Conhecimento etnobotânico sobre plantas medicinais utilizadas por moradores de um município ribeirinho no interior do estado do Amazonas, Brasil / Ethnobotanical knowledge of medicinal plants used by residents of a riverside city in the Amazonas state, Brazil

Mesmo com a evolução do conhecimento científico, a utilização de plantas medicinais é uma das práticas mais antigas ainda realizadas pelo homem, especialmente pelos habitantes de comunidades e municípios do interior do Brasil, principalmente em regiões com baixos índices de desenvolvimento humano. O objetivo deste trabalho foi realizar um estudo etnobotânico sobre as plantas medicinais utilizadas pelos moradores de um bairro localizado em um município ribeirinho do interior do estado do Amazonas. Participaram do estudo cem indivíduos, e os dados obtidos pela pesquisa foram compilados por meio de um formulário, contendo 14 questões (objetivas e discursivas). Os resultados demonstraram que 95% dos moradores faziam uso de plantas medicinais. Foram citadas 89 espécies, pertencentes a 48 famílias botânicas, com destaque para a Lamiaceae. As plantas mais citadas foram: Plectranthus barbatus (boldo) ­ 6,1%, Citrus sinensis (laranjeira) ­ 5,8% e Allium sativum (alho) ­ 4,7%. No entanto, quando analisado o índice de concordância (porcentagem de uso principal = CUP), a Citrus sinensis (laranjeira) apresentou um CUP de 80,9%, seguida por Plectranthus barbatus (boldo) e Disphania ambrosioides (mastruz), com 68,1% e 61,5%, respectivamente. Com relação ao modo de preparo, 61,1% citaram infusão, e as principais enfermidades tratadas foram as dores de estômago, com 13,1%. É importante enfatizar a necessidade de mais estudos acerca dos reais benefícios dessas ervas, a fim de que a divulgação de tais informações possa complementar o conhecimento empírico já difundido entre a população local. Dessa forma, será possível ampliar o conhecimento etnobotânico como um todo e, consequentemente, promover saúde e bem-estar.

Despite the evolution of scientific knowledge, the use of medicinal plants is one of the oldest practices still used by men and, especially by the inhabitants of communities and municipalities of the interior of Brazil, mainly in regions with low human development rates. The purpose of this work was to perform an ethnobotanical study on medicinal plants used by residents of a neighborhood located in a riverside city in the interior of the state of Amazonas. A total of 100 individuals participated in the study, with data being obtained through the use of a form containing 14 open and closed-ended questions. The results showed that 95% of the residents used medicinal plants. A total of 89 species, belonging to 48 botanical families were mentioned, with emphasis to Lamiaceae. The plants that were most frequently mentioned were Plectranthus barbatus (locally known as boldo) ­ 6.1%; Citrus sinensis (orange tree) ­ 5.8%; and Allium sativum (garlic) ­ 4.7%. However, when analyzing the agreement index (percentage of main use = CUP), Citrus sinensis (orange tree) presented a CUP of 80.9%, followed by Plectranthus barbatus (boldo) and Disphania ambrosioides (Mexican tea), with 68.1 and 61.5%, respectively. In relation to the method of preparation, 61.1% cited infusion, with the main disorder treated being stomachache, with 13.1%. It is important to emphasize the need for further studies on the actual benefits of these herbs so that the dissemination of the information can complement the already widespread empirical knowledge among the local population. Thus, it will be possible to expand the ethnobotanical knowledge as a whole and, consequently, promote health and well-being.

O conhecimento dos profissionais de saúde sobre vacinação de pessoas vivendo com HIV - uma revisão integrativa / El conocimiento de los profesionales de la salud sobre la vacunación de personas que viven con VIH - revisión integradora / Health professionals' knowledge about vaccination of people living with HIV - an integrative review

Resumo Objetivo Identificar evidências na literatura acerca do conhecimento dos profissionais de saúde sobre vacinação das pessoas vivendo com HIV. Método Trata-se de uma revisão integrativa. Para a busca, foram utilizados os descritores: pessoal de saúde (health personnel), conhecimento (knowledge), vacinação (vaccination), HIV e seus sinônimos, sem utilização de filtros, nas bases de dados Pubmed, Biblioteca Virtual em Saúde, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Science Direct e Cochrane. Foram incluídos apenas artigos primários analisados por meio do aplicativo RAYYAN. Resultados De 601 publicações iniciais, apenas cinco constituíram a amostra final, todas identificadas no Pubmed publicadas entre 2013 e 2018, sendo nenhum estudo brasileiro. A maioria das publicações estava relacionada a alguma vacina específica e não abordava todo o calendário vacinal. Conclusão e implicações para a prática O déficit de conhecimento dos profissionais de saúde, em relação às vacinas indicadas às pessoas vivendo com HIV, foi o principal aspecto identificado, resultando em insegurança dos profissionais. Há a necessidade de educação permanente das equipes multiprofissionais dos serviços especializados e da atenção primária visando diminuir as barreiras e aumentar a cobertura vacinal desta clientela.

