Does oseltamivir prevent hospitalisation in people with influenza?

Overview of: Hanula R, Bortolussi-Courval É, Mendel A, et al. Evaluation of oseltamivir used to prevent hospitalization in outpatients with influenza: a systematic review and meta-analysis. JAMA Internal Medicine 2024;184:18-27.

A noninferiority randomized open-label pilot study of 3- versus 7-day influenza postexposure prophylaxis with oseltamivir in hospitalized children.

Short influenza postexposure prophylaxis (PEP) showed high efficacy in adults, but studies in children are lacking. This randomized open-label pilot trial aimed to verify noninferiority of a 3- versus 7-day prophylaxis with oral oseltamivir in hospitalized children. Influenza contacts were randomized to the 3- or 7-day group and efficacy, relative risk of adverse events (AEs), and the cumulative costs of drugs and AEs management were compared. The intention-to-treat (ITT) analysis included 59 children (n = 28 and n = 31 in the 3- and 7-day group, respectively). The efficacy was 100% (95% CI 87.7-100%) versus 93.6% (95% CI 78.6-99.2%) in the 3- and 7-day group; the differences were statistically insignificant. A per-protocol (PP) analysis including 56 patients (n = 27 and n = 29, respectively) showed 100% (95% CI 87.2-100%) and 93.1% (95% CI 77.2-99.2%) efficacy, respectively, without statistical significance. Differences were within the predefined noninferiority margin with an efficacy difference Δ = 6.45 percentage points (p.p.) with 1-sided 95% CI (- 2.8, - 1.31, p = 0.86; ITT) and Δ = 6.9 p.p. (1-sided 95% CI - 2.83, - 1.27, p = 0.85; PP). Adverse events did not differ significantly, while the cumulative costs of the prophylaxis and AEs management were higher in the 7-day group (median 10.5 euro vs. 4.5 euro, p < 0.01). This pilot study showed the noninferiority of the 3-day versus 7-day PEP, which was associated with lower costs.Trial registration number: NCT04297462, 5th March 2020, restrospectively registered.

Design and evaluation of oseltamivir phosphate dual-phase extended-release tablets for the treatment of influenza.

In this study, once-daily extended-release tablets with dual-phase release of oseltamivir phosphate were developed for the treatment of influenza. The goal was to improve patient adherence and offer more therapeutic choices. The tablets were manufactured using wet granulation, bilayer tablet compression, and enteric membrane-controlled coating processes. Various polymers, such as hydroxypropyl methylcellulose (HPMC K100MCR, K15MCR, K4MCR, K100LV), enteric polymers (HPMC AS-LF, Eudragit L100-55) and membrane-controlled polymers (OPADRY® CA), were used either individually or in combination with other common excipients. The formulations include enteric-coated extended-release tablet (F1), hydrophilic matrix extended-release tablet (F2), semipermeable membrane-controlled release tablet (F3) and a combination extended-release tablet containing both enteric and hydrophilic matrix (F4). The in vitro drug release profile of each formulation was fitted to the first-order model, and the Ritger-Peppas model suggested that Fickian diffusion was the primary mechanism for drug release. Comparative bioequivalence studies with Tamiflu® (oseltamivir phosphate) capsules revealed that formulations F1, F2, and F3 did not achieve bioequivalence. However, under fed conditions, formulation F4 achieved bioequivalence with a relative bioavailability of 95.30% (90% CI, 88.83%-102.15%). This suggests that the formulation F4 tablet could potentially be a new treatment option for patients with influenza.

Influenza A (H1N1): outbreak management in a dialysis unit and clinical outcomes of infection in chronic hemodialysis patients / Influenza A (H1N1): controle de surto em unidade de diálise e desfechos clínicos da infecção em pacientes em hemodiálise crônica

