RESUMEN
Resumen La diabetes mellitus (DM) es una enfermedad metabólica caracterizada principalmente por signos y síntomas derivados del aumento de glucosa sérica o hiperglucemia. La pandemia por la enfermedad del coronavirus 2019 (COVID- 19) afectó a todo el mundo con informes de pronóstico grave en pacientes diabéticos infectados por el virus del síndrome respiratorio agudo severo por coronavirus 2 (SARS-CoV-2) y elevada admisión hospitalaria en la unidad de cuidados intensivos (UCI) en comparación con pacientes no diabéticos. El objetivo del trabajo de revisión bibliográfica fue evaluar y describir algunos de los mecanismos bioquímicos que conducen al pronóstico grave en pacientes con DM infectados por el virus SARS-CoV-2 mediante la búsqueda sistemática de información en diferentes bases de datos. Los resultados mostraron que la elevada admisión a UCI con un pronóstico grave de pacientes diabéticos infectados por el virus fue por presentar inflamación excesiva que ocasiona síndrome de distrés respiratorio agudo, tormenta de citoquinas, neumonía severa, inmunidad deteriorada e hiperglucemia. El virus ingresa a la célula principalmente por la vía endocítica y no endosómica; los receptores celulares centrales implícitos en los mecanismos son receptores de insulina (RI), transportador de glucosa tipo 2 (GLUT-2), dipeptidil-peptidasa-4 (DPP4), transportador de glucosa tipo 4 (GLUT-4), enzima convertidora de angiotensina 2 (ECA2) y el correceptor proteasa transmembrana de serina 2 (TMPRSS2) esencial para la propagación viral. La mayor susceptibilidad a desarrollar COVID- 19 en pacientes diabéticos se debe a la sobreexpresión de ECA2 y las complicaciones graves se incrementan a niveles micro y macrovascular como nefropatías, neuropatías y enfermedades cardiovasculares.
Abstract Diabetes mellitus (DM) is a metabolic disease characterised mainly by signs and symptoms derived from increased serum glucose or hyperglycemia. The coronavirus disease 2019 (COVID-19) pandemic affected the entire world continenwith reports of severe prognosis in diabetic patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and high hospital admissions in the intensive care unit (ICU) compared to non-diabetic patients. The objective of the bibliographic review was to evaluate and describe some of the biochemical mechanisms that lead to severe prognosis in patients with DM infected by the SARSCoV- 2 virus through a systematic search for information in different databases. The results showed that the high ICU admission with a severe prognosis of diabetic patients infected by the virus was due to excessive inflammation that causes acute respiratory distress syndrome, cytokine storm, severe pneumonia, impaired immunity, and hyperglycemia. The virus enters the cell mainly through the endocytic and non-endosomal pathway; the central cellular receptors involved in the mechanisms are insulin receptors (IR), glucose transporter type 2 (GLUT-2), dipeptidyl peptidase-4 (DPP4), glucose transporter type 4 (GLUT-4), glucose converting enzyme angiotensin 2 (ACE2), and the serine transmembrane protease co-receptor 2 (TMPRSS2) essential for viral propagation. The increased susceptibility to developing COVID-19 in diabetic patients is due to the overexpression of ACE2, and serious complications are increased at the microvascular and macrovascular levels, such as nephropathies, neuropathies, and cardiovascular diseases.
Resumo O diabetes mellitus (DM) é uma doença metabólica caracterizada principalmente por sinais e sintomas decorrentes do aumento de glicose sérica ou hiperglicemia. A pandemia pela doença do coronavírus 2019 (COVID-19) afetou o mundo inteiro com relatos de prognóstico grave em pacientes diabéticos infectados pelo vírus da síndrome respiratória aguda grave por coronavírus 2 (SARS-CoV-2) e altas internações hospitalares na unidade de terapia intensiva (UTI) em comparação com pacientes não diabéticos. O objetivo do trabalho de revisão bibliográfica foi avaliar e descrever alguns dos mecanismos bioquímicos que levam ao prognóstico grave em pacientes com DM infectados pelo vírus SARS-CoV-2 por meio da busca sistemática de informações em diferentes bancos de dados. Os resultados mostraram que a alta admissão na UTI com prognóstico grave de pacientes diabéticos infectados pelo vírus foi devido à inflamação excessiva que apresentavam e que causa síndrome de desconforto respiratório agudo, tempestade de citocinas, pneumonia grave, imunidade prejudicada e hiperglicemia. O vírus entra na célula principalmente pela via endocítica e não endossômica; os receptores celulares centrais envolvidos nos mecanismos são os receptores de insulina (IR), transportador de glicose tipo 2 (GLUT-2), dipeptidil peptidase-4 (DPP4), transportador de glicose tipo 4 (GLUT-4), enzima conversora de angiotensina 2 (ACE2), e o co-receptor protease transmembrana de serina 2 (TMPRSS2) essencial para a propagação viral. A maior suscetibilidade ao desenvolvimento de COVID-19 em pacientes diabéticos deve-se à superexpressão de ECA2, e complicações graves aumentam nos níveis micro e macrovascular, como nefropatias, neuropatias e doenças cardiovasculares.
