Boletim epidemiológico: perfil epidemiológico dos casos de síndrome respiratória aguda grave notificados no Centro Estadual de Reabilitação e Readaptação Dr. Henrique Santillo - CRER, janeiro a setembro/2023 / Epidemiological bulletin: epidemiological profile of cases of severe acute respiratory syndrome reported at the State Center for Rehabilitation and Readaptation Dr. Henrique Santillo - CRER, January to September/2023

Trata-se de um estudo epidemiológico descritivo retrospectivo, realizado a partir dos casos de síndrome respiratória aguda grave notificados em um hospital de referência em reabilitação do Estado de Goiás no período de janeiro a setembro de 2023. Os dados utilizados foram extraídos do SIVEP - Gripe (Sistema de Informação da Vigilância Epidemiológica da Gripe), que integra a base dos sistemas de informação do Departamento de Informática do Sistema Único de Saúde (DATASUS)

This is a retrospective descriptive epidemiological study, carried out based on cases of severe acute respiratory syndrome reported in a reference hospital for rehabilitation in the State of Goiás from January to September 2023. The data used were extracted from SIVEP - Gripe (Influenza Epidemiological Surveillance Information System), which forms part of the information systems base of the Information Technology Department of the Unified Health System (DATASUS)

Ethnological aspects of COVID-19

Abstract Within recent past, coronavirus has shaken the whole world. The world faced a new pandemic of novel coronavirus 2019 (SARS-CoV-2/ COVID-19).It has socioeconomically impacted world population a lot in terms of education, economy as well as physical and mental health. This novel coronavirus is notorious enough that put human health at a great risk. Currently, researchers all over the world aretrying hard to develop a new drug/vaccine for its treatment. In past decades, the world population has faced various viral infectious illness outbreaks. Influenza A, Ebola, Zika, SARS and MERS viruses had whacked public health and economy. Medical science technology achieved the landmark in developing coronavirus (SARS-CoV-2) vaccines that are approved currently for emergency use. Some of the recently approved vaccines are developed by Pfizer and Moderna, Johnson and Johnson, Gam-COVID-vac (Sputnik V), Bharat Biotech (covaxin) andOxford-AstraZeneca vaccines (covishield) (Badenet al., 2021). Here, a short review is drafted focusingon infection, immune system, pathogenesis, phylogenesis, mode of transmission and impact of coronavirus on health and economy and recent developments in treating COVID-19

Cirugia vascular y covid 19: tres casos con diferentes implicaciones / Vascular surgery and covid 19: three cases with different implications

Introducción: por primera vez en poco más de un siglo, el mundo se ha enfrentado a una pandemia, la del COVID 19, que ha infectado y matado a millones de personas . Esta enfermedad presenta una amplia gama de manifestaciones y órganos y sistemas afectados, siendo uno de los principales el sistema circulatorio. Material y Métodos: Se presentan tres casos de enfermedades vasculares complejas, que fueron tratadas quirúrgicamente y en las que el covid 19 alteró el curso normal de la enfermedad y su tratamiento. (AU)

Introduction: after a century the whole world suffered a pandemic: the covid 19 that affected and killed million of patients. This desease cause a wide range of clinical manifestations and organs and systema afectation, including the cisrculatory system. Methods: we describe three complex vascular desease cases that needed surgical treatment and in which the covid 19 alters the normal disease and surgical course. (AU)

SARS-Cov-2, el virus emergente que causa la pandemia de COVID-19 / SARS-CoV-2, the emerging virus behind the COVID-19 pandemic

Resumen La emergencia del nuevo SARS-CoV-2 - y el reconocimiento de la enfermedad que produce como pandemia - constituye el evento sanitario de mayor importancia en 2020. Debido a su reciente aparición y la inexistencia de medicamentos o vacunas seguras y eficaces, el manejo de casos y el control de brotes de la enfermedad se hace difícil. En esta revisión, se expone información sobre la pandemia, las características del virus, las manifestaciones clínicas de la enfermedad, su adecuado diagnóstico, las alternativas de tratamiento y las acciones que se ejecutan para su control (AU).

