Individual and contextual factors associated with the survival of patients with severe acute respiratory syndrome by COVID-19 in Brazil.

OBJECTIVE: To analyze the influence of individual and contextual factors of the hospital and the municipality of care on the survival of patients with Severe Acute Respiratory Syndrome due to COVID-19. METHODS: Hospital cohort study with data from 159,948 adults and elderly with Severe Acute Respiratory Syndrome due to COVID-19 hospitalized from January 1 to December 31, 2022 and reported in the Influenza Epidemiological Surveillance Information System. The contextual variables were related to the structure, professionals and equipment of the hospital establishments and socioeconomic and health indicators of the municipalities. The outcome was hospital survival up to 90 days. Survival tree and Kaplan-Meier curves were used for survival analysis. RESULTS: Hospital lethality was 30.4%. Elderly patients who underwent invasive mechanical ventilation and were hospitalized in cities with low tax collection rates had lower survival rates compared to other groups identified in the survival tree (p<0.001). CONCLUSION: The study indicated the interaction of contextual factors with the individual ones, and it shows that hospital and municipal characteristics increase the risk of death, highlighting the attention to the organization, operation, and performance of the hospital network.

Vacunación en el embarazo. Documento de consenso del CAV-AEP y la SEGO / Vaccination in pregnancy. Consensus document of the CAV-AEP and the SEGO

Durante el embarazo, los cambios fisiológicos en la respuesta inmunitaria favorecen que las gestantes sean más susceptibles a infecciones graves, tanto para ellas como para el feto, el recién nacido y el lactante. Todas las mujeres deberían entrar en el período reproductivo con su calendario vacunal correctamente cumplimentado, sobre todo en lo que respecta a enfermedades como tétanos, hepatitisB, sarampión, rubeola y varicela. Además de las vacunas recomendadas, en situaciones de riesgo las vacunas inactivadas podrían ser administradas en aquellas mujeres que no estuvieran correctamente inmunizadas con anterioridad, mientras que las atenuadas están contraindicadas.A pesar de que la vacunación durante el embarazo es una medida preventiva muy importante, y de las recomendaciones de autoridades sanitarias, sociedades científicas y profesionales sanitarios, las coberturas vacunales son claramente mejorables, especialmente en lo que respecta a gripe y COVID-19, por lo que todo profesional sanitario que atienda a la embarazada debe ser proactivo en aconsejarlas.La Asociación Española de Pediatría (AEP), a través de su Comité Asesor de Vacunas (CAV), y la Sociedad Española de Ginecología y Obstetricia (SEGO) recomiendan las siguientes vacunaciones durante la gestación: frente a gripe y COVID-19, en cualquier trimestre del embarazo, y durante el puerperio (hasta los 6meses) en aquellas que no hubieran sido vacunadas durante la gestación; frente a tosferina con Tdpa, entre las 27 y 36 semanas de gestación (el CAV-AEP da preferencia entre las 27 y 28 semanas); y frente al VRS con RSVPreF, entre las 24 y 36 semanas de gestación, de preferencia entre las 32 y 36 semanas. (AU)

During pregnancy, physiological changes in the immune response make pregnant women more susceptible to serious infection, increasing the risk for the mother as well as the foetus, newborn and infant. All women should be correctly and fully vaccinated as they enter their reproductive years, especially against diseases such as tetanus, hepatitisB, measles, rubella and varicella. In addition to the recommended vaccines, in risk situations, inactivated vaccines could be administered to women who were not correctly vaccinated before, while attenuated vaccines are contraindicated.Despite the fact that vaccination during pregnancy is a very important preventive measure and the existing recommendations from public health authorities, scientific societies and health professionals, the vaccination coverage could clearly be improved, especially against influenza and SARS-CoV-2, so any health professional involved in the care of pregnant women should proactively recommend these vaccines.The Spanish Association of Pediatrics (AEP), through its Advisory Committee on Vaccines (CAV), and the Spanish Society of Gynaecology and Obstetrics (SEGO) recommend vaccination against the following diseases during pregnancy: against influenza and COVID-19, in any trimester of pregnancy and during the postpartum period (up to 6months post birth) in women not vaccinated during pregnancy; against pertussis, with the Tdap vaccine, between weeks 27 and 36 of gestation (in the CAV-AEP recommendations, preferably between weeks 27 and 28); and against RSV, with RSVPreF, between weeks 24 and 36 of gestation, preferably between weeks 32 and 36. (AU)

Virus removal by high-efficiency air (HEPA) filters and filtration capacity enhancement by nanotextiles: a pilot study.