Resumen Objetivo Identificar evidencias en la literatura acerca del conocimiento de los profesionales de la salud sobre la vacunación de personas que viven con VIH. Método Revisión integradora. Para la búsqueda, se utilizaron los descriptores: personal de salud (health personnel), conocimiento (knowledge), vacunación (vaccination), VIH y sus sinónimos, sin el uso de filtros, en las bases de datos Pubmed, Biblioteca Virtual en Salud, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Science Direct y Cochrane. Solo se incluyeron los artículos primarios analizados mediante la aplicación RAYYAN. Resultados De 601 publicaciones iniciales, solo cinco constituyeron la muestra final, todas identificadas en Pubmed y publicadas entre 2013 y 2018, sin ningún estudio brasileño. La mayoría de las publicaciones estaban relacionadas con una vacuna específica y no abordaban todo el calendario de vacunación. Conclusión e implicaciones para la práctica El desconocimiento de los profesionales de la salud en relación a las vacunas indicadas para personas que viven con VIH fue el principal aspecto identificado, lo que generó inseguridad entre los profesionales. Se advierte la necesidad de disponer la educación permanente de los equipos multiprofesionales de servicios especializados y de atención primaria para reducir barreras y aumentar las coberturas de vacunación de esta clientela.

Abstract Objective to identify evidence in the literature about the health professionals' knowledge concerning vaccination of people living with HIV. Method This is an integrative review. In this research, the descriptors used were the following: health personnel, knowledge, vaccination, HIV and its synonyms, without the use of filters, in the Pubmed, Virtual Health Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Embase, Scopus, Science Direct and Cochrane databases. Only primary articles analyzed using the RAYYAN application were included. Results Out of 601 initial publications, only five comprised the final sample, all identified in Pubmed and published between 2013 and 2018, with no Brazilian studies. Most of the publications were related to a specific vaccine and did not address the entire vaccination schedule. Conclusion and implications for the practice The health professionals' lack of knowledge in relation to vaccines indicated to people living with HIV was the main aspect identified, resulting in insecurity among the professionals. There is a need for permanent education of the multidisciplinary teams of specialized services and primary care in order to reduce barriers and to increase vaccination coverage for this clientele.

Infecção por Influenza B e doença de Kawasaki em adolescente durante a pandemia da COVID-19: relato de caso / Influenza B infection and Kawasaki disease in an adolescent during the COVID-19 pandemic: a case report

RESUMO Apresentação de um caso de infecção por Influenza B e doença de Kawasaki em adolescente ocorrido durante a pandemia da COVID-19. Adolescente asmática evoluiu com febre e síndrome gripal por 7 dias e deu entrada com quadro de insuficiência respiratória aguda, necessitando de intubação orotraqueal. Evoluiu também com instabilidade hemodinâmica respondedora ao uso de droga vasoativa. Foram introduzidas antibioticoterapia e medidas de suporte. Apresentou melhora hemodinâmica e respiratória progressiva, porém mantinha febre e alteração de provas inflamatórias. Durante internação, evoluiu com conjuntivite não purulenta bilateral, descamação de mão e pés, língua em framboesa e linfonodomegalia cervical, recebendo diagnóstico de doença de Kawasaki. Recebeu gamaglobulina e, por conta de quadro clínico refratário, foi administrado também corticoide, evoluindo afebril 24 horas após. Não apresentou alterações coronarianas. O único agente isolado foi Influenza B, mesmo realizando painel viral e investigação para COVID-19 com reação em cadeia da polimerase e sorologia. Durante internação, apresentou tromboembolismo pulmonar, e, em investigação de coagulopatias, foi diagnosticada com mutação em heterozigose de fator V de Leiden. Há uma potencial associação entre doença de Kawasaki e infecção por Influenza B ou outros vírus, como o coronavírus e, por isso, esses diagnósticos devem ser investigados nos pacientes pediátricos, incluindo adolescentes, com quadros febris prolongados.

ABSTRACT We report a case of Influenza B infection and Kawasaki disease in an adolescent, diagnosed during the COVID-19 pandemic. An asthmatic female adolescent presented with fever and flu-like symptoms for 7 days and was admitted with acute respiratory failure requiring mechanical ventilation. She progressed with hemodynamic instability responsive to vasoactive drugs. Antibiotic therapy and support measures were introduced, showing progressive hemodynamics and respiratory improvement, however with persistent fever and increased inflammatory markers. During the hospitalization, she developed bilateral non-purulent conjunctivitis, hand and feet desquamation, strawberry tongue, and cervical adenopathy, and was diagnosed with Kawasaki disease. She was prescribed intravenous immunoglobulin and, due to the refractory clinical conditions, corticosteroid therapy was added; 24 hours later, the patient was afebrile. No coronary changes were found. A full viral panel including COVID-19 C-reactive protein and serology could only isolate the Influenza B virus. During the hospitalization, she was diagnosed with pulmonary thromboembolism; coagulopathies were investigated, and she was diagnosed with heterozygous factor V Leiden mutation. There is a potential association between Kawasaki disease and infection with Influenza B or with other viruses such as coronavirus. Therefore, this association should be considered in pediatric patients, adolescents included, with prolonged febrile conditions.