ABSTRACT Introduction: Chronic hemodialysis (HD) patients are considered to be at high risk for infection. Here, we describe the clinical outcomes of chronic HD patients with influenza A (H1N1) infection and the strategies adopted to control an outbreak of influenza A in a dialysis unit. Methods: Among a total of 62 chronic HD patients, H1N1 infection was identified in 12 (19.4%). Of the 32 staff members, four (12.5%) were found to be infected with the H1N1 virus. Outcomes included symptoms at presentation, comorbidities, occurrence of hypoxemia, hospital admission, and clinical evaluation. Infection was confirmed by real-time reverse transcriptase polymerase chain reaction. Results: The 12 patients who had H1N1 infection did not differ significantly from the other 50 non-infected patients with respect to age, sex, dialysis vintage, dialysis modality, or proportion of comorbidities. Obesity was higher in the H1N1-infected group (41.5 vs. 4%, p<0.002). The most common symptoms were fever (92%), cough (92%), and rhinorrhea (83%). Early empirical antiviral treatment with oseltamivir was started in symptomatic patients and infection control measures, including the intensification of contact-reduction measures by the staff members, antiviral chemoprophylaxis to asymptomatic patients undergoing HD in the same shift of infected patients, and dismiss of staff members suspected of being infected, were implemented to control the spread of infection in the dialysis unit. Conclusion: The clinical course of infection with H1N1 in our patients was favorable. None of the patients developed severe disease and the strategies adopted to control the outbreak were successful.

RESUMO Introdução: Pacientes em hemodiálise (HD) crônica apresentam risco elevado para infecções. O presente estudo descreve os desfechos clínicos de pacientes em HD crônica com infecção pelo vírus influenza A (H1N1) e as estratégias adotadas para controlar um surto de influenza A numa unidade de diálise. Métodos: Doze (19,4%) de 62 pacientes em HD crônica e quatro (12,5%) de 32 funcionários desta unidade de diálise apresentaram infecção pelo vírus H1N1. Os desfechos incluíram sintomas à apresentação, comorbidades, ocorrência de hipoxemia, internação hospitalar e avaliação clínica. A presença de infecção foi confirmada por reação em cadeia da polimerase via transcriptase reversa (RT-PCR) em tempo real. Resultados: Os 12 pacientes com infecção por H1N1 não diferiram significativamente dos 50 pacientes sem infecção no tocante a idade, sexo, tempo em diálise, modalidade de diálise e percentual de comorbidades. O percentual de obesidade foi mais elevado no grupo com infecção por H1N1 (41,5% vs. 4%, p<0,002). Os sintomas mais comuns foram febre (92%), tosse (92%) e rinorreia (83%). Os pacientes foram submetidos a tratamento antiviral com oseltamivir e medidas de controle (intensificação das medidas de redução de contato pelos funcionários da clínica, quimioprofilaxia com antiviral para pacientes assintomáticos em HD na mesma sala dos pacientes com infecção e afastamento de funcionários da clínica com suspeita de infecção) para controlar a disseminação da infecção pela unidade de diálise. Conclusão: O curso clínico da infecção por H1N1 em nossos pacientes foi favorável. Nenhum evoluiu para doença grave e as estratégias adotadas foram efetivas no controle do surto.

Encefalopatía necrotizante aguda asociada a influenza A / Influenza A-associated acute necrotizing encephalopathy

INTRODUCCIÓN: La encefalopatía necrotizante aguda (ENA) es una patología rara, caracterizada por compromiso de conciencia y presencia de múltiples lesiones encefálicas simétricas localizadas principalmente en tá lamo. Se asocia a alta letalidad e importantes secuelas. OBJETIVO: Describir el caso de un paciente escolar con ENA asociada a influenza-A con evolución favorable. CASO CLÍNICO: Paciente de 6 años de edad, con historia de 3 días de evolución de síntomas respiratorios altos asociados a fiebre (39 °C). Veinticuatro horas previo a la consulta destacaba compromiso de conciencia cualicuantitativo. Se realizó punción lumbar con proteinorraquia leve. En resonancia magnética (RM) se identificó focos de restricción a la difusión bilaterales de distribución simétrica, talámicos, en cuerpos mamila res, periacueductales, de tegmento pontino, hipocampales y en ambas cápsulas externas, asociado a componente hemorrágico y edema vasogénico, sugerente de ENA. Recibió tratamiento empírico con metilprednisolona y oseltamivir. Posteriormente, se recibió resultado positivo para virus influenza- AH1. Dado diagnóstico, se decidió administrar inmunoglobulina, evolucionando lento pero favora blemente. Al alta levemente bradipsíquico, con disminución de agudeza visual, lenguaje espontáneo y marcha con apoyo. A los 6 meses de seguimiento presentaba lenguaje y marcha normales, persis tiendo alteración visual a derecha. CONCLUSIÓN: Nuestro paciente presentó una ENA cuyo diagnóstico y manejo oportunos se asociaron a una favorable evolución neurológica en el largo plazo. Si bien la ENA es una patología infrecuente, la morbimortalidad asociada es altísima, por lo que resulta de gran importancia tener un alto grado de sospecha, a fin de solicitar estudio imagenológico dirigido, buscar causas infecciosas relacionadas e iniciar un manejo oportuno.

