ABSTRACT
The D222G substitution in the hemagglutinin (HA) gene of the pandemic influenza A(H1N1)pdm09 virus has been identified as a potential virulence marker, because this change allows for virus invasion deeper into the respiratory tract. In this study, we analyzed D, G and N polymorphisms at residue 222 by pyrosequencing (PSQ). We initially analyzed 401 samples from Brazilian patients. These were categorized with respect to clinical conditions due to influenza infection (mild, serious or fatal) and sub-stratified by risky factors. The frequency of mixed population of virus, with more than one polymorphism at residue 222, was significantly higher in serious (10.6%) and fatal (46.7%) influenza cases, whereas those who showed mild influenza infections were all infected by D222 wild-type. Mixtures of quasi-species showed a significant association of mortality, especially for those with risk factors, in special pregnant women. These results not only reinforce the association between D222G substitution and influenza A(H1N1)pdm09-associated morbidity and mortality, but also add the perspective that a worse clinical prognosis is most likely correlated with mixtures of quasi-species at this HA residue. Therefore, quasi-species may have a critical and underestimated role in influenza-related clinical outcomes.
Subject(s)
Hemagglutinin Glycoproteins, Influenza Virus/genetics , Influenza A Virus, H1N1 Subtype/genetics , Influenza, Human , Pandemics , Polymorphism, Genetic , Pregnancy Complications, Infectious , Female , Humans , Influenza, Human/genetics , Influenza, Human/mortality , Male , Pregnancy , Pregnancy Complications, Infectious/genetics , Pregnancy Complications, Infectious/mortality , Risk FactorsSubject(s)
Antiviral Agents/pharmacology , Influenza A Virus, H1N1 Subtype/drug effects , Influenza, Human/epidemiology , Oseltamivir/pharmacology , Pandemics , Adolescent , Adult , Aged , Brazil/epidemiology , Child , Child, Preschool , Drug Resistance, Viral/drug effects , Female , Humans , Infant , Infant, Newborn , Influenza, Human/virology , Male , Middle Aged , Young AdultABSTRACT
BACKGROUND: The novel influenza A pandemic virus (H1N1pdm) caused considerable morbidity and mortality worldwide in 2009. The aim of the present study was to evaluate the clinical course, duration of viral shedding, H1N1pdm evolution and emergence of antiviral resistance in hospitalized cancer patients with severe H1N1pdm infections during the winter of 2009 in Brazil. METHODS: We performed a prospective single-center cohort study in a cancer center in Rio de Janeiro, Brazil. Hospitalized patients with cancer and a confirmed diagnosis of influenza A H1N1pdm were evaluated. The main outcome measures in this study were in-hospital mortality, duration of viral shedding, viral persistence and both functional and molecular analyses of H1N1pdm susceptibility to oseltamivir. RESULTS: A total of 44 hospitalized patients with suspected influenza-like illness were screened. A total of 24 had diagnosed H1N1pdm infections. The overall hospital mortality in our cohort was 21%. Thirteen (54%) patients required intensive care. The median age of the studied cohort was 14.5 years (3-69 years). Eighteen (75%) patients had received chemotherapy in the previous month, and 14 were neutropenic at the onset of influenza. A total of 10 patients were evaluated for their duration of viral shedding, and 5 (50%) displayed prolonged viral shedding (median 23, range=11-63 days); however, this was not associated with the emergence of a resistant H1N1pdm virus. Viral evolution was observed in sequentially collected samples. CONCLUSIONS: Prolonged influenza A H1N1pdm shedding was observed in cancer patients. However, oseltamivir resistance was not detected. Taken together, our data suggest that severely ill cancer patients may constitute a pandemic virus reservoir with major implications for viral propagation.
Subject(s)
Influenza A Virus, H1N1 Subtype/drug effects , Influenza, Human/drug therapy , Influenza, Human/epidemiology , Neoplasms/epidemiology , Oseltamivir/therapeutic use , Adolescent , Adult , Aged , Antiviral Agents/therapeutic use , Biological Evolution , Brazil/epidemiology , Child , Child, Preschool , Comorbidity , Female , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Pandemics , Prospective Studies , Virus Shedding/drug effects , Young AdultABSTRACT
Foi estudada no Rio de Janeiro, RJ, Brasil, a circulação de vírus influenza C detectando-se níveis significativos de anticorpos (56,7 por cento) através de reação de inibição de hemaglutinação, o qual é considerada com padrão para estudos em influenzavírus
Subject(s)
Humans , Gammainfluenzavirus , Hemagglutination Inhibition TestsABSTRACT
Relata que a análise junguiana contribui de forma significativa para o estudo do gênero e da sexualidde nas organizaçöes. O conceito de individuaçäo e a noçäo de arquétipos säo de interesse particular para a pesquisa das masculinidades, feminilidades e sexualidade nas organizaçöes. Afirma que esse é o caminha que procura trilhar. A idéia é demonstrar o relacionamento entre gênero e sexualidade com poder e cultura organizacional näo como um segmento mas como alguma coisa que está presente na maior parte do texto.
Subject(s)
Humans , Male , Female , Organizational Culture , Power, Psychological , Sex , Interprofessional Relations , Organizations/trends , Organization and Administration , Social ValuesABSTRACT
Discorre sobre os pressupostos de Schein para cultura organizacional. (NMPM)