Asunto(s)
Humanos , Diabetes Mellitus , SARS-CoV-2 , Hiperglucemia , VirologíaRESUMEN
Resumo O artigo analisa como a dengue se apresentou como desafio virológico na década de 1980. O objetivo é entender o papel dos estudos virológicos na compreensão da doença e a construção de uma expertise em arboviroses. Embora surtos da doença já tivessem sido relatados ao longo do século XX, a dengue era pouco conhecida nas Américas até a epidemia de dengue hemorrágica em Cuba, em 1981. Quando em 1986 a doença atingiu a cidade de Nova Iguaçu (RJ), a equipe de virologistas liderada por Hermann Schatzmayr tomaria a doença como objeto, mobilizando esforços a partir da criação do Laboratório de Flavivírus do Instituto Oswaldo Cruz.
Abstract This article analyzes how dengue presented a virological challenge during the 1980s in order to explore the role of virological studies in understanding this disease and constructing expertise in arboviral diseases. Although outbreaks were reported throughout the twentieth century, dengue was barely known in the Americas until the epidemic of dengue fever in Cuba in 1981. When the disease reached the Brazilian city of Nova Iguaçu (RJ) in 1986, it became the focus of attention for a team of virologists led by Hermann Schatzmayr, who mobilized efforts after the creation of the Flavivirus Laboratory at the Oswaldo Cruz Institute.
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Virología , Enfermedades Endémicas , Planes y Programas de Investigación en Salud , Brasil , Dengue/historia , Historia del Siglo XXRESUMEN
En los últimos años los microorganismos han generado múltiples evoluciones, provocando enfermedades y problemas agudos de salud pública. Para poder controlar las virosis es necesario conocer su biología y epidemiología, establecer tratamiento y profilaxis adecuada para su control. Para ello, es indispensable comenzar con la formación de los profesionales de la salud, en particular, los estudiantes de medicina, es necesario potenciar el desarrollo de sus habilidades y competencias, no solo dominio del conocimiento científico, si no también pueda promoverlo, transferirlo y aplicarlo con impacto en la salud colectiva y que vaya a la par de los avances tecno-científicos. Es por ello, que surge la inquietud del fórum, discusión acerca del análisis de la enseñanza de la virología para enfrentar enfermedades emergentes en función de perfil del egresado. Se realizó encuesta a los estudiantes de los últimos diez años de la carrera de medicina de UNIANDES, sobre la biología, epidemiologia, respuesta inmunológica y diagnóstico, para mencionadas áreas de conocimiento se obtuvo, tanto en la evaluación objetiva estructurada y evaluación práctica, un nivel altamente satisfactorio. En la pirámide de Miller, se alcanzó nivel tres con conocimiento y desarrollo de habilidades, destrezas y actitudes del egresado satisfactorias. Sin embargo, los profesores de Virología están de acuerdo con innovar en la docencia integrando los contenidos transversalmente a las áreas de conocimiento: enfermedades infecciosas, clínicas, patologías, epidemiología y salud pública, lo que permitirá un aprendizaje integral para realizar abordaje adecuado de caso positivos de las virosis, además de tener capacidades para establecer vigilancia epidemiológica(AU)
In recent years, microorganisms have generated multiple evolutions, causing diseases and acute public health problems. In order to control virosis, it is necessary to know their biology and epidemiology, establish adequate treatment and prophylaxis for their control. For this, it is essential to start with the training of health professionals, in particular, medical students, it is necessary to promote the development of their skills and competencies, not only mastery of scientific knowledge, but also be able to promote it, transfer it and apply it with an impact on collective health and that goes hand in hand with techno-scientific advances. That is why the concern of the forum arises, a discussion about the analysis of the teaching of virology to face emerging diseases based on the profile of the graduate. A survey was conducted to the students of the last ten years of the UNIANDES medical career, on biology, epidemiology, immunological response and diagnosis, for mentioned areas of knowledge it was obtained, both in the objective structured evaluation and practical evaluation, a level highly satisfactory. In the Miller pyramid, level three was reached with satisfactory knowledge and development of abilities, skills and attitudes of the graduate. However, Virology professors agree with innovating in teaching by integrating the content transversally to the areas of knowledge: infectious diseases, clinics, pathologies, epidemiology and public health, which will allow comprehensive learning to carry out an adequate approach to positive cases of virosis, in addition to having the capacity to establish epidemiological surveillance(AU)
Asunto(s)
Virología/educación , Virus/patogenicidad , Monitoreo Epidemiológico , Biología , Salud Pública , Epidemiología , Enfermedades Transmisibles , Encuestas y Cuestionarios , Educación MédicaRESUMEN