INTRODUCTION: Acute necrotizing encephalopathy of childhood (ANEC) is a rare disease characterized by alteration of consciousness and multiple symmetric brain lesions mainly involving the thalamus. It presents a high mortality rate and severe sequelae. OBJECTIVE: To describe a school-age patient with influenza A-related ANEC with favorable evolution. CLINICAL CASE: Six-year-old boy with 3 days history of upper respiratory symptoms and fever (39 °C). One day previous to admission, he presented altered state of consciousness. A lumbar puncture was performed, showing a mild increase of protein level in CSF. MRI showed bilateral foci of symmetric restricted signal in the thalamus, mammillary bodies, periaqueductal gray, ventral tegmentum, hippocampus, and in both external capsules, which was compatible with ANEC. The patient received empirical treatment with methylprednisolone and oseltamivir. Subsequently, a positive result was received for influenza. Considering diagnosis and severity of illness, it was decided to administer immunoglobulin. The patient got better slowly but favorably. At discharge, he still was mildly bradypsychic with decreased visual acuity, spontaneous speech and walking with assistance. At 6 months of follow-up, the patient presented normal speech and gait, with persistent visual impairment in the right eye. CONCLUSIONS: Our patient presented ANEC, whose timely diagnosis and management were associated with a favorable neurological evolution in the long term. Although ANEC is an infrequent pathology, it has very high morbidity and mortality rates, so it is very important to have a high degree of suspicion in order to request a targeted imaging study, search for related infectious causes, and start proper treatment.

Oseltamivir para el tratamiento de la gripe en niños y adolescentes / Oseltamivir for the treatment of influenza in children and adolescents

Introducción: La gripe es una enfermedad generalmente benigna, pero en ocasiones puede ocasionar complicaciones graves. Existe controversia sobre los beneficios del tratamiento con antivirales. Objetivos: Proporcionar unas recomendaciones sobre el tratamiento con oseltamivir en pacientes pediátricos con gripe, basadas en los mejores datos disponibles y válidas en nuestro medio. Métodos: El Grupo de Infecciones Respiratorias de la Sociedad Española de Infectología Pediátrica llevó a cabo una revisión de la bibliografía. Los hallazgos se analizaron mediante la metodología GRADE, y se elaboraron unas recomendaciones. Resultados: No se recomienda el uso sistemático de pruebas diagnósticas para la gripe en el ámbito ambulatorio y en urgencias hospitalarias en pacientes inmunocompetentes con un cuadro clínico compatible. No se recomienda el uso de antivirales a la gran mayoría de los pacientes sanos y asmáticos con gripe o sospecha de gripe estacional, si el objetivo es prevenir eventos graves. No se recomienda el uso de oseltamivir de forma sistemática en pacientes hospitalizados con gripe. Se recomienda tratar con oseltamivir a los pacientes con gripe y neumonía o enfermedad grave o a los pacientes críticos, especialmente durante las primeras 48 h de enfermedad. Se recomienda el tratamiento de los pacientes con factores de riesgo, teniendo en cuenta su enfermedad de base. La vacunación antigripal, junto a las medidas básicas de evitación, continúan siendo la principal herramienta en la prevención de la gripe. Conclusión: En algunas situaciones hay datos suficientes para emitir recomendaciones claras. En otras situaciones los datos son incompletos y solo permiten hacer recomendaciones débiles