Abstract The emergency of the novel coronavirus, and the recognition of the disease it causes as a pandemic, constitute the main sanitary event in 2020. Because its recent discovery and the lack of safe and effective drugs or vaccines, the managing of cases and the control of the pandemic is problematic. In this review, the authors summarize the basic characteristics of the pathogen, the signs and symptoms of disease, and the diagnosis tools to identify presence of the virus. Furthermore, we also review the current knowledge on the treatment of infected cases as well as information about vaccine candidates. We highlight actions executed in Cuba to control the pandemic (AU).

Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection / Recomendações de suporte intensivo para pacientes graves com infecção suspeita ou confirmada pela COVID-19

ABSTRACT In December 2019, a series of patients with severe pneumonia were identified in Wuhan, Hubei province, China, who progressed to severe acute respiratory syndrome and acute respiratory distress syndrome. Subsequently, COVID-19 was attributed to a new betacoronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Approximately 20% of patients diagnosed as COVID-19 develop severe forms of the disease, including acute hypoxemic respiratory failure, severe acute respiratory syndrome, acute respiratory distress syndrome and acute renal failure and require intensive care. There is no randomized controlled clinical trial addressing potential therapies for patients with confirmed COVID-19 infection at the time of publishing these treatment recommendations. Therefore, these recommendations are based predominantly on the opinion of experts (level C of recommendation).

RESUMO Em dezembro de 2019, uma série de pacientes com pneumonia grave foi identificada em Wuhan, província de Hubei, na China. Esses pacientes evoluíram para síndrome respiratória aguda grave e síndrome do desconforto respiratório agudo. Posteriormente, a COVID-19 foi atribuída a um novo betacoronavírus, o coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2). Cerca de 20% dos pacientes com diagnóstico de COVID-19 desenvolvem formas graves da doença, incluindo insuficiência respiratória aguda hipoxêmica, síndrome respiratória aguda grave, síndrome do desconforto respiratório agudo e insuficiência renal aguda e requerem admissão em unidade de terapia intensiva. Não há nenhum ensaio clínico randomizado controlado que avalie potenciais tratamentos para pacientes com infecção confirmada pela COVID-19 no momento da publicação destas recomendações de tratamento. Dessa forma, essas recomendações são baseadas predominantemente na opinião de especialistas (grau de recomendação de nível C).

COVID-19 diagnostic and management protocol for pediatric patients

This review aims to verify the main epidemiologic, clinical, laboratory-related, and therapeutic aspects of coronavirus disease 2019 (COVID-19) in critically ill pediatric patients. An extensive review of the medical literature on COVID-19 was performed, mainly focusing on the critical care of pediatric patients, considering expert opinions and recent reports related to this new disease. Experts from a large Brazilian public university analyzed all recently published material to produce a report aiming to standardize the care of critically ill children and adolescents. The report emphasizes on the clinical presentations of the disease and ventilatory support in pediatric patients with COVID-19. It establishes a flowchart to guide health practitioners on triaging critical cases. COVID-19 is essentially an unknown clinical condition for the majority of pediatric intensive care professionals. Guidelines developed by experts can help all practitioners standardize their attitudes and improve the treatment of COVID-19.

Caracterización epidemiológica y clínica de la infección por influenza A (H1N1) 2009 en San Felipe, Región de Valparaíso, Chile: Junio a agosto 2009 / Epidemiological and clinical characteristics of influenza A (H1N1) 2009 at San Felipe, Valparaiso Region, Chile: June-August 2009

In order to understand the clinical and epidemiological aspects of infection with the AH1N1 influenza virus in Chile, a prospective study in the city of San Felipe was undertaken. It analyses the trends in consultations for respiratory causes in three primary care centers and hospital discharges by comparing data from years 2008 and 2009 until epidemiological week 37.It also includes a study of cases of ILI / SARI (influenza like disease/severe acute respiratory disease) in which viruses were detected by direct immunofluorescence (DIF) of nasopharyngeal aspirates and by real-time polymerase chain reaction in the case of influenza A (H1N1) 2009. A household survey was conducted in those cases with confirmed A (H1N1) infection, to identify contacts and history related to influenza virus transmission. The results indicate that the behavior of the pandemic was similar to that observed in the rest of the country, with an increase in emergency room visits for ILI. The most affected age group was from 5 to 14 years (26.5 per thousand inhabitants) and the least affected 60 years or older (1.2 per thousand). A 2.78% of the cases corresponded to SARI and the fatality rate was 0.11%.