Contexte/objectif : La maladie à coronavirus (COVID-19) est une maladie émergente, dont l'agentpathogène est le virus du syndrome respiratoire aigu sévère dû au coronavirus 2 (SRAS-CoV-2). L'objectif de cette étudeétait de décrire le profil virologique et clinique des patients diagnostiqués dans deux laboratoires. Matériels et méthodes : Il s'est agi d'uneétude descriptive avec collecte rétrospective de données des patients atteints de COVID-19, qui a couvert la période du 04 avril au 31 décembre 2020. Le test de khi deux et le test exact de Fisher sont les tests statistiques utilisées. Résultats : Au total, 28 872 échantillons ont été testés dans les deux laboratoires. L'étude arévélé 1965 cas positifs soit 6, 80% (63 % hommes et 37,05 % femmes). La tranche d'âge de 20 à 50 ans représentait 68,68 %. La province de la capitale a enregistré autant le plus grand nombre d'échantillons (26277 soit91,00%) que le plus grand nombre des cas positifs (91,15%). Les manifestations cliniques étaient dominées par la toux 68,42%, la fatigue générale (43,86%), les céphalées (43,86%), l'écoulement nasal (40,93%), la fi èvre (39,18%). Les comorbidités les plus fréquentes étaient l'hypertension artérielle (HTA) et le diabète. Conclusion: Cette étude a montré unepopulation jeune testée. La capitale (Ouagadougou) a enregistré le plus grand nombre de demandeurs de tests et de cas positifs. La toux était la principale manifestation clinique. Les patients avec comorbidités dont l'HTA et le diabète ont été les plus nombreux a effectué le test
Background/Purpose. Coronavirus disease (COVID-19) is an emerging disease, whose pathogen is the severe acute respiratory syndrome virus due to coronavirus 2 (SARS-CoV-2). The objective of this study was to describe the virological and clinical profile of patients diagnosed in two laboratories. Methods. This was a descriptive study with retrospective data collection of patients with COVID-19, which covered the period from 04 April to 31 December 2020. Chisquare test and Fisher's exact test were used as statistical tests. Results. A total of 28,872 samples were tested in the two laboratories. The study revealed 1965 positive cases or 6, 80% (63% male and 37.05% female). The age group 20-50 years represented 68.68%. The capital province recorded both the largest number of samples (26277 or 91.00%) and the largest number of positive cases (91.15%). Clinical manifestations were dominated by cough 68.42%, general fatigue (43.86%), headache (43.86%), nasal discharge (40.93%), fever (39.18%). The most frequent comorbidities were arterial hypertension (AH) and diabetes. Conclusion. This study showed a young population tested. The capital (Ouagadougou) recorded the highest number of testers and positive cases. Cough was the main clinical manifestation. Patients with comorbidities including hypertension and diabetes were the most numerous to be tested
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Virología , Diagnóstico , COVID-19 , Laboratorios ClínicosRESUMEN
Nowadays, the coronavirus epidemic represents a major threat to the human being, represented by great numbers of deaths and wide world life disrupt. COVID-19 virus, is not only representing a threat to the life of human being, but also to the economic activities that nearly stopped in many countries due to the partial to complete closure of life activities in order to control the wide spread of virus infections. In these extraordinary and unprecedented critical times of human being life, it is essential to review and discus the virus epidemic in trial to suggest an idea that might be beneficial to researchers to find out an exit from this dark tunnel and to prevent as possible epidemic recurrence. Many attempts of management protocols and trials all over the world, nearly failed until now to control the wide spread and the high incidence of morbidity and mortality of this viral infection. In this review, we highlight the virology and pathogenesis of epidemic and possible used therapeutics in a simplified and concise form to be easily understood and available for healthcare members and even general population. This might help in control and eradication of the current epidemic
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Humanos , Virología , Atención a la Salud , COVID-19 , Terapéutica , Brotes de Enfermedades , Coronavirus , EpidemiasRESUMEN
Resumen La detección de SARS-CoV-2 y su implicancia en el diagnóstico de COVID-19 han sido muy debatidas en la pandemia. El objetivo de este estudio fue evaluar el costo/beneficio de la detección de SARS-CoV-2 en contactos estrechos asintomáticos (CE) mediante el uso de distintas pruebas de diagnóstico molecular. Se estudiaron 51 CE de personas con diagnóstico de SARS-CoV-2 confirmado por RTqPCR, clasificadas por el umbral de ciclos (Ct) (<20, entre 20 y 30 y >30) en hospitales públicos de la provincia de Buenos Aires. Del total de contactos estudiados el 15,7% resultó confirmado para SARS-CoV-2; no hubo contactos positivos de casos con Ct>30. La cantidad de contactos positivos de casos con Ct<20 fue significativamente mayor que la de casos con Ct>20. Las muestras con Ct<20 se asociaron a una carga viral estimada de entre uno a cuatro órdenes de magnitud de diferencia con los rangos de Ct>20. Un 13,7% de contactos positivos fueron casos con Ct<20. De las muestras positivas confirmadas por PCR, correspondientes a la semana epidemiológica 1 de 2021 (SE1), sólo un 19,35% correspondían a muestras con Ct<20 y un 50,7% con Ct entre 20 y 30. Estos datos muestran un incremento de sólo un 3,7% de casos detectados. El esfuerzo por parte del sistema de salud pública para esta estrategia, con bajo poder predictivo, puede tener un efecto negativo para el cumplimiento del aislamiento de los contactos y podría generar una demora en los resultados de los casos sospechosos, sin aportar significativamente en el control de la pandemia.