Introduction: Influenza is a generally a benign disease, but occasionally it can cause serious complications. There is controversy about the benefits of antiviral treatment. Objectives: To provide some recommendations on the treatment with oseltamivir in paediatric patients with influenza, based on the best data available and valid in our environment. Methods: The Respiratory Infections Group of the Spanish Society of Paediatric Infectious Diseases carried out a review of the literature. The findings were analysed using the GRADE methodology, and recommendations were made. Results: The systematic use of diagnostic tests for influenza in the outpatient setting, or in the emergency room, in immunocompetent patients with a compatible clinical picture is not recommended. If the aim is to prevent serious events, the use of antivirals is not recommended for the vast majority of healthy and asthmatic patients with influenza or suspected seasonal flu. The systematic use of oseltamivir in patients admitted to hospital with influenza is not recommended. Oseltamivir treatment is recommended in any patients with influenza and pneumonia or severe illness, and critically ill patients, especially during the first 48 hours of illness. The treatment of patients with risk factors is recommended, considering their underlying disease. Influenza vaccination, together with basic isolation measures, continue to be the main tool in the prevention of influenza. Conclusion: In some situations, there are sufficient data to issue clear recommendations. In other situations, the data are incomplete, and only allows weak recommendations

Influenza A. Manejo ambulatorio / Influenza A. Ambulatory management

Introducción. La influenza A constituye uno de los principales problemas de salud que enfrenta la humanidad.El manejo clínico ambulatorio usando el protocolo de oseltamivir y saturomería permite realizar una práctica evaluación. Objetivo. Evaluar resultados usando protocolo de oseltamivir y saturometría en atención médica ambulatoria y emergencias en pacientes con influenza A. Métodos. Realizar un estudio clínico experimental aleatorio en pacientes con influenza A, usando protocolo con oseltamivir y saturometría y compararlo con tratamiento estándar. Conclusiones. La influenza A seguirá afectandónos por varios años más, debemos asumir una capacidad de respuesta, que incluya: la detección y confirmación de casos; así como su manejo clínico oportuno y eficaz. (AU)

Introduction. Influenza A is one of the main health problems facing humanity. Outpatient clinical management using the oseltamivir and saturomer protocol allows a practical evaluation. Objective. To evaluate results using oseltamivir protocol and saturometry in ambulatory medical care and emergencies in patients with influenza A. Methods. Perform a randomized experimental clinical study in patients with influenza A, using procolo with oseltamivir and saturometry and compare it with standard treatment. Conclusions. Influenza A will continue to affect us for several more years, we must assume a capacity to respond, that include: the detection and confirmation of cases; as well as its timely and effective clinical management. (AU)

Gripe ou resfriado? Sinusite ou rinite? / Influenza or cold? Sinusitis or rhinitis?

Resfriado comum e gripe são habitualmente confundidos, principalmente se o resfriado for mais intenso. Coriza é rotulada tanto como alergia como sinusite. Os processos inflamatórios das vias aéreas superiores envolvidos nessas entidades clínicas conjugam fatores comuns, embora tenham etiologias diferentes. Graças a isso, diagnósticos equivocados geram tratamento inadequado, geralmente com emprego desnecessário de antibióticos. O resfriado comum e a gripe (influenza) são infecções virais do trato respiratório, assim como a maioria das rinossinusites. Já a rinite é, em sua maior parte, manifestação da atopia respiratória.

Common cold and flu are usually confused, especially if the cold is more intense. Many times, coryza is labeled as being allergy or sinusitis. The inflammation of the upper airways involved in these clinical entities combine common factors, although they have different etiologies. As a result, misdiagnosis generates inadequate treatment, usually with unnecessary use of antibiotics. The common cold and the flu (influenza) are viral infections of the respiratory tract, as well as most cases of rhinosinusitis. On the other hand, rhinitis is, most of the time, a manifestation of respiratory atopy.

Profilaxis de infección por virus respiratorios en niños y adultos sometidos a trasplante de órganos sólidos y precursores hematopoyéticos / Prophylaxis against respiratory viral disease in pediatric and adult patients undergoing solid organ and hematopoietic stem cells transplantation

Respiratory viruses have been identified as a cause of morbidity and mortality in patients undergoing SOT and HSCT, specially in children. The most frequent are respiratory syncytial virus (RSV), influenza (FLU), parainfluenza (PI) and adenovirus (ADV). These infections are associated with progression to severe lower respiratory tract infections in up to 60% of the cases. It is advised to apply universal protection recommendations for respiratory viruses (A2) and some specific measures for FLU and AD. FLU: Annual anti-influenza vaccination (from 4-6 months post-transplantation in SOT, 6 months in HSCT (A2)); post- exposure prophylaxis in FLU (oseltamivir for 10 days (B2)). In lung transplantion, the prophylaxis should last as long as the risk period (B2). ADV: There is no vaccine nor valid chemoprophylaxis strategy to prevent ADV disease. In some specific HSCT recipients, weekly PCR monitoring is recommended until day+100 (A3).