Comparison of COVID-19 and influenza characteristics / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

The emergence of coronavirus disease 2019 (COVID-19) not only poses a serious threat to the health of people worldwide but also affects the global economy. The outbreak of COVID-19 began in December 2019, at the same time as the influenza season. However, as the treatments and prognoses of COVID-19 and influenza are different, it is important to accurately differentiate these two different respiratory tract infections on the basis of their respective early-stage characteristics. We reviewed official documents and news released by the National Health Commission of the People's Republic of China, the Chinese Center for Disease Control and Prevention (China CDC), the United States CDC, and the World Health Organization (WHO), and we also searched the PubMed, Web of Science, Excerpta Medica database (Embase), China National Knowledge Infrastructure (CNKI), Wanfang, preprinted bioRxiv and medRxiv databases for documents and guidelines from earliest available date up until October 3rd, 2020. We obtained the latest information about COVID-19 and influenza and summarized and compared their biological characteristics, epidemiology, clinical manifestations, pathological mechanisms, treatments, and prognostic factors. We show that although COVID-19 and influenza are different in many ways, there are numerous similarities; thus, in addition to using nucleic acid-based polymerase chain reaction (PCR) and antibody-based approaches, clinicians and epidemiologists should distinguish between the two using their respective characteristics in early stages. We should utilize experiences from other epidemics to provide additional guidance for the treatment and prevention of COVID-19.

Opportunities in the teaching of medical specialties, regarding influenza and COVID-19 / Oportunidades perdidas en la enseñanza de especialidades médicas, a propósito de la influenza y COVID-19

Abstract Medical specialties’ teaching is an area of health systems that deserves special consideration in light of the lessons learned from influenza and COVID-19; educational programs and implementation of the training strategies that are used must be reevaluated, since the level of training of most specialty students does not allow to consider them as personnel who can face these global problems. The number of specialization courses has exponentially grown, and their main threat is the cancellation or partial execution of their academic programs as a consequence of not implementing functional operational strategies during a contingency.

Resumen La enseñanza en las especialidades médicas es un rubro de los sistemas de salud que merece consideraciones especiales de acuerdo con las lecciones aprendidas de la influenza y COVID-19. Deben reevaluarse los programas educativos y las estrategias de capacitación implementadas, ya que la preparación escolar de la mayoría de los alumnos no les permite ser considerados como personal que pueda enfrentar esos problemas globales. Los cursos de especialización han crecido en número, pero su principal amenaza es la suspensión de los programas académicos o que sean parcialmente cubiertos como consecuencia de no implementar estrategias operativas funcionales durante una contingencia.

Remedios curativos y propaganda médica contra la influenza de 1918 en México: ideas y conocimientos / Therapeutic remedies and medical propaganda on influenza in Mexico in 1918: ideas and knowledge sets

Resumen El artículo explora el pensamiento médico en torno al impacto de la pandemia de influenza de 1918 en México. Se analizan las ideas científicas sobre la etiología de la gripe, las cuales se reflejaron en el tipo de remedios y recetas médicas que se publicaron en la prensa y en boletines de salud. Para adentrarse en este tema profundizamos en el contexto histórico internacional dominado por la guerra. En México, años de conflictos armados a consecuencia de la Revolución agravaron las condiciones de vida de la población: hambre, tifo, viruela y otros padecimientos infecciosos se presentaron antes y durante el brote de la pandemia. El trabajo se apoya en documentación de archivo, boletines de salud, prensa de la época y bibliografía actualizada.

Abstract This article explores medical thought on the impact of the influenza pandemic of 1918 in Mexico. It analyzes scientific ideas on the etiology of the flu, as reflected in the types of remedies and medical prescriptions published in the press and in health bulletins. It then goes deeper into the topic by examining the international historic context, dominated by the war. In Mexico, years of armed conflict unleashed by the Revolution exacerbated living conditions among the population: starvation, typhus, smallpox and other infectious diseases were present before and during the outbreak of the pandemic. This study is based on archival documentation, health bulletins, press sources from the period, and modern bibliography.

Influenza A. Manejo ambulatorio / Influenza A. Ambulatory management

Introducción. La influenza A constituye uno de los principales problemas de salud que enfrenta la humanidad.El manejo clínico ambulatorio usando el protocolo de oseltamivir y saturomería permite realizar una práctica evaluación. Objetivo. Evaluar resultados usando protocolo de oseltamivir y saturometría en atención médica ambulatoria y emergencias en pacientes con influenza A. Métodos. Realizar un estudio clínico experimental aleatorio en pacientes con influenza A, usando protocolo con oseltamivir y saturometría y compararlo con tratamiento estándar. Conclusiones. La influenza A seguirá afectandónos por varios años más, debemos asumir una capacidad de respuesta, que incluya: la detección y confirmación de casos; así como su manejo clínico oportuno y eficaz. (AU)

Introduction. Influenza A is one of the main health problems facing humanity. Outpatient clinical management using the oseltamivir and saturomer protocol allows a practical evaluation. Objective. To evaluate results using oseltamivir protocol and saturometry in ambulatory medical care and emergencies in patients with influenza A. Methods. Perform a randomized experimental clinical study in patients with influenza A, using procolo with oseltamivir and saturometry and compare it with standard treatment. Conclusions. Influenza A will continue to affect us for several more years, we must assume a capacity to respond, that include: the detection and confirmation of cases; as well as its timely and effective clinical management. (AU)

Caracterização de pacientes transportados com suporte respiratório e/ou cardiovascular extracorpóreo no Estado de São Paulo - Brasil / Characterization of patients transported with extracorporeal respiratory and/or cardiovascular support in the State of São Paulo, Brazil