Abstract The detection of SARS-CoV-2 and its implication in the diagnosis of COVID-19 have been highly debated in the pandemic. The objective of this study was to evaluate the cost/benefit of detecting SARS-CoV-2 in asymptomatic close contacts (CC) using different molecular diagnostic tests. A total of 51 CC of people with a diagnosis of SARS-CoV-2 confirmed by RTqPCR, classified by the cycle threshold (Ct) (<20, between 20 and 30 and >30), were studied in public hospitals in the Province of Buenos Aires. Of the total contacts studied, 15.7% were confirmed for SARS-CoV-2; there were no positive contacts of cases with Ct>30 positive. The number of positive contacts of cases with Ct<20 was significantly higher than that of cases with Ct>20. Samples with Ct<20 were associated with an estimated viral load of one to four orders of magnitude difference with Ct ranges >20. A total of 13.7% of positive close contacts were from cases with Ct<20. When studying positive samples with confirmed diagnosis by PCR, corresponding to 1 epidemiological week of 2021 (EW1), only 19.35% corresponded to samples with Ct<20 and 50.7% with Ct between 20 and 30. From these data it is shown that with the CC test only 3.7% of the cases were detected. The effort by the public health system for this strategy, with low predictive power, may have a negative effect on the fulfillment of the isolation of contacts and could generate a delay in the results of suspected cases, without contributing significantly to controlling the pandemic.
Resumo A detecção do SARS-CoV-2 e seu envolvimento no diagnóstico da COVID-19 têm sido muito discutidos durante a pandemia. O objetivo desse estudo foi avaliar a relação custo/benefício na detecção de SARSCoV- 2 em casos de contatos próximos assintomático (CP), por meio do uso de diferentes testes de diagnóstico molecular. Foram estudados 51 casos de CP de pessoas com diagnóstico de SARS-CoV-2 confirmado pelo RTqPCR, sendo classificados pelo limiar de ciclos (Ct) (<20, entre 20 e 30 e >30), em hospitais públicos da província de Buenos Aires. Do total de contatos estudados, 15,7% foram confirmados para SARS-CoV-2, não houve contatos positivos de casos com Ct>30. O número de contatos positivos de casos com Ct<20, foi significativamente maior que os casos com Ct>20. As amostras com Ct<20 foram associadas a uma carga viral estimada de uma a quatro ordens de magnitude de diferença com os intervalos de Ct>20. Dos casos positivos, 13,7% foram com Ct<20. Das amostras positivas confirmadas por PCR, correspondentes à semana epidemiológica 1 de 2021 (SE1), apenas 19,35% correspondiam a amostras com Ct>20 e 50,7% com Ct entre 20 e 30. Esses dados mostram incremento de apenas 3,7% de casos detectados. O esforço por parte do sistema de saúde pública para essa estratégia, com baixo poder preditivo, pode ter um efeito negativo no cumprimento do isolamento dos contatos e poderia gerar uma demora nos resultados dos casos suspeitos, sem contribuir significativamente para o controle da pandemia.
Asunto(s)
Virología , SARS-CoV-2 , Aislamiento de Pacientes , Salarios y Beneficios , Sistemas de Salud , Poder Psicológico , Portador Sano , Reacción en Cadena de la Polimerasa , Salud Pública , Carga Viral , Técnicas y Procedimientos Diagnósticos , Costos y Análisis de Costo , Escala de Richter , Técnicas de Diagnóstico Molecular , Diagnóstico , Patología Molecular , Pandemias , Procrastinación , COVID-19 , Hospitales Públicos , PersonasRESUMEN
Resumo O artigo analisa a singularidade dos processos históricos, científicos e políticos que vão da descoberta da doença que passou a ser conhecida como mixomatose infecciosa, causada pelo vírus do mixoma (MYXV), à sua aplicação no controle de uma praga de coelhos na Austrália. A narrativa segue especialmente as pesquisas de Henrique de Beaurepaire Aragão, pesquisador do Instituto Oswaldo Cruz, e posteriormente os esforços da cientista Jean Macnamara para promover pesquisas e implementar o MYXV na Austrália. Foram consultadas notas de pesquisa de cientistas, documentos oficiais que registraram o desenvolvimento dos experimentos, bem como periódicos. Nesse processo, foi considerado o desenvolvimento histórico do campo de estudos da virologia e controle biológico.
Abstract This article analyzes the singularity of historical, scientific, and political processes from the discovery of the disease caused by the myxoma virus (MYXV) that came to be known as infectious myxomatosis to the application of this virus against a plague of rabbits in Australia. This narrative focuses on research by Henrique de Beaurepaire Aragão, a researcher at the Oswaldo Cruz Institute, and later efforts by the scientist Jean Macnamara to promote studies and implement MYXV in Australia. The scientists' research notes were consulted, along with official documents recording the experiments and periodicals. In this process, the historical development of virology and biological controls as a field of study was also considered.
Asunto(s)
Conejos , Control de Plagas , Control Biológico de Vectores , Mixomatosis Infecciosa , Australia , Virología , Historia del Siglo XXRESUMEN
Hasta diciembre del 2019, seis tipos de coronavirus ya estaban identificados como generadores de enfermedad en humanos, destacándose dos brotes epidemiológicos anteriores: SARS-CoV en 2002 y MERS-CoV en 2012. El nuevo agente infeccioso que causó la pandemia de 2019 se denominó SARS-CoV-2, el que se manifiesta como un síndrome respiratorio agudo severo (CO-VID-19). Al respecto, el 30 de enero del 2020, la Organización Mundial de la Salud (OMS) decretó la emergencia sanitaria. El propósito de esta revisión fue analizar el contexto epidemio-lógico alrededor del SARS-CoV-2, mediante una búsqueda bibliográfica en las bases de datos científicas como: PubMed Central, LILACS y Google académico. Se concluyó que el SARS-CoV-2 es altamente transmisible, con una tasa de letalidad en Ecuador del 8,59%.