Los virus respiratorios se han identificado como causa de morbi-mortalidad en pacientes sometidos a TOS y TPH, particularmente en pediatría. Los más frecuentes son virus respiratorio sincicial (VRS), influenza (FLU), parainfluenza (PI) y adenovirus (ADV). La fuente de contagio está en la comunidad y en el hospital afectando al paciente en cualquier período post-trasplante. Se describe progresión a infecciones graves del tracto respiratorio bajo hasta en 60 % de los casos. Se recomienda aplicar medidas de aislamiento de precaución universal para todos los virus respiratorios (A2) y se describen algunas medidas específicas para FLU y AlDV. Vacunación anti-influenza anual con vacuna inactivada (en TOS a partir de 4-6 meses post-trasplante (A2), en TPH a partir de 6 meses (A2)); profilaxis post exposición a virus FLU (oseltamivir durante 10 días (B2)). En trasplante de pulmón, la duración de la profilaxis se extenderá mientras dure el período de riesgo (B2). Con respecto a ADV, no se dispone de una vacuna adecuada y no existe a la fecha una estrategia validada de quimioprofilaxis para prevenir enfermedad por ADV; en casos específicos de TPH pediátrico, se recomienda vigilancia semanal con RPC en sangre periférica hasta el día +100 post-TPH (A3).

Perfil dos pacientes internados no Hospital São José do Avaí com suspeita de gripe A H1N1 / Profile of patients admitted at São José do Avaí Hospital suspected Influenza A H1N1

JUSTIFICATIVA E OBJETIVOS: A gripe A H1N1 tão logo que surgiu, tornou-se uma pandemia, afetando diversos países e gerando preocupações, tanto por levar a um número elevado de internações hospitalares, não somente no Brasil, mas em todo o mundo, por estar vinculada a complicações. Oobjetivo deste estudo foi avaliar o perfil dos primeiros pacientes com suspeita de gripe A H1N1 e a sua evolução clínica.MÉTODO: Participaram deste estudo 101 pacientes internados no período de 5 de agosto a 23 de novembro de 2009,avaliados através de dados secundários dos prontuários do Hospital São José do Avaí (HSJA) e dados do Setor de Epidemiologia do Posto de Saúde Raul Travassos (Secretaria Municipal de Saúde de Itaperuna, RJ).RESULTADOS: Dos 101 pacientes avaliados, 59,4% eram dos exo feminino e 40,6% do sexo masculino. A faixa etária varioude zero a 82 anos com predomínio de menores de 20 anos(34,7%). Foi coletado material para confirmação diagnóstica de 15 pacientes, com um total de 11 resultados positivos e 4 negativos. Desses 15 pacientes, 11 necessitaram de ventilação mecânica e 8 evoluíram para óbito. Todos os pacientes confirmados com gripe A que evoluíram para óbito, apresentavam comorbidades prévias. CONCLUSÃO: A avaliação inicial atenta dos pacientes com suspeita de gripe A é de suma importância para o diagnóstico clínico da doença, a fim de que através do tratamento adequado e precoce possa reduzir a ocorrência de complicações,formas graves e óbitos, obtendo melhor prognóstico.

BACKGROUND AND OBJECTIVES: As soon as Influenza A H1N1 emerged, it became a pandemic, affecting many countries, raising concern both for causing a high number of hospital admissions, not only in Brazil but all over the world, and for being linked to complications. The aim of this study was to evaluate the profile of the first patients suspected influenza A H1N1 and the clinical outcome.METHOD: In this study, a cohort of 101 patients was hospitalized from August 5 to November 23, 2009, assessed through secondary data from medical records at HSJA and data from the Epidemiology Section of Raul Travassos Health Post (Municipal Health Itaperuna, RJ).RESULTS: Of 101 patients, 59.4% were female and 40.6% male. Their ages ranged from 0 to 82 years with a prevalence of less than 20 years old (34.7%). Material was obtained to confirm the diagnosis of 15 patients, with a total of 11 positive and 4 negative. Of these 15 patients, 11 required mechanical ventilation and 8 died. All patients with confirmed influenza A who died, had comorbidities. CONCLUSION: The initial alert evaluation of patients suspectedof having influenza A is of great importance for theclinical diagnosis of the disease, so that by early and adequate treatment, the occurrence of complications and death can be reduced, obtaining a better prognosis.