RESUMO Objetivo: Caracterizar pacientes graves transportados em suporte respiratório ou cardiovascular extracorpóreo. Métodos: Descrição de uma série de 18 casos registrados no Estado de São Paulo. Todos os pacientes foram consecutivamente avaliados por uma equipe multidisciplinar no hospital de origem. Os pacientes foram resgatados, sendo a oxigenação por membrana extracorpórea instalada in loco. Os pacientes foram, então, transportados para os hospitais referenciados já em oxigenação por membrana extracorpórea. Os dados foram recuperados de um banco de dados prospectivamente coletado. Resultados: De 2011 até 2017, 18 pacientes com 29 (25 - 31) anos, SAPS3 de 84 (68 - 92), com principais diagnósticos de leptospirose e influenza A (H1N1) foram transportados no Estado de São Paulo para três hospitais referenciados. Uma distância mediana de 39 (15 - 82) km foi percorrida em cada missão, em um tempo de 360 (308 - 431) minutos. As medianas de um (0 - 2) enfermeiro, três (2 - 3) médicos e um (0 - 1) fisioterapeuta foram necessárias por missão. Dezessete transportes foram realizados por ambulância e um por helicóptero. Existiram intercorrências: em duas ocasiões (11%), houve falha de fornecimento de energia para a bomba e, em duas ocasiões, queda da saturação de oxigênio < 70%. Treze pacientes (72%) sobreviveram para a alta hospitalar. Dos pacientes não sobreviventes, dois tiveram morte encefálica; dois, disfunção de múltiplos órgãos; e um, fibrose pulmonar considerada irreversível. Conclusões: O transporte com suporte extracorpóreo ocorreu sem intercorrências maiores, com uma sobrevida hospitalar alta dos pacientes.

ABSTRACT Objective: To characterize the transport of severely ill patients with extracorporeal respiratory or cardiovascular support. Methods: A series of 18 patients in the state of São Paulo, Brazil is described. All patients were consecutively evaluated by a multidisciplinary team at the hospital of origin. The patients were rescued, and extracorporeal membrane oxygenation support was provided on site. The patients were then transported to referral hospitals for extracorporeal membrane oxygenation support. Data were retrieved from a prospectively collected database. Results: From 2011 to 2017, 18 patients aged 29 (25 - 31) years with a SAPS 3 of 84 (68 - 92) and main primary diagnosis of leptospirosis and influenza A (H1N1) virus were transported to three referral hospitals in São Paulo. A median distance of 39 (15 - 82) km was traveled on each rescue mission during a period of 360 (308 - 431) min. A median of one (0 - 2) nurse, three (2 - 3) physicians, and one (0 - 1) physical therapist was present per rescue. Seventeen rescues were made by ambulance, and one rescue was made by helicopter. The observed complications were interruption in the energy supply to the pump in two cases (11%) and oxygen saturation < 70% in two cases. Thirteen patients (72%) survived and were discharged from the hospital. Among the nonsurvivors, there were two cases of brain death, two cases of multiple organ dysfunction syndrome, and one case of irreversible pulmonary fibrosis. Conclusions: Transportation with extracorporeal support occurred without serious complications, and the hospital survival rate was high.

Impact of A/H1N1 influenza in children at a Brazilian University Hospital

ABSTRACT Background A/H1N1 influenza is a viral disease that affects a significant part of the population mainly in winter, leading to increased number of medical consultations, hospitalizations and consequently care spending in emergency. Methods This is a case-series retrospective study, involving patients admitted to a tertiary hospital in southern Brazil in 2016 with a clinical diagnosis of acute respiratory infection of the influenza type and laboratory confirmation of influenza A/H1N1. Results 64 patients were included, mostly male, median age of 48.3 months. Chronic underlying diseases were found in 73% of the patients, and these patients evolved to the most unfavorable outcome. About vaccination, of the 57 patients with an age range for vaccination, only 28% had complete vaccination coverage. The main clinical manifestations found in the included patients were fever, cough, intercostal indrawing, wheezing, tachypnea and pulmonary crackles. These patients were mainly followed-up with laboratory tests and chest X-ray. Consolidation was evident in 43% of patients followed by interstitial infiltrate in 33%. A five-day course of neuraminidase inhibitor was prescribed for all patients, as recommended by the WHO, but due to the complications, 73% of the patients required antibiotic therapy, and 61% oxygen therapy. The majority of patients had a favorable outcome, but 11 required intensive care and one died. Conclusions A/H1N1 influenza persists as an important public health problem, mainly due to high morbidity and hospitalization rates. It is important to identify patients with A/H1N1 influenza and clinical situations with higher risk of complications. Through this study, it is possible to analyze the characteristics of pediatric patients with A/H1N1 influenza and mainly to emphasize assistance of populations with comorbidities, since they present higher rates of complications and death.