Con el objetivo de conocer los aspectos clínicos y epidemiológicos de la infección por el virus A (H1N1) en Chile, se realizó un estudio prospectivo en la ciudad de San Felipe, lugar donde el brote de influenza se inició tardíamente en relación a otras ciudades del país. Se analizó la tendencia en las consultas por causa respiratorias en tres centros de atención primaria y egresos hospitalarios comparando los años 2008 y 2009 hasta la semana epidemiológica 37, y se realizó un estudio prospectivo de casos de enfermedad tipo influenza/infección respiratoria aguda grave (ETI/IRAG), tomando muestras mediante aspirado nasofaríngeo para detección de virus respiratorios por in-munofluorescencia directa (IFD) e identificación de virus influenza A (H1N1) 2009 por reacción de polimerasa en cadena en tiempo real (RPC-TR). En los pacientes confirmados se hizo una encuesta en visita domiciliaria para identificación de contactos y antecedentes relacionados con la transmisión de la influenza. Los resultados indican que el comportamiento de la pandemia fue similar a lo observado en el resto del país, con aumento de consulta principalmente en los servicios de urgencia; el grupo de edad más afectado fue el de 5 a 14 años (26,5 por mil habitantes), el menos afectado el grupo mayor de 60 años (1,2 por mil habitantes). Un 2,78% de los casos correspondió a IRAG y la tasa de letalidad fue de 0,11%.

Infecção pelo vírus Influenza pandêmico (H1N1) 2009 / Infection by the Influenza virus pandêmico (H1N1) 2009

Apresenta-se abordagem da infecção pelo vírus Influenza pandêmico (H1N1) 2009 como fonte de consulta para organização de sistemas de atendimento em vários níveis de atenção à saúde.

This is the approach of the pandemic influenza virus infection (H1N1) 2009 as a consulting resource to the organization of care systems at various levels of health care.

Síndrome de distres respiratorio agudo en niños ingresados en cuidados intensivos pediátricos del Hospital Fernando Vélez Paiz, en el período de septiembre 2008 - noviembre del 2009 / Acute respiratory distress syndrome in children admitted to pediatric intensive care Fernando Velez Paiz Hospital in the period September 2008 - November 2009

El Síndrome de Distres Respiratorio Agudo (SDRA) constituye, el daño severo del parénquima pulmonar una patología de alta mortalidad en las Terapias Intensivas de pediatría ocurre como resultado a una gran variedad de insultos directos e indirectos al pulmón.Se realizó un estudio descriptivo de corte transversal en la unidad de cuidados intensivos pediátricos del HFVP, en el periodo comprendido de septiembre del 2008 a noviembre del 2009. El universo de trabajo estuvo constituido por 25 pacientes que ameritaron ventilación mecánica invasiva que tenían diagnostico de SDRA pero solo 17 cumplieron con los criterios establecidos en la Conferencia de Consenso Europea Americana de Síndrome de Distres Respiratorio Agudo (SDRA). De estos 4 criterios, el radiológico es donde hay mucha diversidad de opiniones en cuanto al patrón característico. La incidencia de la patología fue de 9 casos x 100.000 habitantes en el periodo de estudio, constituyendo un 30% de las admisiones a cuidados intensivos. El porcentaje de mortalidad que resulto fue alto de 82.3%. Afectando como gran mayoría a los menores de 12 meses.Las causas más comunes asociadas al síndrome fueron las relacionadas con insultos pulmonares directo como la neumonía bacteriana y la neumonía aspirativa. A pesar de los avances que han existido en el manejo ventilatorio de estos pacientes, la estrategia optima de ventilación y las terapias adjuntas para pacientes con lesión pulmonar aguda (LPA), y/o Síndrome Distres Respiratorio Agudo (SDRA) no están aún definidas completamente. Resulto que no se esta siendo uso correcto de las estrategias ventilatorias de protección pulmonar, principalmente de un PEEP optimo y de la fracción inspiratoria de oxigeno entre 0.5 a 0.6.De las terapéuticas adjuntas al manejo del SDRA, el uso de los corticoides es muy controversial a nivel mundial, hecho que no cambio en este estudio mostrando una diversidad en cuando iniciar dicha terapia...