Six types of coronaviruses were already identified as generators of disease in humans as of 2019, with two previous epidemiological outbreaks standing out: SARS-CoV in 2002 and MERS-CoV in 2012. The new infectious agent that caused the 2019 pandemic was called SARS -CoV-2, which manifests as a severe acute respiratory syndrome (COVID-19). In this regard, on January 30, 2020, the World Health Organization decreed the health emergency. The purpose of this review was to analyze the epidemiological context around SARS-CoV-2 through a bibliographic review in scientific databases such as: PubMed Central, LILACS and Google Scholar. It was concluded that SARS-CoV-2 is highly transmissible, with a fatality rate in Ecuador of 8.59%.
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Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Virología , Epidemiología , COVID-19 , Síndrome Respiratorio Agudo Grave , Pandemias , SARS-CoV-2RESUMEN
Objective: COVID-19 is presently the most serious public health concern and diagnosis is a principal tool for controlling and monitoring the spread of the disease. This study aimed to evaluate the efficiency of direct RT-PCR (dRT-PCR) for detection of SARS-CoV-2. Methods: Twenty-seven nasopharyngeal swabs from symptomatic individuals were evaluated. Standard RT-PCR was conducted, and for dRT-PCR the samples were preheated before amplification. Results: Positive agreement was 63.2% and negative agreement was 100%, being moderately in accord. Conclusion: dRT-PCR may be an alternative for screening symptomatic patients and a reliable option during an eventual shortage of viral RNA purification kits.
Objetivo: A COVID-19 é atualmente um sério problema de saúde pública e o diagnóstico é a principal ferramenta para controlar e monitorar a propagação da doença. Este estudo teve como objetivo avaliar a eficiência da RT-PCR direta (dRT-PCR) para detecção do SARS-CoV-2. Métodos: Vinte e sete amostras de swab nasofaríngeo de indivíduos sintomáticos foram avaliados. A RT-PCR padrão foi realizada e para a dRT-PCR as amostras foram pré-aquecidas antes da amplificação. Resultados: A concordância positiva foi de 63,2% e a concordância negativa foi de 100%, sendo moderadamente concordante. Conclusão: A dRT-PCR pode ser uma alternativa para a triagem de pacientes sintomáticos e uma opção confiável durante uma eventual escassez de kits de purificação de RNA viral.
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Humanos , Virología , Reacción en Cadena de la Polimerasa , Triaje , Técnicas de Diagnóstico Molecular , Prueba de Ácido Nucleico para COVID-19 , COVID-19RESUMEN
Abstract Objective The coronavirus disease 2019 (COVID-19) is a pandemic viral disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The impact of the disease among the obstetric population remains unclear, and the study of the placenta can provide valuable information. Adequate sampling of the placental tissue can help characterize the pathways of viral infections. Methods A protocol of placental sampling is proposed, aiming at guaranteeing representativity of the placenta and describing the adequate conservation of samples and their integrity for future analysis. The protocol is presented in its complete and simplified versions, allowing its implementation in different complexity settings. Results Sampling with the minimum possible interval from childbirth is the key for adequate sampling and storage. This protocol has already been implemented during the Zika virus outbreak. Conclusion A protocol for adequate sampling and storage of placental tissue is fundamental for adequate evaluation of viral infections on the placenta. During the COVID-19 pandemic, implementation of this protocol may help to elucidate critical aspects of the SARS-CoV-2 infection.
Resumo Objetivo A doença do novo coronavírus (COVID-19) é uma doença viral pandêmica causada pelo coronavírus da síndrome respiratória aguda 2 (SARS-CoV-2). O impacto da doença entre a população obstétrica ainda é incerto, e o estudo da placenta pode fornecer informações valiosas. Assim, a coleta adequada do tecido placentário pode ajudar a caracterizar algumas propriedades das infecções virais. Métodos Um protocolo de coleta placentária é proposto, objetivando a garantia de representatividade da placenta, descrevendo a maneira de conservação adequada das amostras, e visando garantir sua integridade para análises futuras. O protocolo é apresentado em suas versões completa e simplificada, permitindo sua implementação em diferentes configurações de infraestrutura. Resultados A amostragem com o intervalo mínimo possível do parto é essencial para coleta e armazenamento adequados. Esse protocolo já foi implementado durante a epidemia de vírus Zika. Conclusão Um protocolo para coleta e armazenamento adequados de tecido placentário é fundamental para a avaliação adequada de infecções virais na placenta. Durante a pandemia de COVID-19, a implementação deste protocolo pode ajudar a elucidar aspectos críticos da infecção por SARS-CoV-2.