Oxigenação por membrana extracorpórea na síndrome do desconforto respiratório agudo devido à pneumonia por influenza A (H1N1) pdm09. Experiência em um único centro durante a temporada de 2013-2014 / Extracorporeal membrane oxygenation in acute respiratory distress syndrome due to influenza A (H1N1)pdm09 pneumonia. A single-center experience during the 2013-2014 season

RESUMO Objetivo: Descrever os desfechos de pacientes com síndrome do desconforto respiratório agudo associada à influenza subtipo H1N1 grave tratados com oxigenação por membrana extracorpórea. Métodos: Trata-se de revisão retrospectiva de uma coorte de pacientes oriunda de um único centro, constituída por adultos com síndrome do desconforto respiratório agudo relacionada com influenza subtipo H1N1 e tratados com oxigenação venovenosa por membrana extracorpórea durante a temporada de inverno no hemisfério norte de 2013/2014. Resultados: Dez pacientes receberam oxigenação venovenosa por membrana extracorpórea para tratamento de influenza subtipo H1N1 entre janeiro de 2013 e março de 2014. Sete deles foram transferidos para nosso centro visando à utilização de oxigenação por membrana extracorpórea dentro de um período de 72 horas após o início da ventilação mecânica. A idade mediana foi de 40 anos, sendo 30% dos pacientes do sexo feminino. O valor mediano da proporção entre pressão parcial de oxigênio e fração inspirada de oxigênio foi de 62,5, sendo o escore RESP mediano de 6. Três pacientes receberam inalação de óxido nítrico e quatro utilizaram posição prona como tratamento de resgate antes de ser iniciada a oxigenação por membrana extracorpórea. A duração mediana da ventilação mecânica foi de 22 dias (variação de 14 - 32). O tempo mediano de permanência na unidade de terapia intensiva foi de 27 dias (variação de 14 - 39). O tempo mediano de permanência no hospital foi de 29,1 dias (variação de 16,0 - 46,9). Ocorreram complicações não importantes de sangramento em seis dos dez pacientes. Oito dos dez pacientes sobreviveram até a alta hospitalar. Conclusão: Os sobreviventes eram relativamente jovens e tiveram alta com boas condições funcionais, o que salienta os anos de vida ajustados pela qualidade que foram salvos. Nossa experiência demonstra que mesmo um programa ainda relativamente novo de oxigenação por membrana extracorpórea pode desempenhar um papel importante, e proporcionar resultados excelentes para os pacientes mais graves.

ABSTRACT Objective: This report aimed to describe the outcomes of the patients with severe H1N1 associated acute respiratory distress syndrome who were treated with extracorporeal membrane oxygenation therapy. Methods: This retrospective review analyzed a single-center cohort of adult patients with H1N1-related acute respiratory distress syndrome who were managed with veno-venous extracorporeal membrane oxygenation during the winter of 2013/2014. Results: A total of 10 patients received veno-venous extracorporeal membrane oxygenation for H1N1 influenza between January 2013 and March 2014. Seven patients were transferred to our center for extracorporeal membrane oxygenation consideration (all within 72 hours of initiating mechanical ventilation). The median patient age was forty years, and 30% were female. The median arterial oxygen partial pressure to fraction of inspired oxygen ratio was 62.5, and the median RESP score was 6. Three patients received inhaled nitric oxide, and four patients were proned as rescue therapy before extracorporeal membrane oxygenation was initiated. The median duration of mechanical ventilation was twenty-two days (range, 14 - 32). The median length of stay in the intensive care unit was twenty-seven days (range, 14 - 39). The median hospital length of stay was 29.1 days (range, 16.0 - 46.9). Minor bleeding complications occurred in 6 of 10 patients. Eight of the ten patients survived to hospital discharge. Conclusion: The survivors were relatively young and discharged with good functional status (i.e., enhancing quality-adjusted life-years-saved). Our experience shows that even a relatively new extracorporeal membrane oxygenation program can play an important role in that capacity and provide excellent outcomes for the sickest patients.

Dimensiones políticas de una epidemia: el caso de la gripe A (H1N1) en la prensa escrita de Argentina / Political dimensions of an epidemic: the case of influenza A (H1N1) in the Argentine press / Dimensões políticas de uma epidemia: o caso da gripe A(H1N1) na imprensa escrita da Argentina

El objetivo de este estudio se orienta a comprender las representaciones sociales que expresan los periódicos, en torno a la epidemia de gripe A (H1N1) en Argentina para el año 2009, a través del análisis cuali-cuantitativo de dos dimensiones fundamentales: la forma en que se construye el "objeto" epidemia y las fuentes de información de las noticias. A partir de ello, es posible identificar que en la forma de nombrar y construir la epidemia subyace cierta decisión política de eliminar la responsabilidad que cabe a un modo de producción pecuaria riesgosa, responsabilizando al individuo que incurre en conductas de riesgo. El análisis muestra la vigencia de la hegemonía biomédica en las recomendaciones de representantes políticos, especialmente a nivel internacional, lo que contribuye a la farmacologización de una epidemia, posicionamiento que reproduce la población en sus reclamos. El comportamiento de la prensa ante la epidemia, no responde a eventos vinculados a la epidemiología del virus, sino que publica la mayor parte de noticias ante eventos asociados a la política local.

The current study addresses social representations of the influenza A (H1N1) epidemic in Argentina in 2009, in the country's mainstream newspapers. The methodology was twofold, qualitative and quantitative, with an analysis of two dimensions: the construction of the epidemic as an "object" (designation and characterization) and the sources of information in the news stories, seeking to identify the social actors involved in each case. The results show that designating the epidemic as "H1N1" rather than "swine flu" was a conscious political decision to exempt a hazardous form of livestock production from its role in the disease, while focusing responsibility on individual patients. The study addresses the relations between recommendations by policy spokespersons (especially at the international level), the pharmaceuticalization of the epidemic, shifting of the population's demands to validate biomedical hegemony, and local press coverage of the epidemic.

