week and 12 weeks post-treatment to look for sustained virologic response (SVR 12). RESULTS: Infection due to genotype 1 was seen in 12 (66.7%) patients followed by genotype 3 in 4 (22.3%) with each patient of genotype 2 and 5. The median value of HCV RNA was 2,35,000 IU/mL. On TE, all had liver stiffness of <9.4 KPa. All patients had HCV RNA of <15 IU/mL at 4th and 12th week of treatment and 12 weeks post-treatment. No significant change in hemoglobin, eGFR and liver stiffness was observed. CONCLUSION: Full dose sofosbuvir i.e. 400 mg, in combination with NS5A inhibitors daclatasvir or ledipasvir is found to be safe and effective in patients with end stage renal disease, who are on maintenance hemodialysis.


RESUMO CONTEXTO: A infecção pelo vírus da hepatite C (HCV) é a infecção viral hepática mais comum que afeta pacientes em hemodiálise de manutenção. O tratamento da infecção crônica por HCV no estágio 4 e 5 da doença renal crônica inclui uma combinação de elbasvir/grazoprevir e glecaprevir/pibrentasvir, que não estão disponíveis em muitos países. OBJETIVO: Portanto, realizamos este estudo para procurar a segurança e eficácia da terapia combinada de sofosbuvir nesta população de difícil tratamento. MÉTODOS: Realizamos um estudo de centro único, prospectivo e aberto, no qual pacientes com doença renal crônica em estágio 5 em hemodiálise de manutenção com infecção por HCV. Um total de 18 pacientes foi incluído. Sofosbuvir com daclatasvir ou ledipasvir foi usado de acordo com o genótipo por 12 semanas. O HCV RNA, genótipo, elastografia transitória foi considerado para cada paciente. O HCV RNA foi quantificado na 4ª semana, 12ª semana e 12 semanas após o tratamento para procurar uma resposta virológica sustentada. RESULTADOS: A infecção por genótipo 1 foi observada em 12 (66,7%) pacientes, seguido pelo genótipo 3 em 4 (22,3%), em um paciente do genótipo 2 e em outro, 5. O valor mediano do HCV RNA foi de 2.35.000 IU/mL. Na elastografia transitória, todos tinham rigidez hepática de <9.4 KPa. Todos os pacientes tinham RNA HCV <15 IU/mL na 4ª e 12ª semana de tratamento e 12 semanas após o tratamento. Não foi observada nenhuma alteração significativa na hemoglobina, eGFR e rigidez hepática. CONCLUSÃO: A dose completa sofosbuvir ou seja, 400 mg, em combinação com inibidores NS5A daclatasvir ou ledipasvir foi considerada segura e eficaz em pacientes com doença renal em estágio final, que estão em manutenção hemodiálise.


Subject(s)
Humans , Male , Female , Adult , Antiviral Agents/administration & dosage , Hepatitis C, Chronic/drug therapy , 2-Pyridinylmethylsulfinylbenzimidazoles/administration & dosage , Fluorenes/administration & dosage , Sofosbuvir/administration & dosage , Imidazoles/administration & dosage , Severity of Illness Index , RNA, Viral , Prospective Studies , Renal Dialysis , Treatment Outcome , Hepacivirus/genetics , Drug Therapy, Combination , Sustained Virologic Response , Genotype , Middle Aged
20.
Mem. Inst. Oswaldo Cruz ; 115: e200009, 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1135259

ABSTRACT

BACKGROUND Influenza viral load (VL) can be a decisive factor in determining the antiviral efficacy in viral clearance. OBJECTIVE This study aimed to evaluate the rate of infection and the role of influenza VL on the clinical spectrum of illnesses among different patient groups attended at a tertiary hospital in Brazil. METHODS Samples were collected from patients presenting acute respiratory infection from 2009 to 2013. Overall, 2262 samples were analysed and distributed into three groups: (i) asymptomatic (AS); (ii) symptomatic outpatients (OP); and (iii) hospitalised patients (HP). VL (expressed in Log10 RNA copies/mL) was calculated through a quantitative real-time one-step reverse transcription-polymerase chain reaction (RT-PCR) assay aimed at the M gene, with human RNAseP target as internal control and normalising gene of threshold cycle values. FINDINGS A total of 162 (7.16%) H1N1pdm09 positive samples were analysed. Patients aged from 0.08 to 77 years old [median ± standard deviation (SD): 12.5 ± 20.54]. Children with 5 to 11 years old presented the highest detection (p < 0.0001). AS patients had the lowest VL, with a significant difference when compared with symptomatic patients (p = 0.0003). A higher VL was observed within two days of disease onset. Ten patients (HP group) received antiviral treatment and were followed up and presented a mean initial VL of 6.64 ± 1.82. A complete viral clearance for 50% of these patients was reached after 12 days of treatment. MAIN CONCLUSIONS It is important to evaluate AS patients as potential spreaders, as viral shedding was still present, even at lower VL. Our results suggest that patients with underlying diseases and severe clinical symptoms may be considered for prolonged viral treatment.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Aged , Young Adult , Respiratory Tract Infections/virology , Influenza, Human/virology , Influenza A Virus, H1N1 Subtype/genetics , RNA, Viral/genetics , Acute Disease , Viral Load , Influenza A Virus, H1N1 Subtype/classification , Influenza A Virus, H1N1 Subtype/pathogenicity , Real-Time Polymerase Chain Reaction , Middle Aged
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