O que o passado tem a nos ensinar sobre a Influenza? / What does the past have to teach us about influenza? / ¿Qué puede enseñarnos el pasado sobre la Influenza?

Objetivo: apresentar narrativa dos acontecimentos históricos sobre a epidemia de Influenza e suas interfaces com a saúde pública e enfermagem. Conteúdo: destaca-se a cultura, e os modos de ver a história ao longo dos anos para compreensão do comportamento epidemiológico da Influenza no Brasil, suas epidemias e o que se apreendeu e construiu após 100 anos cuidando e estudando sobre este agravo durante as epidemias que ocorreram no Brasil. Conclusão: entender que a imunização é a estratégia mais eficaz no controle de doenças transmissíveis e, no caso da Influenza, como imunobiológico potente, deve ser o legado apreendido das grandes epidemias deste agravo, mas também, a vigilância e educação em saúde das populações para tal, principalmente com foco nos movimentos antivacinas.

Objective: to present a narrative of historical events regarding the influenza epidemic and its interfaces with public health and nursing. Content: the study highlights culture and ways of seeing history over the years, in order to understand the epidemiological behavior of influenza in Brazil, its epidemics, and what has been learned and built after 100 years' caring for and studying this condition during epidemics that occurred in Brazil. Conclusion: immunization is the most effective strategy for controlling communicable diseases and, in the case of Influenza, is a powerful immunobiological resource. This should be the legacy learned from the major epidemics of this disease, as well as health surveillance and education of the public for the same purpose, with a special focus on anti-vaccine movements.

Objetivo: presentar narrativa de los sucesos históricos sobre la epidemia de Influenza y sus interfaces con la salud pública y la enfermería. Contenido: se destacan la cultura y los modos de ver la historia a lo largo de los años, para comprender el comportamiento epidemiológico de la Influenza en Brasil, sus epidemias y lo que se aprendió y construyó después de 100 años cuidando y estudiando sobre este agravio durante las epidemias que ocurrieron en Brasil. Conclusión: entender que la inmunización es la estrategia más eficaz en el control de enfermedades transmisibles y, en el caso de la Influenza, como inmunobiológico potente, ese debe ser el legado comprendido de las grandes epidemias. Asimismo, se debe llevar en cuenta la vigilancia y la educación en salud de las poblaciones, principalmente con foco en los movimientos antivacunas.

H1N1: perfil clínico-epidemiológico de pacientes atendidos em um hospital / H1N1: clinical and epidemiological profile of patients treated in a hospital

Objetivo: Avaliar casos de suspeita de gripe H1N1, bem como comparar aspectos epidemiológicos e clínicos dos pacientes com gripe H1N1 confirmada em relação àqueles não confirmados; analisar os critérios de gravidade clínica com relação à confirmação (ou não) da gripe H1N1 e seu desfecho (mortalidade); e criar um banco de dados para fins de comparação com a literatura nacional e mundial. Métodos: Estudo retrospectivo de coorte transversal realizado no período sazonal (outono e inverno) no ano de 2016. Foram analisados os prontuários, acessíveis e completos, de pacientes com suspeita clínica de H1N1, além daqueles com resultados definidos na sorologia. A partir dos dados coletados, foi elaborada tabela de análise epidemiológica, com informações clínicas, laboratoriais e sorológicas. Resultados: Destacam-se a média das faixas etárias mais acometidas de 48 anos, além dos sintomas mais comuns que foram dispneia, tosse e mialgia; as comorbidades foram hipertensão arterial sistêmica, cardiopatias, diabetes e doença pulmonar obstrutiva crônica. Conclusão: Este trabalho contribuiu com a caracterização do perfil epidemiológico regional e auxiliou na definição de indicadores de diagnóstico e gravidade, além de agregar à literatura conteúdos de caráter relevante. Este estudo está registrado como CAAE 58664016.2.0000.5515 na Plataforma Brasil. (AU)

Objective: To evaluate cases of suspected H1N1 flu, as well as to compare epidemiological and clinical aspects of patients with confirmed H1N1 influenza to those who were not confirmed; to analyze the criteria of clinical severity regarding the confirmation (or not) of H1N1 influenza, and its outcome (mortality); and to create a database to be compared with the national and world literature. Methods: This is a cross-sectional retrospective cohort study, carried out in the seasonal period ( fall/winter) of 2016. Accessible and complete medical records of patients with clinical suspicion of H1N1 were analyzed along with those with defined serology results. Based on the collected data, a table of epidemiological analysis was elaborated with clinical, laboratory and serological information. Results: The mean age of the most affected age groups was 48 years; the most common symptoms were dyspnea, cough and myalgia; and the comorbidities were systemic arterial hypertension, cardiopathies, diabetes, and chronic obstructive pulmonary disease. Conclusion: This work contributed to the characterization of the regional epidemiological profile, and helped in the definition of indicators of diagnosis and severity, besides adding relevant content to the literature. This study is registered as CAAE 58664016.2.0000.5515 at Plataforma Brasil. (AU)

Muscle biopsy features in critical ill patients with 2009 influenza A (H1N1) virus infection / Alterações da biópsia muscular em pacientes gravemente acometidos pela infecção por vírus influenza A (H1N1) 2009

Higher serum creatine kinase (CK) levels in critically ill patients with a confirmed 2009 influenza A (H1N1) infection suggests a possible relationship between the H1N1 virus and muscle tissue. However, there have been no reports with an emphasis on muscle biopsies for patients infected with the H1N1 virus. The objective of this study was to investigate the histological characteristics of the muscle biopsies from critically ill patients with confirmed 2009 H1N1 infections. A series of ten patients with confirmed 2009 H1N1 infection, who presented increased serum CK levels, was analyzed. Histological study found small histochemical alterations in muscles fibers (mainly in NADH, SDH, COX, myophosphorylase, adenylate deaminase and PAS stains), and no histological changes were compatible with inflammatory myopathy. Although our critically ill patients had elevated CK levels, they exhibited few histological/histochemical abnormalities in their muscle biopsy samples; however, those alterations could be consistent with metabolic dysfunction associated with influenza H1N1 infection.