O presente estudo tem como objetivo compreender as representações sociais sobre a epidemia de influenza A (H1N1), na Argentina em 2009, nos jornais de maior circulação no país. A metodologia foi qualitativa e quantitativa com base na análise de duas dimensões: a forma em que se constrói o "objeto" epidemia (designação e caracterização dos mesmos) e as fontes de informação das notícias, procurando identificar em cada caso os atores sociais envolvidos. Os resultados mostram que na nomeação da epidemia fica a decisão política de eliminar a responsabilidade de um modo de produção de gado de risco, culpando o indivíduo. Observa-se que as recomendações dos representantes políticos, especialmente no nível internacional e promovida a farmacologização da epidemia, a reprodução do posicionamento da população em suas reivindicações que demonstra a validade da hegemonia biomédica e, finalmente, o comportamento da imprensa para a epidemia concentra-se em puramente ligado aos acontecimentos políticos locais.

Estudio observacional de cohorte de pacientes con enfermedad tipo influenza durante el período 2010 ­ 2013 / Observational cohort study of patients with influenza-like illness during the period 2010 - 2013

Desde la pandemia de Influenza del año 2009, se realizaron campañas de vacunación, aumentaron las consultas médicas y el uso de medicación. Los datos recolectados durante las últimas temporadas nos permitieron describir incidencia de casos de influenza, comparar la incidencia de tipos y subtipos, y la frecuencia de vacunación. Para ello se realizó un estudio prospectivo, observacional de cohorte, sobre la población de pacientes que consultaron al Hospital J. M. Ramos Mejía desde octubre/2010 a septiembre/2013. Participaron 336 pacientes de los cuales 147 tuvieron resultado positivo para Influenza. La incidencia de casos de Influenza fue 43,7% sobre los pacientes con síntomas gri-pales durante el periodo evaluado. Se observó que el odds de presen-tar infección por influenza fue 3,8 veces de los pacientes no vacunados que los que recibieron la vacuna antigripal. Estos resultados permitie-ron observar una variación estacional de los subtipos virales de Influen-za, frecuencia de vacunación y complicaciones de nuestra población

Since the 2009 pandemic Influenza, vaccination campaigns were conducted, and medical visits and medication use increased. The data collected during recent flu seasons allowed us to describe Influenza type and subtype incidence, and to compare the incidence and frequency of vaccination. A prospective, observational cohort study was conducted of the patient population attended in the J. M. Ramos Mejia Hospital from October / 2010 to September / 2013. It involved 336 patients of which 147 were positive for influenza. The incidence of influenza was of 43.7% over the symptomatic subjects during the study period. It was observed that the odds of presenting influenza infection was 3.8 times in unvaccinated patients than those who received flu vaccine. These results show a seasonal variation of influenza viral subtypes, the vaccination frequency and the medical complications

Acción virucida directa sobre el virus influenza de un extracto de Punica granatum L (granada) / Direct virucidal action against influenza virus of an extract of Punica granatum L (granada)

INTRODUCCIÓN: la especie vegetal Punica granatum L. se conoce en Cuba como granada. A esta planta se le atribuye acción anticatarral en la medicina tradicional, entre otras propiedades. En estudios previos realizados al extracto hidroalcohólico liofilizado preparado con el fruto de esta planta, se informaron la presencia de numerosos componentes químicos, la mayoría flavonoides. Estos compuestos, unidos a la variedad de metabolitos secundarios detectados, le confieren a este liofilizado la posibilidad de poseer acción antiinfluenza, tal como ha sido demostrado en estudios previos del mismo. OBJETIVO: evaluar la acción virucida directa del extracto hidroalcohólico liofilizado de P. granatum frente a la cepa Influenza A/Mississippi/1/85 (H3N2), con diferentes variantes de tratamiento. MÉTODOS: las variantes de tratamiento directo se realizaron en 27 combinaciones de las variables; tiempo de contacto de: 60, 30 y 15 minutos; concentración del extracto de: 1000, 200 y 125 µg/mL y temperatura de incubación de la mezcla extracto-virus: 4, 25 y 37 0C. La presencia o no de la hemaglutinina del virus influenza en cada una de las muestras tratadas, se midió por la titulación de la Inhibición de la Hemaglutinación (IHA) y el título infectivo viral (DIE50). RESULTADOS: la concentración mínima efectiva para ejercer el extracto liofilizado, la acción virucida directa, in vitro, fue 125 µg/mL, a los 15 minutos. La acción virucida directa de éste extracto estuvo siempre presente en las diferentes temperaturas y tiempos de exposición ensayados. CONCLUSIONES: la variante de ensayo que utilizó 125 µg/mL, con independencia del tiempo y la temperatura de tratamiento, resultó suficiente efectiva para reducir la presencia de hemaglutinina del virus influenza.