Gripe (H1N1) 2009 en Castilla y León: estudio de casos dospitalizados y concordancia con los protocolos de actuación desarrollados / Influenza (H1N1) 2009 in Castilla y León: hospitalized care studies and match with the protocols of action developed

Fundamento: En abril del año 2009 la Organización Mundial de la Salud declaró una Emergencia de Salud Pública de Importancia Internacional por la aparición de casos en humanos por un nuevo virus de la gripe A H1N1. El objetivo de este trabajo es analizar las características de los casos investigados y valorar la conformidad de los sujetos estudiados con las indicaciones y recomendaciones de la Consejería de Sanidad de Castilla y León. Métodos: Estudio epidemiológico descriptivo del total de las peticiones de laboratorio solicitadas en Castilla y León, entre las semanas epidemiológicas 44 y 50, ambas inclusive y de los casos que resultaron positivos. Resultados: Se solicitaron 588 peticiones analíticas para gripe A H1N1 (58% hombres). La edad media fue de 34,8 años (27,1% entre 15 y 44 años) y la enfermedad respiratoria crónica el factor de riesgo más frecuente (18,9%). En el 19,1% se instauró tratamiento antiviral (54,5% en las primeras 48 horas). El 42% de las peticiones cumplían criterios de gravedad y el 27,4% de las peticiones fueron positivas (53,4% varones). La edad media en las peticiones positivas fue 34,52 años (33,1% entre 15 y 44 años). En el 26,7% el factor de riesgo más frecuente fue la enfermedad respiratoria crónica, el 6,8% tenía obesidad mórbida. El 28,9% de los sujetos que dieron positivo recibió tratamiento antiviral (61,4% en las primeras 48 horas) y el 47,8% cumplían criterios de gravedad. Conclusión: La mayoría de los casos estudiados no cumplían criterios de gravedad, lo que pone de manifiesto el bajo cumplimiento de los protocolos de vigilancia en el ámbito asistencial(AU)

Background: In April 2009, the World Health Organization declared the emergence of human cases by a new influenza virus H1N1 as a Public Health Emergency of International Importance. Our objective was to analyze the characteristics of the cases investigated and to assess the compliance of the subjects studied with the indications and recommendations of the Health Regional Ministry of Health Castilla y León. Methods: A descriptive epidemiological study of all positive cases and every requests made to Castilla y León, from epidemiological weeks 44 to 50, both included. Results: 588 requests were made to test for influenza A H1N1 (58% males). The mean age was 34.8 years (27.1% between 15 and 44 years). 42% fulfilled criteria for severity. Chronic respiratory disease was the most common risk factor found (18.9%). Antiviral treatment was found in 19.1% (54.5% within the first 48 hours). 27.4% of the requests were positive (53.4% males). The mean age of the positive cases was 34.52 years was positive (33.1% between 15 and 44 years). 47.8% of them fulfilled criteria for severity and chronic respiratory disease was also the most common risk factor found also in the positive (26.7%). Only 6.8% were morbidly obese. 28.9% of positives received antiviral treatment (61.4% within the first 48 hours). Conclusion: Most cases did not fulfil severity criteria, which illustrates the low compliance of monitoring protocols in sanitary care system(AU)

Primeros casos positivos de infección por influenza A H1N1 / The firsts positive cases of A H1N1 influenza infection

Se realizó un estudio descriptivo para caracterizar los primeros casos de pacientes obstétricas con influenza A H1N1 confirmada. Se analizaron variables demográficas, obstétricas y aquellas relacionadas con las características clínicas, de manejo y evolución de la influenza en estos casos. Los datos se procesaron usando el sistema estadístico para Windows SPSS versión 11. La edad media de las pacientes fue 23,04 a±os, el 87,5 por ciento estaban cursando el 2do o 3er trimestres del embarazo, el 50 por ciento tenían una enfermedad subyacente, el asma bronquial fue la más frecuente. Los síntomas más frecuentes fueron la tos (88,46 por ciento) y la fiebre (80,76 por ciento). El 50 por ciento de las pacientes se complicaron con neumopatía y de estas el 84,61 por ciento ingresaron en cuidados intensivos. En general la estadía hospitalaria no fue prolongada y no se produjeron fallecimientos, se concluyó que el ingreso y tratamiento precoz con antiviral, así como el manejo multidisciplinario, fueron pilares de los resultados satisfactorios obtenidos