Síndrome de distres respiratorio agudo en niños ingresados en cuidados intensivos pediátricos del Hospital Fernando Vélez Paiz, en el período de septiembre 2008- noviembre del 2009 / Acute respiratory distress syndrome in children admitted to pediatric intensive care Fernando Velez Paiz Hospital in the period September 2008 - November 2009

El Síndrome de Distres Respiratorio Agudo (SDRA) constituye, el daño severo del parénquima pulmonar una patología de alta mortalidad en las Terapias Intensivas de pediatría ocurre como resultado a una gran variedad de insultos directos e indirectos al pulmón.Se realizó un estudio descriptivo de corte transversal en la unidad de cuidados intensivos pediátricos del HFVP, en el periodo comprendido de septiembre del 2008 a noviembre del 2009. El universo de trabajo estuvo constituido por 25 pacientes que ameritaron ventilación mecánica invasiva que tenían diagnostico de SDRA pero solo 17 cumplieron con los criterios establecidos en la Conferencia de Consenso Europea Americana de Síndrome de Distres Respiratorio Agudo (SDRA). De estos 4 criterios, el radiológico es donde hay mucha diversidad de opiniones en cuanto al patrón característico. La incidencia de la patología fue de 9 casos x 100.000 habitantes en el periodo de estudio, constituyendo un 30% de las admisiones a cuidados intensivos. El porcentaje de mortalidad que resulto fue alto de 82.3%. Afectando como gran mayoría a los menores de 12 meses.Las causas más comunes asociadas al síndrome fueron las relacionadas con insultos pulmonares directo como la neumonía bacteriana y la neumonía aspirativa. A pesar de los avances que han existido en el manejo ventilatorio de estos pacientes, la estrategia optima de ventilación y las terapias adjuntas para pacientes con lesión pulmonar aguda (LPA), y/o Síndrome Distres Respiratorio Agudo (SDRA) no están aún definidas completamente. Resulto que no se esta siendo uso correcto de las estrategias ventilatorias de protección pulmonar, principalmente de un PEEP optimo y de la fracción inspiratoria de oxigeno entre 0.5 a 0.6.De las terapéuticas adjuntas al manejo del SDRA, el uso de los corticoides es muy controversial a nivel mundial, hecho que no cambio en este estudio mostrando una diversidad en cuando iniciar dicha terapia...

Production of specific antibodies against SARS-coronavirus nucleocapsid protein without cross reactivity with human coronaviruses 229E and OC43

Severe acute respiratory syndrome (SARS) is a life-threatening disease for which accurate diagnosis is essential. Although many tools have been developed for the diagnosis of SARS, false-positive reactions in negative sera may occur because of cross-reactivity with other coronaviruses. We have raised polyclonal and monoclonal antibodies (Abs) using a recombinant form of the SARS virus nucleocapsid protein. Cross-reactivity of these anti-SARS Abs against human coronavirus (HCoV) 229E and HCoV OC43 were determined by Western blotting. The Abs produced reacted with recombinant SARS virus nucleocapsid protein, but not with HCoV 229E or HCoV OC43.

Influenza viral infection in 2005-2006 in Samitivej Hospital.

OBJECTIVE: Set an alarm system for early detection of respiratory viral infection. MATERIAL AND METHOD: The authors prospectively investigated avian flu and SARS between March 2005 and April 2006. Specimens from a nasopharyngeal swab or bronchial washing were analyzed for influenza A, B, parainfluenza, adenovirus, respiratory syncytial virus and avian flu and SARS by using technique of PCR and immunofluorescence by the Department of Medical Sciences. RESULTS: Eighty-nine patients who were enrolled in the present study. Peak of the incidence was 43% on April 2005 and there was no incidence of the influenza from December 2005 till April 2006. This may be due to the mass campaign of influenza vaccination or seasonal variation. CONCLUSION: Vaccination remains the primary strategy for the prevention of influenza, and the broadened recommendations should lead to protection of a larger portion of the population.