Asunto(s)
Humanos , Femenino , Embarazo , Placenta/virología , Manejo de Especímenes/métodos , Manejo de Especímenes/normas , COVID-19/virología , Virología/métodos , Virología/normas , Virosis/virologíaRESUMEN
RESUMEN: El virus SARS-CoV-2 ingresa al organismo de un individuo susceptible a través de la cavidad oral, nasal o de la mucosa conjuntival; busca ensamblarse por medio de su glicoproteína de superficie o espiga con los receptores de la enzima convertidora de angiotensina 2 que en boca los encontramos con mayor expresión en las células escamosas que recubren el epitelio lingual y las glándulas salivales, una vez que ingresa por medio de la activación de proteasas ingresa a la célula huésped para denudar su RNA viral, a diferencia de otros virus no necesita ir hasta el núcleo de tal forma que en el citoplasma inicia su replicación y utiliza los ribosomas del huésped para formar una gran cantidad de proteínas virales tanto estructurales como accesorias que le permita formar nuevos viriones potencialmente infecciosos; los estomatólogos deben tomar en cuenta esta vía de infección y extremar las medidas para disminuir su carga viral local en la cavidad oral y las barreras físicas de protección para el operador, el paciente y la ergonomía del consultorio.
ABSTRACT: SARS-CoV-2 virus enters the body of a susceptible individual through oral, nasal or conjunctival mucosa, seeking to bind to the spike glycoprotein surface through angiotensin-converting enzyme 2 receptors. These are found in the mouth with a higher expression in oral squamous cells that cover the lingual epithelium and salivary glands. Once proteolytic activation begins, it enters the host cell to denudate its viral RNA. In contrast with other viruses, it does not require nucleus access, and therefore replicates in the cytoplasm using the host's ribosomes to produce great amounts of both structural and accessory viral proteins. Since this generates new and potentially infectious virions, dentists must consider this route of infection and take extreme measures to decrease their viral load in the oral cavity. Physical protection barriers for the operator, the patient and the health and safety of the work place are critical in these cases.
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Humanos , Neumonía Viral , Infecciones por Coronavirus , Pandemias , Betacoronavirus , Glándulas Salivales/virología , Virología/métodos , Peptidil-Dipeptidasa A , Interacciones Huésped-Patógeno/genética , BocaRESUMEN
Abstract Within the framework of recent historiography about the role of the World Health Organization (WHO) in modernizing public health and the multifaceted concept of global health, this study addresses the impact of the WHO's "country programs" in Spain from the time it was admitted to this organization in 1951 to 1975. This research adopts a transnational historical perspective and emphasizes attention to the circulation of health knowledge, practices, and people, and focuses on the Spain-0001 and Spain-0025programs, their role in the development of virology in Spain, and the transformation of public health. Sources include historical archives (WHO, the Spanish National Health School), various WHO publications, the contemporary medical press, and a selection of the Spanish general press.
Resumen En el marco de la reciente historiografía sobre el papel de la Organización Mundial de la Salud (OMS) en la modernización de la salud pública y el concepto multifacético de salud global, se estudia el papel de los llamados "programas país" de la OMS en España desde su admisión en 1951 hasta 1975. Adoptando perspectiva histórica transnacional y enfatizando el estudio de la circulación de personas, conocimientos y prácticas científico-sanitarias, nuestro análisis se centra en los programas España-0001 y España-0025, en evaluar su papel en el desarrollo de la virología en España y en la transformación de la salud pública. Nuestras fuentes vienen de archivos históricos (OMS, Escuela Nacional de Sanidad), publicaciones de la OMS, revistas médicas contemporáneas, y una selección de prensa general española.
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Humanos , España , Virología , Organización Mundial de la Salud/historia , Investigación Biomédica , Práctica de Salud Pública/historiaRESUMEN
Severe cases infected with the coronavirus disease 2019 (COVID-19), named by the World Health Organization (WHO) on Feb. 11, 2020, tend to present a hypercatabolic state because of severe systemic consumption, and are susceptible to stress ulcers and even life-threatening gastrointestinal bleeding. Endoscopic diagnosis and treatment constitute an irreplaceable part in the handling of severe COVID-19 cases. Endoscopes, as reusable precision instruments with complicated structures, require more techniques than other medical devices in cleaning, disinfection, sterilization, and other reprocessing procedures. From 2016 to 2019, health care-acquired infection caused by improper endoscope reprocessing has always been among the top 5 on the list of top 10 health technology hazards issued by the Emergency Care Research Institute. Considering the highly infective nature of COVID-19 and the potential aerosol contamination therefrom, it is of pivotal significance to ensure that endoscopes are strictly reprocessed between uses. In accordance with the national standard "Regulation for Cleaning and Disinfection Technique of Flexible Endoscope (WS507-2016)," we improved the workflow of endoscope reprocessing including the selection of chemicals in an effort to ensure quality control throughout the clinical management towards COVID-19 patients. Based on the experience we attained from the 12 severe COVID-19 cases in our hospital who underwent endoscopy 23 times in total, the article provides an improved version of endoscopic reprocessing guidelines for bedside endoscopic diagnosis and treatment on COVID-19 patients for reference.
