Afecção Pulmonar pelo Vírus SARS-CoV-2: Clínica e Diagnóstico / SARS-CoV-2 Lung Infection: Clinic and Diagnosis

O pulmão é o órgão que diariamente está exposto e é agredido por diferentes infecções e poluentes do meio ambiente e do local de trabalho. O coronavírus SARS-CoV-2 é o agressor mais recente que chega ao pulmão através das células respiratórias das vias aéreas superiores e com enorme capacidade de desenvolver novas infecções. Este vírus liga-se ao receptor da Enzima Conversora de Angiotensina humana (hACE-2), causa sintomas constitucionais e respiratórios. A média de novos casos gerados por um caso com a infecção provocada pelo novo Coronavírus (R0) oscila entre 2,24 (IC 95%: 1,96-2,55) e 3,58 (IC 95%: 2,89-4,39)21, ou seja um indivíduo com COVID-19 pode infectar cerca de 2 a 4 pessoas, o que caracteriza a sua elevada contagiosidade. A doença disseminou-se por diferentes países e continentes. Em Março de 2020 foi caracterizada pela Organização Mundial da Saúde (OMS) como uma pandemia, tornando-se uma preocupação séria e um desafio extremo para a sua contenção. O tempo de incubação após o contágio pode variar de dois a 14 dias. Durante este período, também conhecido como período "pré-sintomático", algumas pessoas infectadas podem ser contagiosas de um a três dias antes do início dos sintomas. Neste contexto, o sistema respiratório não é só o principal órgão a ser agredido, mas também o principal responsável pela sua transmissibilidade.

The lung is the organ that is daily exposed and assaulted by different infections and pollutants from the environment and workplace. The SARS-CoV-2 coronavirus is the most recent aggressor that reaches the lung through the respiratory cells of the upper airways and with enormous capacity to develop new infections. This virus binds to the human angiotensin-converting enzyme receptor (hACE-2), causes constitutional and respiratory symptoms. The average number of new cases generated by a case with the infection caused by the new coronavirus (R0) ranges from 2.24 (95% CI: 1.96-2.55) to 3.58 (95% CI: 2.89-4.39)21, i.e., an individual with COVID-19 can infect about 2 to 4 people, which characterizes its high contagiousness. The disease has spread to different countries and continents. In March 2020 it was characterized by the World Health Organization (WHO) as a pandemic, making it a serious concern and an extreme challenge to contain. The incubation time after contagion can range from two to 14 days. During this period, also known as the "pre-symptomatic" period, some infected people may be contagious from one to three days before the onset of symptoms. In this context, the respiratory system is not only the main organ to be attacked, but also the main organ responsible for its transmissibility.

Tuberculosis infection risk, preventive therapy care cascade and incidence of tuberculosis disease in healthcare workers at Maputo Central Hospital.

BACKGROUND: Mozambican healthcare workers have high rates of latent and active tuberculosis, but occupational screening for tuberculosis is not routine in this setting. Furthermore, the specificity of tuberculin skin testing in this population compared with interferon gamma release assay testing has not been established. METHODS: This study was conducted among healthcare workers at Maputo Central Hospital, a public teaching quaternary care hospital in Mozambique. With a cross sectional study design, risk factors for tuberculosis were assessed using multivariable logistic regression. The care cascade is reported for participants who were prescribed six months of isoniazid preventive therapy for HIV or highly reactive testing for latent tuberculosis infection. The agreement of interferon-gamma release assay results with positive tuberculin skin testing was calculated. RESULTS: Of 690 screened healthcare workers, three (0.4%) had active tuberculosis and 426 (61.7%) had latent tuberculosis infection. Less education, age 35-49, longer hospital service, and work in the surgery department were associated with increased likelihood of being tuberculosis infected at baseline (p < 0.05). Sex, Bacillus Calmette-Guerin vaccination, HIV, outside tuberculosis contacts, and professional category were not. Three new cases of active tuberculosis developed during the follow-up period, two while on preventive therapy. Among 333 participants offered isoniazid preventive therapy, five stopped due to gastrointestinal side effects and 181 completed treatment. For HIV seropositive individuals, the agreement of interferon gamma release assay positivity with positive tuberculin skin testing was 50% among those with a quantitative skin test result of 5-10 mm, and among those with a skin test result ≥10 mm it was 87.5%. For HIV seronegative individuals, the agreement of interferon gamma release assay positivity with a tuberculin skin test result of 10-14 mm was 63.6%, and for those with a quantitative skin test result ≥15 mm it was 82.2%. CONCLUSIONS: There is a high prevalence of tuberculosis infected healthcare workers at Maputo Central Hospital. The surgery department was most heavily affected, suggesting occupational risk. Isoniazid preventive therapy initiation was high and just over half completed therapy. An interferon gamma release assay was useful to discern LTBI from false positives among those with lower quantitative tuberculin skin test results.

Pleurodesis: a comparison of two sclerosing agents for pleural effusions in Mozambique.

BACKGROUND: Pleural effusions constitute one of the most frequent pathologies encountered in the pulmonary service of Maputo Central Hospital (MCH) in Mozambique. Bleomycin and talc are commonly used for pleurodesis, but cost prohibitive, therefore we aimed to retrospectively compare the efficacy and safety of sodium hydroxide (NaOH) with bleomycin for pleurodesis. METHODS: Case records of pleurodesis using bleomycin and NaOH from 2002 to 2013 were reviewed. Standard of care for pleurodesis for recurrent pleural effusions at MCH was developed using the materials available. NaOH remained the agent of choice until 2006 when bleomycin became available. Clinical data regarding general complications, rate of success and lung expansion were noted for every patient who underwent pleurodesis at MCH during this time frame. RESULTS: Review of pleurodesis at MCH revealed 24 cases using bleomycin and 23 cases using NaOH as the sclerosing agent. Patient characteristics were balanced between the two groups with majority of pleural effusions malignant in etiology. CONCLUSIONS: There was no statistically significant difference between the use of bleomycin and NaOH as defined by lung expansion. General complications were observed less frequently in 2 (10%) of patients treated with NaOH compared with 8 (38%) of patients using bleomycin. Only three patients presented with recurrent pleural effusion after pleurodesis with NaOH. NaOH may offer a low cost alternative sclerosing agent for resource limited areas.