A descriptive study was conducted to characterize the firsts cases of obstetric patents presenting with confirmed A H1N1 influenza. The demographic, obstetric variables were analyzed as well as those related to the clinical features, of management and evolution of influenza en these cases. Data were processed using the statistical system for Windows SPSS version 11. Mean age of patient was of 23,04 percent years, the 87,5 percent was at the second or third trimester of pregnancy, the 50 percent had a underlying disease, bronchial asthma was the more frequent. The commonest symptoms were cough (88.46 percent) and fever (80.76 percent). The 50 percent of patients had complications including pneumonia and from these the 84,61 percent were admitted in intensive care units. In general hospital stay wasn't lengthy without deaths concluding that admission and early treatment sing antiviral methods, as well as the multidisciplinary management were pillars of the satisfactory results obtained

Primeros casos positivos de infección por influenza A H1N1 / The firsts positive cases of A H1N1 influenza infection

Se realizó un estudio descriptivo para caracterizar los primeros casos de pacientes obstétricas con influenza A H1N1 confirmada. Se analizaron variables demográficas, obstétricas y aquellas relacionadas con las características clínicas, de manejo y evolución de la influenza en estos casos. Los datos se procesaron usando el sistema estadístico para Windows SPSS versión 11. La edad media de las pacientes fue 23,04 a±os, el 87,5 por ciento estaban cursando el 2do o 3er trimestres del embarazo, el 50 por ciento tenían una enfermedad subyacente, el asma bronquial fue la más frecuente. Los síntomas más frecuentes fueron la tos (88,46 por ciento) y la fiebre (80,76 por ciento). El 50 por ciento de las pacientes se complicaron con neumopatía y de estas el 84,61 por ciento ingresaron en cuidados intensivos. En general la estadía hospitalaria no fue prolongada y no se produjeron fallecimientos, se concluyó que el ingreso y tratamiento precoz con antiviral, así como el manejo multidisciplinario, fueron pilares de los resultados satisfactorios obtenidos (AU)

A descriptive study was conducted to characterize the firsts cases of obstetric patents presenting with confirmed A H1N1 influenza. The demographic, obstetric variables were analyzed as well as those related to the clinical features, of management and evolution of influenza en these cases. Data were processed using the statistical system for Windows SPSS version 11. Mean age of patient was of 23,04 percent years, the 87,5 percent was at the second or third trimester of pregnancy, the 50 percent had a underlying disease, bronchial asthma was the more frequent. The commonest symptoms were cough (88.46 percent) and fever (80.76 percent). The 50 percent of patients had complications including pneumonia and from these the 84,61 percent were admitted in intensive care units. In general hospital stay wasn't lengthy without deaths concluding that admission and early treatment sing antiviral methods, as well as the multidisciplinary management were pillars of the satisfactory results obtained (AU)

Influenza humana a H1N1: pandemia esperada / H1N1 human influenza: pandemic expected

La influenza es responsable de incremento en la morbilidad y mortalidad, del costo de las hospitalizaciones y de ausentismo escolar y laboral. Es producida por el virus de la influenza perteneciente a la familia Orthomixoviridae y es un virus ARN envuelto. El período de incubación va de 1 a 4 días. Las manifestaciones clínicas incluyen fiebre y varían desde conjuntivitis leve a neumonía grave con falla multiorgánica, hemorragia pulmonar, náuseas, vómito y diarrea. Se ha reportado pandemias importantes con cifras de defunciones alarmantes. La influencia AH1N1, actualmente circulante desde marzo del 2009, es el producto de la recombinación genética del virus de la influenza porcina euroasiática, influenza porcina de Norteamérica, influenza aviar no H5, e influenza humana. Hasta el 13 de septiembre del presente año la OMS ha notificado la apararición de más de 296471 casos y al menos 3486 defunciones. En la regtión de América se informa de más de 124126 casos con 2625 defunciones. Según el Ministerio de Salud, en Venezuela se informa de 5171 casos sospechosos, 1316 confirmados y 67 defunciones por influenza AH1N1, hasta el 17 de septiembre de 2009. El lavado frecuente de manos, aislamiento de los sospechosos, tratamiento con oseltamivir o zanamivir y la inmunización al personal susceptible al tener disponible la vacuna son medidas indispensables en la prevención de la diseminación de la pandemia.