Síndrome respiratorio agudo grave. El laboratorio de salud pública frente a una emergencia global / Severe acute respiratory syndrome: the public health laboratory in a global emergency

By the end of year 2002 there was an outbreak of atypical pneumonia in Southeast Asia which soon spread to other continents. This new severe acute respiratory syndrome (SARS) was produced by a novel coronavirus. Due to the severity of the situation and risk of introduction of this pathology in our country, the need to arrange specific laboratory diagnostic tests arose. Classic techniques, such as the electron microscopy and molecular biology test such as retrotranscription followed by the polymerase chain reaction (RT-PCR) were implemented. The araldit included cells infected with bovine coronavirus which allowed the viral particles to be visualized easily but it took more time in comparison with the negative staining of free particles from viral cultures. RT-PCR was able to detect RNA of isolated viruses from cases in Hong Kong and Germany.

A fines del año 2002 se inicia un brote de neumonía atípica en el Sudeste asiático el cual se extiende posteriormente a otros continentes. El nuevo síndrome respiratorio agudo grave (SARS) era producido por un coronavirus novedoso. Debido a la gravedad de la situación y al riesgo de introducción de esta patología en Argentina, se implementaron técnicas de diagnóstico clásicas como la microscopía electrónica, y moleculares como una reacción de retrotranscripción seguida de una reacción en cadena de la polimerasa (RT-PCR). La inclusiónen araldita de células infectadas con un coronavirus bovino permitió visualizar más fácilmente las partículas virales, pero requirió más tiempo en comparación con la coloración negativa de partículas libres de cultivos virales.La RT-PCR implementada fue capaz de detectar ARN de cepas de casos de Hong Kong y de Alemania.

Development and comparison of the real-time amplification based methods--NASBA-Beacon, RT-PCR taqman and RT-PCR hybridization probe assays--for the qualitative detection of sars coronavirus.

The aim of this study was to develop a rapid, sensitive and robust procedure for the qualitative detection of SARS coronavirus RNA. Three unique detection formats were developed for real-time RNA amplification assays: a post amplification detection step with a virus-specific internal capture probe based on Taqman (RT-PCR TaqMan assay), hybridization probe (RT-PCR hybridization probe assay) and a real-time assay with virus-specific molecular beacon probes (NASBA-Beacon assay). The analytical sensitivity or reproducibility of the test results among those three assays was compared. All assays yielded results by detecting SARS coronavirus targeting the BNI-1 region in less than 2 hours. RNA detection by all the formats was unaffected by the presence of human sputum. The limits of detection were at least 10 copies of input RNA for both RT-PCR formats (RT-PCR TaqMan and RT-PCR hybridization probe assays), while the NASBA-Beacon assay could detect as little as 1 copy per reaction, with high reproducibility of the coefficient of variation (CV) of <10. These results demonstrate that real-time NASBA provides a rapid and sensitive alternative to RT-PCR for the routine qualitative assay of sputum for SARS corona viral RNA detection.

Equipo para el control del SARS en las unidades de atención de pacientes y de procesamiento de muestras infectadas / Equipment for SARS control in patient care units and in units that process infected samples

The information on severe acute respiratory syndrome (SARS) that has been gathered up to this point has made it possible to prepare recommendations concerning the equipment needed to protect health workers responsible for patient care and for processing potentially infected samples. Protecting such personnel is a key element in the strategy to control the spread of SARS. The needed equipment includes clothing; footwear; such protective devices as masks, safety glasses, and gloves; disinfectant solutions; laboratory equipment; and materials for obtaining and transporting samples. Prepared by the Western Pacific Regional Office of the World Health Organization, this list will help implement measures to contain the epidemic. The list gives the recommended quantities, specifications for the items, and possible alternatives for some items. This list of equipment is not exhaustive; it is intended to provide a small emergency supply for a period of 3 or 4 days for a single isola-tion unit with approximately 50 workers. To guarantee the availability of the equipment in the needed quantities, infection control authorities should take into account the number of isolation units needed and the length of time that containment measures will need to be in place. Adequate reserves should be available 24 hours a day, and plans should be made for rapid access to larger stocks in the event of a larger outbreak