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Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Betacoronavirus , China , Infecciones por Coronavirus , Diagnóstico , Terapéutica , Infección Hospitalaria , Desinfección , Métodos , Endoscopios , Virología , Contaminación de Equipos , Pandemias , Ácido Peracético , Equipo de Protección Personal , Neumonía Viral , Diagnóstico , Terapéutica , Esterilización , Métodos , Flujo de TrabajoRESUMEN
We present an unusual case of a patient with bilateral-lung transplantation due to severe coronavirus disease 2019 (COVID-19), who subsequently suffered complications with acute myocardial infarction and underwent primary percutaneous coronary intervention (PCI).
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Anciano , Humanos , Masculino , Betacoronavirus , China , Infecciones por Coronavirus , Enfermedades Pulmonares , Cirugía General , Virología , Trasplante de Pulmón , Pandemias , Intervención Coronaria Percutánea , Neumonía Viral , Infarto del Miocardio con Elevación del ST , Cirugía General , VirologíaRESUMEN
As of Apr. 22, 2020, the World Health Organization (2020) has reported over 2.4 million confirmed coronavirus disease 2019 (COVID-19) patients and 169 151 deaths. Recent articles have uncovered genomic characteristics and clinical features of COVID-19 (Chan et al., 2020; Chang et al., 2020; Guan et al., 2020; Zhu et al., 2020), while our understanding of COVID-19 is still limited. As suggested by guidelines promoted by the General Office of National Health Commission of the People's Republic of China (2020) (from Versions 1 to 6), discharged standards for COVID-19 were still dependent on viral real-time polymerase chain reaction (RT-PCR) tests of respiratory specimens, showing that recovered COVID-19 patients with twice negative RT-PCR could meet discharge criteria. Here, we examined two cases in which nucleic acid test results were inconsistent with clinical and radiological findings, leading to suboptimal care.
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Betacoronavirus , China , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus , Diagnóstico , Pandemias , Alta del Paciente , Neumonía Viral , Diagnóstico , Reacción en Cadena en Tiempo Real de la Polimerasa , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Esputo , VirologíaRESUMEN
The recently emerged novel coronavirus pneumonia, named the coronavirus disease 2019 (COVID-19), shares several clinical characteristics with severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), and spread rapidly throughout China in December of 2019 (Huang et al., 2020). The pathogen 2019 novel coronavirus (2019-nCoV) is now named SARS coronavirus 2 (SARS-CoV-2) and is highly infectious. As of Apr. 9, 2020, over 80 000 confirmed cases had been reported, with an estimated mortality rate of 4.0% (Chinese Center for Disease Control and Prevention, 2020). Person-to-person transmission and familial clustering have been reported (Chan et al., 2020; Nishiura et al., 2020; Phan et al., 2020). However, there is no evidence of fetal intrauterine infection in pregnant women who have been infected with SARS-CoV-2 in their third trimester (Chen et al., 2020). It is unclear whether breastfeeding transmits the virus from previously infected and recovered mothers to their babies. Here we report the clinical course of a pregnant woman with COVID-19. In order to determine whether SARS-CoV-2 can be transmitted to newborns through breastfeeding, we measured viral RNA in the patient's breastmilk samples at different time points after delivery.
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Adulto , Femenino , Humanos , Recién Nacido , Embarazo , Betacoronavirus , Lactancia Materna , China , Infecciones por Coronavirus , Diagnóstico , Transmisión Vertical de Enfermedad Infecciosa , Leche Humana , Virología , Pandemias , Neumonía Viral , Diagnóstico , Complicaciones Infecciosas del Embarazo , Virología , ARN ViralRESUMEN
OBJECTIVE@#This study summarizes and compares clinical and laboratory characteristics of 34 patients admitted to the intensive care unit (ICU) for complications from coronavirus disease 2019 (COVID-19) at the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China from Jan. 22 to Mar. 5, 2020.@*METHODS@#A total of 34 patients were divided into two groups, including those who required noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) with additional extracorporeal membrane oxygenation (ECMO) in 11 patients. Clinical features of COVID-19 patients were described and the parameters of clinical characteristics between the two groups were compared.@*RESULTS@#The rates of the acute cardiac and kidney complications were higher in IMV cases than those in NIV cases. Most patients had lymphocytopenia on admission, with lymphocyte levels dropping progressively on the following days, and the more severe lymphopenia developed in the IMV group. In both groups, T lymphocyte counts were below typical lower limit norms compared to B lymphocytes. On admission, both groups had higher than expected amounts of plasma interleukin-6 (IL-6), which over time declined more in NIV patients. The prothrombin time was increased and the levels of platelet, hemoglobin, blood urea nitrogen (BUN), D-dimer, lactate dehydrogenase (LDH), and IL-6 were higher in IMV cases compared with NIV cases during hospitalization.@*CONCLUSIONS@#Data showed that the rates of complications, dynamics of lymphocytopenia, and changes in levels of platelet, hemoglobin, BUN, D-dimer, LDH and IL-6, and prothrombin time in these ICU patients were significantly different between IMV and NIV cases.