INTRODUCTION: Punica granatum L. is known in Cuba as grenade. In traditional medicine, among other properties, antiflu action is attributed to this plant. In previous studies with the hydroalcoholic lyophilized extract, prepared with the fruit of this specie, several chemical compounds were reported, specially the presence of flavonoids. The variety of secondary metabolites detected for this lyophilized extract, added to a flavonoid fraction confers a high possibility of anti-influenza activity, as has been demonstrated in previous studies. OBJECTIVE: to evaluate the virucidal activity of the hydroalcoholic lyophilized extract of P. granatum against Influenza A/Mississippi/1/85 (H3N2), with different schemes of treatments. METHODS: the different schemes of treatments included 27 variants of the variables such as contact time of 60, 30 and 15 minutes; extract concentration of 1000, 200 and 125 µg/mL; an incubation temperature of the mix extract-virus of 4, 25 and 37 0C; and the corresponding replicas. The presence or not of hemaglutinin of influenza virus in each one of the treated samples, was measured by titration of Hemaglutination Inhibition (HAI) and the Embryo Infection Doses (EID50). RESULTS: the minimal effective concentration to show in the hydroalcoholic lyophilized extract the direct virucidal action in vitro was 125 µg/mL, in 15 minutes of contact. This virucidal action was always present in the different assessed temperature and time exposures. CONCLUSIONS: the treatment of 125 µg/mL, regardless of time and temperature of treatment, was effective enough to reduce the presence of hemaglutinin of the influenza virus.

Secondary Infections in Swine Flu.

Swine influenza is respiratory disease of pigs caused by type A influenza virus that causes regular outbreak in pigs. Human to human transmission occurs. Some people develop severe respiratory symptoms and need ventilator. Patients can get secondary bacterial infections in form of pneumonia if viral infections persist. Death of swine flu occurs due to secondary bacterial infections leading to bacterial pneumonias. Method : 369 patients having acute respiratory illness suspected to be suffering from swine flu were included. Real time reverse transcriptase polymerase chain reaction (RT-PCR) was performed on sputum samples or tracheal aspirates of 134 patients admitted in Hospital due to pneumonia. 90 of these patients were positive for swine flu by RT-PCR. Result : Among 90 patients 55 patients’ shows bacterial growth and 35 patients did not show any growth. Maximum patients 17 shows Klebseilla pneumoniae,17 show Staphylococcus aureus ,10 show Escherichia coli,8 show Pseudomonas aeruginosa and 3 patients show Streptococccus pneumoniae. Even after treatment, death of 36 patients occurred. Among these 36 patients, 19 had both, bacterial as well as swine flu infection and 17 patients had only swine flu infection. Conclusion : Secondary bacterial infections in swine flu patients were multiresistant to antibiotics were noted. Pneumonia caused by co-infection contributes to a severe rapidly progressive illness.

Intervenciones de enfermería para la atención en adultos de 65 años y más con infecciones de vías respiratorias en el primero y segundo nivel de atención / Nursing interventions for care in adults 65 years and older with respiratory tract infection in the first and second level of care

OBJETIVO: Establecer intervenciones de enfermería efectivas para la atención de los adultos de 65 años y más con infecciones de vías respiratorias, para disminuir la incidencia de morbilidad y mortalidad y mejorar la calidad para contribuir a garantizar la seguridad de la atención y el autocuidado.MATERIALES Y MÉTODOS: Elaboración de las preguntas a responder y conversión a preguntas clínicas estructuradas, búsqueda y revisión sistemática de la literatura: recuperación de guías internacionales o meta análisis, o ensayos clínicos aleatorizados, o estudios observacionales publicados que den respuesta a las preguntas planteadas, de los cuales se seleccionarán las fuentes con mayor puntaje obtenido en la evaluación de su contenido y las de mayor nivel en cuanto a gradación de evidencias y recomendaciones.Protocolo sistematizado de búsqueda: Algoritmo de búsqueda reproducible en bases de datos electrónicas, en centros elaboradores o compiladores de guías, de revisiones sistemáticas, meta análisis, en sitios Web especializados y búsqueda manual de la literatura.RESULTADOS Y DISCUSIÓN: Un total de fuentes documentadas y utilizadas: 81 (Pud Med, BVS, TRIPDATA BASE, Otros sitios Web). guías seleccionadas: 4, revisiones sistemáticas: 26, ensayos clínicos aleatorizados: 14, meta análisis: 17, estudios de cohorte: 6, casos y controles: 5 y otros documentos: 9.CONCLUSIONES: La vacunación contra la influenza a los grupos más vulnerables y el constante lavado de manos, son algunas de las intervenciones que contribuyen a la prevención y control de las enfermedades respiratorias en los adultos mayores.

OBJECTIVE: Establish effective nursing interventions for the care of adults 65 years and older with respiratory tract infections, to reduce the incidence of mordidito and mortality and improve quality to help ensure the safety of care and self-care.MATERIALS AND METHODS:Development of questions to answer and conversion to questions structured clinical, research and systematic review of the literature: recovery of international or meta guides analysis or randomized clinical trials, or published observational studies that respond to the questions, of which will select the sources with the highest score obtained in the evaluation of its content and the higher level as to grading evidence and recommendations.Search systemized protocol: search algorithm reproducible electronic databases, in institutions or compilers processors guides, systematic reviews, meta analysis, specialized Web sites and manual literature search.RESULTS AND DISCUSSION:A total of documented and used sources: 81 (Pud Med, BVS, TRIPDATA BASE, Other Web sites). Selected guides: 4, systematic reviews: 26 randomized clinical trials: 14, meta analysis: 17 cohort studies: 6 cases and controls 5 and other documents: 9.CONCLUSIONS: Influenza vaccination the most vulnerable groups and constant hand washing, are some of the interventions that contribute to the prevention and control of respiratory diseases in older adults.