Influenza impacts morbidity, mortality and health care costs. It causes school and work absenteeism. The responsible microorganisms are RNA viruses belonging to Orthomixoviridae family. Uncomplicated influenza begins after an incubation period of 1 to 4 days. Symptoms include fever, and in some cases mild conjunctivitis, but other patients have severe pneumonia with multiorgan failure, pulmonary bleeding, nausea, vomiting, and diarrhea. New influenza AH1N1 is a genetic recombination of Euro-Asian swine influenza virus, seasonal influenza virus, and H3N2 virus as the one isolated in Australia in 2007 (A/Brisbane/10/2007). As of September 13, 2009, the World Health Organization reported more than 296471 confirmed cases worldwide with at least 3486 deaths. In the Americas the figure reaches more than 124126 cases, and 2625 dealths. Venezuelan Ministry of Health has confirmed 1316 cases with 67 deaths. Regular hand hygiene measures, isolation of cases, oseltamivir or zanamivir therapy to suspected or confirmed cases, and vaccination of susceptible people once the new vaccines become available are all important prevention measures.

Manifestaciones psiquiátricas relacionadas con oseltamivir / Oseltamivir-related psychiatric manifestations

Destacar la afectación en la población del nuevo virus Influenza A/H1N1 y la posibilidad terapéutica con oseltamivir. Caso clínico. Paciente de 62 años, sin antecedentes de interés, que contrajo la Gripe A, sufre un Síndrome confusional, que responde a antipsicóticos y con recuperación completa tras el episodio. Conclusiones. Establecer la posible relación entre los diversos factores que influyen en la aparición de un síndrome confusional en un paciente infectado con la gripe A que recibe tratamiento con Oseltamivir (AU)

The involvement of the new Influenza A/H1N1 virus and the treatment potential with Oseltamivir in the populationis stressed. Clinical case. A 62-year old patient, with no history of interest, who contracted Influenza A, suffered a confusional syndrome that responded to antipsychotics, with complete recovery after the episode. Conclusions. To establish the possible relationship between the various factors that affect the onset of a confusional syndrome in a patient infected with Influenza A treated with Oseltamivir (AU)

Actividad de un extracto de equinácea purpúrea frente a los virus de la influenza H1N1, H5n1 y H7N7 / Activity of an extracto f purple corneflower against the influenza virus H1N1, H5N1 and H7N7

Las infecciones producidas por los virus de la influenza (VI) representan un problema de grandes dimensiones epidemiológicas en todo el mundo. La terapia antiviral incluye vacunas y algunos medicamentos antivirales. Sin embargo no siempre se dispone de las vacunas adecuadas y los virus desarrollan resistencia a los inhibidores de la neuraminidasa como Tamiflu (oseltamivir). Se estudió la actividad antiviral de un extracto comercial estandarizado de Echinacea purpurea (Echinaforce, EF), comprobándose su capacidad para inactivar, en cultivos celulares, los virus de la influenza tipo H1N1, H1N5 y H7N7, inhibiendo la capacidad de unión del virus al receptor y su entrada en la célula. A diferencia del Tamifú, no sólo las incubaciones sucesivas con EF no desarrollan resistencias virales, si no que EF fu activo frente a los virus resistentes al oseltamivir. En conclusión, este preparado de equinácea puede constituir un complemento útil para el control de la replicación y difusión de los virus de la influenza (AU)

Infections caused by influenza virases represent a large epidemiological problema Worl wide. Antiviral therapy includes vaccines and few antiviral drugs. However vaccines are not always available in time and viruses develop resistance to neuraminidase inhibitors such as Tamiflu (oseltamivir). We studied the antiviral activity of a commercial standardized extract of Echinacea purpurea (Echinaforce, EF), that demonstrated its ability to inactivate, in cell culture, the influenza viruses H1N1, H5N1 and H7N7, inhibiting the virus binding capacity to the cell receptor and its entry into the cell. Unlike Tamiflu, not only successive incubations with EF did not develop viral resistance, but EF was active against oseltamivir-viruses. In conclusion, this preparation of Echinacea could be a useful addition for the control of replication and spread on influenza virus (AU)