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Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Lesión Renal Aguda , Virología , Betacoronavirus , Nitrógeno de la Urea Sanguínea , China , Infecciones por Coronavirus , Terapéutica , Oxigenación por Membrana Extracorpórea , Productos de Degradación de Fibrina-Fibrinógeno , Cardiopatías , Virología , Hemoglobinas , Hospitalización , Unidades de Cuidados Intensivos , Interleucina-6 , Sangre , L-Lactato Deshidrogenasa , Sangre , Linfopenia , Virología , Ventilación no Invasiva , Pandemias , Neumonía Viral , Terapéutica , Respiración con Presión Positiva , Tiempo de Protrombina , Estudios RetrospectivosRESUMEN
OBJECTIVES@#To analyze the clinical characteristics of 71 patients with coronavirus disease 2019 (COVID-19).@*METHODS@#The general data, epidemiological data, laboratory tests, imaging examinations, and treatment of 71 patients with COVID-19 admitted to the Sixth People's Hospital of Zhengzhou from January 19, 2020 to March 3, 2020 were retrospectively analyzed.@*RESULTS@#Of the 71 COVID-19 patients, the ages were 4-84 (41.29±15.21) years, 38 (53.5%) patients were male, 33 (46.5%) were female, and 52 (73.2%) were in 22 clusters. The main clinical manifestations were fever (78.9%), cough (64.8%), and sputum (38.0%). The fever was mainly low and moderate, with 49 patients (69.0%) at 37.3-39.0 ℃. Most of the leukocytes, neutrophils, and lymphocytes were normal, accounting for 47 (66.2%), 51 (71.8%), and 51 (71.8%) patients, respectively; a few of them were decreased, accounting for 21 (29.6%), 16 (22.5%), and 20 (28.2%) patients, respectively. There were 38 (53.5%) and 31 (43.7%) patients with the decreased CD4 and CD8 T cell counts, respectively. There were 41 (57.7%), 38 (53.5%), 32 (45.1%), 26(36.6%), 22 (31.0%), 20 (28.2%), 14 (19.7%), 14 (19.7%), and 9 (12.7%) patients with the increased levels of C-reactive protein, erythrocyte sedimentation rate, procalcitonin, fibrinogen,interleukin 6, lactate dehydrogenase,-dimer,alanine aminotransferase, and aspartate aminotransferase, respectively. Of the 71 patients, the lung was involved in 60 (84.5%) patients, the double lung was involved in 47 (66.2%) patients, and the single lung was involved in 13 (18.3%) patients. The course of the disease was long, and the time from symptom onset to the second severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid negative transformation was (17.22±6.34) days.There were no significant differences in the incubation period (=-0.453, >0.05), the complicates (χ=0.042, >0.05), and the time from symptom onset to diagnosis (=-1.330, >0.05) in patients between the non-severe group and the severe group. The onset age, gender, SARS-CoV-2 nucleic acid negative time, lymphocyte count, -dimer, C-reactive protein, total bilirubin, direct bilirubin, lactate dehydrogenase, calcium ion, CD4 T cell count, CD8 T cell count, calcitonin, procalcitonin, and troponin were significantly different between the severe group and the non-severe group (all <0.05). Among the 71 patients, 4 (5.6%) patients were mild, 59 (83.1%) were normal, and 8 (11.3%) were severe or critical.@*CONCLUSIONS@#The aggregation phenomenon of COVID-19 is obvious. Fever and cough are the main clinical manifestations. White blood cells, neutrophils, and lymphocytes in the most patients in the early onset are normal. Most COVID-19 patients are light and ordinary type, with good prognosis.
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Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Betacoronavirus , China , Infecciones por Coronavirus , Diagnóstico , Tos , Virología , Fiebre , Virología , Recuento de Leucocitos , Pandemias , Neumonía Viral , Diagnóstico , Estudios RetrospectivosRESUMEN
BACKGROUND@#Human infections with zoonotic coronaviruses (CoVs), including severe acute respiratory syndrome (SARS)-CoV and Middle East respiratory syndrome (MERS)-CoV, have raised great public health concern globally. Here, we report a novel bat-origin CoV causing severe and fatal pneumonia in humans.@*METHODS@#We collected clinical data and bronchoalveolar lavage (BAL) specimens from five patients with severe pneumonia from Wuhan Jinyintan Hospital, Hubei province, China. Nucleic acids of the BAL were extracted and subjected to next-generation sequencing. Virus isolation was carried out, and maximum-likelihood phylogenetic trees were constructed.@*RESULTS@#Five patients hospitalized from December 18 to December 29, 2019 presented with fever, cough, and dyspnea accompanied by complications of acute respiratory distress syndrome. Chest radiography revealed diffuse opacities and consolidation. One of these patients died. Sequence results revealed the presence of a previously unknown β-CoV strain in all five patients, with 99.8% to 99.9% nucleotide identities among the isolates. These isolates showed 79.0% nucleotide identity with the sequence of SARS-CoV (GenBank NC_004718) and 51.8% identity with the sequence of MERS-CoV (GenBank NC_019843). The virus is phylogenetically closest to a bat SARS-like CoV (SL-ZC45, GenBank MG772933) with 87.6% to 87.7% nucleotide identity, but is in a separate clade. Moreover, these viruses have a single intact open reading frame gene 8, as a further indicator of bat-origin CoVs. However, the amino acid sequence of the tentative receptor-binding domain resembles that of SARS-CoV, indicating that these viruses might use the same receptor.@*CONCLUSION@#A novel bat-borne CoV was identified that is associated with severe and fatal respiratory disease in humans.