OBJETIVO: Estabelecer intervenções eficazes de enfermagem para o cuidado dos adultos com 65 anos e mais velhos com infecções do trato respiratório, para reduzir a incidência de morbidade e mortalidade e melhorar a qualidade para ajudar a garantir a segurança dos cuidados e auto-cuidado.MATERIAIS E MÉTODOS:Desenvolvimento de perguntas para responder e conversão às perguntas estruturadas clínica, pesquisa e revisão sistemática da literatura: a recuperação da análise de guias internacionais ou meta ou ensaios clínicos randomizados, ou publicados estudos observacionais que respondam às perguntas, das quais irá selecionar as fontes com o maior resultado obtido na avaliação do seu conteúdo e do nível superior como a classificação de evidências e recomendações.Pesquisar protocolo sistematizado: algoritmo de busca bases de dados electrónicas reprodutíveis, em instituições ou compiladores processadores guias, revisões sistemáticas, meta-análise, sites especializados e busca manual de literatura.RESULTADOS E DISCUSSÃO:Um total de fontes documentados e usados: 81 (Pud Med, BVS, TRIPDATA BASE, outros sites). guias selecionadas: 4, revisões sistemáticas: 26 ensaios clínicos randomizados: 14, meta-análise: estudos de coorte 17: 6 casos e controles 5 e outros documentos: 9.CONCLUSÕES: Vacinação contra a Gripe dos grupos mais vulneráveis e a lavagem das mãos constante, são algumas das intervenções que contribuam para a prevenção e controlo de doenças respiratórias em adultos mais velhos.

Actividad antiviral de un extracto acuoso del alga roja Laurencia obtusa frente a virus influenza A y B / Antiviral activity of an aqueous extract from the red alga Laurencia obtusa against influenza A and B viruses

(au)INTRODUCCIÓN: la terapia antiviral frente a las infecciones provocadas por virus influenza se basa en empleo de inhibidores de las proteínas M2 y neuraminidasa (NA). Sin embargo, la emergencia de cepas estacionales resistentes a ambos grupos de fármacos motiva la búsqueda de nuevos fármacos anti-influenza. Los extractos de algas pueden ser utilizados como fuente para la obtención de estos compuestos, teniendo en cuenta la diversidad de metabolitos descrita en estos organismos. OBJETIVO: evaluar la actividad antiviral in vitro de un extracto acuoso del alga roja Laurencia obtusa frente a virus influenza A (H1N1), A (H3N2) e influenza B. MÉTODOS: se evaluó la citotoxicidad en células MDCK, mediante cálculo de la viabilidad celular, en presencia de concentraciones crecientes del extracto. Los efectos sobre la replicación viral se cuantificaron mediante determinación de los niveles de la hemaglutinina (HA) y de la inhibición del efecto citopático (ECP). El índice selectivo (IS) se calculó a partir de la relación IS=CC50/CE 50. RESULTADOS: el extracto acuoso de Laurencia obtusa posee actividad antiviral in vitro frente a virus influenza B, A (H3N2) y A (H1N1) con valores de IS de 7,73; 11,79 y 12,95; respectivamente. CONCLUSIONES: Laurencia obtusa inhibe la replicación de virus influenza de elevada importancia clínica. La realización de ensayos secundarios de caracterización de la actividad biológica, así como de caracterización molecular del extracto, podrían permitir el desarrollo de novedosos compuestos antivirales. Este trabajo constituye el primer informe de actividad inhibitoria de esta especie de macroalga frente a virus influenza.compuestos antivirales. Este trabajo constituye el primer informe de actividad inhibitoria de esta especie de macroalga frente a virus influenza(AU)

INTRODUCTION: antiviral therapy against infections caused by influenza viruses is based on the use of inhibitors of M2 protein and neuraminidase (NA). However, the emergence of seasonal strains resistant to both drug groups has led to the search for new anti-influenza medications. Extracts from algae may be used as a source of compounds, considering the diversity of metabolites described for these organisms. OBJECTIVE: evaluate the in vitro antiviral activity of an aqueous extract from the red alga Laurencia obtusa against influenza A (H1N1), A (H3N2) and B viruses. METHODS: cytotoxicity was evaluated in MDCK cells by cell viability estimation in the presence of growing concentrations of the extract. The effects over viral replication were quantified by determining hemagglutinin (HA) levels and inhibition of the cytopathic effect (CPE). The selective index (SI) was estimated by SI=CC50/CE50. RESULTS: the aqueous extract of Laurencia obtusa showed in vitro antiviral activity against influenza B, A (H3N2) and A (H1N1) viruses with SI values of 7.73, 11.79 and 12.95, respectively. CONCLUSIONS: Laurencia obtusa inhibits the replication of influenza viruses, a fact of great clinical importance. Secondary assays to characterize the biological activity and molecular composition of the extract may lead to the development of novel antiviral compounds. The present paper is the first report on the inhibitory activity of this macroalga species against influenza viruses(AU)