Os elevados níveis séricos da creatina quinase (CK) em pacientes gravemente acometidos pela infecção por influenza A (H1N1) 2009 sugerem uma possível relação entre infecção pelo vírus H1N1 e alterações do tecido muscular. No entanto, não existem relatos com ênfase nas alterações histológicas encontradas no músculo dos pacientes infectados pelo vírus H1N1. O objetivo deste estudo foi investigar as características histológicas, em biópsia muscular, de pacientes gravemente acometidos pela infecção por vírus H1N1 2009. Foi analisada uma série de dez pacientes com infecção confirmada por vírus H1N1, que apresentavam nível sérico elevado de CK. O estudo histológico evidenciou pequenas alterações histoquímicas nas fibras musculares (mais evidentes nas colorações por NADH, SDH, COX, miofosforilase, adenilato deaminase e PAS) mas sem alterações histológicas compatíveis com miopatia inflamatória. Embora nossos pacientes mostrassem níveis séricos elevados de CK, foram poucas as alterações histológicas e histoquímicas encontradas em suas biópsias musculares. Contudo, essas alterações podem ser consistentes com uma disfunção metabólica da fibra muscular associada à infecção pelo H1N1.

Desempeño de la prueba de inmunofluorescencia directa en el diagnóstico del virus Influenza A(H1N1) / Direct immunofluorescence assay performance in diagnosis of the Influenza A(H1N1) virus

El 25 de abril de 2009, a menos de un mes de la detección en México del primer humano con virus Influenza A(H1N1), la enfermedad ya se había propagado a más de 40 países superando los 10 000 casos notificados. Dada su naturaleza impredecible, este tipo de virus requiere métodos diagnósticos apropiados, confiables y seguros, pero que también estén al alcance de los laboratorios clínicos. Mediante el estudio de 291 muestras de pacientes con sospecha de infección por virus Influenza A(H1N1) en Neuquén, Argentina, el presente trabajo compara los dos métodos de diagnóstico utilizados simultáneamente: la prueba de inmunofluorescencia directa (DFA) y la de reacción en cadena de la polimerasa en tiempo real (RT-PCR). La DFA dio una sensibilidad de 44,4 por ciento, especificidad de 99,6 por ciento, valor predictivo positivo de 95,2 por ciento y valor predictivo negativo de 90,7 por ciento. Los resultados positivos de la metodología pueden considerarse verdaderos positivos. Un resultado negativo no excluye la presencia del virus y la muestra debe examinarse mediante RT-PCR. Del total de 291 muestras, 45 resultaron positivas por RT-PCR y 21 por DFA.

By 25 April 2009, less than one month after the first human with Influenza A(H1N1) virus was detected in Mexico, the disease had already spread to more than 40 countries, with over 10 000 cases reported. Due to its unpredictability, this type of virus requires appropriate, reliable, and safe diagnostic methods that are also accessible to clinical laboratories. Through the analysis of 291 samples taken from patients with suspected Influenza A(H1N1) virus infection in Neuquén, Argentina, this study compares the two diagnostic methods used simultaneously: direct immunofluorescence assay (DFA) and real-time polymerase chain reaction (RT-PCR). DFA had a sensitivity of 44.4 percent, a specificity of 99.6 percent, a positive predictive value of 95.2 percent, and a negative predictive value of 90.7 percent. Positive results obtained with this method can be considered true positives. A negative result does not rule out the presence of the virus. In this case, the sample should be examined by RT-PCR. Out of a total of 291 samples, there were 45 positive results with RT-PCR and 21 positive results with DFA.

Clinical characteristics of 74 pandemic HlNl influenza patients from Turkey. Risk factors for fatality

To evaluate the clinical characteristics and certain risk factors that may be associated with fatal outcome in patients with HlNl influenza. This retrospective study was conducted between October and December 2009 in the Department of Infectious Diseases and Clinical Microbiology, SB Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey. Data regarding the epidemiological and clinical characteristics of 74 hospitalized cases of confirmed pandemic HlNl influenza were reviewed. The median age was 49 [18-83] years, and 34 [46%] were males. The most common symptom and signs on admission were cough [91.9%] and fever >38°C [71.7%]. More than two-thirds of patients [68.9%] had at least one underlying condition; most frequently chronic respiratory disease, including asthma and diabetes. Seventy-seven percent had evidence of pneumonia on their chest x-rays at presentation. Of the 74 cases, 16 [21.6%] were followed up in the Intensive Care Unit, and 10 [13.5%] died. Obesity and oxygen saturation below 92% at the time of admission were found to be significantly related with fatal outcome. In addition, fatal patients had significantly higher levels of alanine aminotransferase [ALT], aspartate aminotransferase [AST], lactate dehydrogenase [LDH], urea, creatinine, d-dimer on admission and prothrombin time [PT], activated partial thromboplastin time, and the international normalized ratio [INR] was longer. Timely identification and management of patients with higher risk for fatality may improve outcomes