Portable household air purifiers are widely used devices designed to maintain a high-quality level of indoor air. Portable air purifiers equipped with the high-efficiency air (HEPA) filter served 100 h in a household space occupied by two adults without any symptoms of respiratory tract infection. The main objective of the study was to determine microbial contamination on the HEPA filter and to investigate if the selected nanotextile monolayer made of polyamide 6 (PA6) nanofibers can capture potential microorganisms when installed downstream of the HEPA filter as the final filtration medium. Samples were taken from the inlet and outlet surfaces. Samples from the nanotextile were collected in the same manner as from the HEPA filter. QIAStat DX® 1.0 Analyzer using the Respiratory SARS CoV-2 Panel multiplex PCR detection system was selected for microorganism detection. Adenovirus was detected on the inlet surface of the HEPA filter. The outlet surface of the filter contained no viruses included in the Respiratory SARS CoV-2 Panel portfolio. The nanotextile monolayer was replaced twice during the 100 h of operation, so three pieces were used and all contained coronavirus 229 E. Coronavirus 229 E was then detected in the nasopharynx of one of the members of the household as well. It may be assumed that the selected nanotextile is capable of capturing a virus of a small size.

Multimerization of the heptad repeat regions of the SARS-CoV 2 spike protein.

The heptad repeat 1 and 2 (HR1, HR2) regions in the spike protein of SARS-CoV 2 play a key role in the fusogenic mechanism of the virus with the host cell. During the fusion process they are thought to rearrange into an interdomain multimer. Functional fragments of the heptad repeat 1 and 2 regions in the spike protein of SARS-CoV 2 were chemically synthesized, labeled with nitrofurazone (NBD) and their interactions investigated by fluorescence spectroscopy. Steady state emission, fluorescence quenching, anisotropy and lifetime measurements in combination with a fluorophore dilution scheme were used to dissect multimer formation of HR1 and HR2 in quantitative detail. In addition, the investigation of the multimers by homo-FRET (via anisotropy) and lifetime measurements reveals new insights into the mechanism of fluorophore-fluorophore interactions in biological samples.

Knowledge, attitude, and practice regarding COVID-19 skin manifestations among doctors working at Khartoum dermatology and venereology teaching Hospital, 2021

Background: COVID-19 is a global pandemic caused by SARS_COV2. The symptoms of covid-19 include: fever, dyspnea, fatigue, a recent loss of smell and taste, sore throat, cough, and cutaneous lesions. In addition, some skin manifestations were reported to be associated with COVID-19. Methods: The study design is a descriptive cross-sectional hospital-based study. The study aimed to evaluate the level of knowledge and practice about skin manifestations of COVID-19 among doctors working at Khartoum dermatology and venereology teaching hospital. A self-administrated questionnaire was used for data collection after an informed consent was taken. Results: Among 140 doctors working in the dermatology and venereology teaching hospital, 75.7% of the doctors had knowledge that COVID-19 can present with skin manifestations. The study results showed that about half of the participants have poor knowledge about COVID-19 skin manifestations while 25% have no knowledge, and that 35 (25%) doctors have good knowledge. From a total of 140 doctors; 46.4% reported that when patients present with COVID-19 skin lesions, they will isolate them in separate rooms and call the epidemiology center, whereas, 61 doctors (43.6%) did not know if they have a protocol for COVID-19 suspected cases. This study reported a significant association between job category and level of knowledge toward COVID-19 skin manifestations measured by Chi-square test, the P-value was 0.003 (significant at 0.05), and the same significant association was found between the year of rotation and knowledge. Conclusion: Half of the doctors covered by this study had poor knowledge about COVID-19 skin manifestations, and therefore, educating doctors in dermatology hospitals about skin manifestations of COVID-19 is recommended, besides clear and precise guidelines and protocols for diagnosis and management.

Comparative analysis of Respiratory Syncytial Virus frequency rates and viral load in different patient cohorts in a University Hospital in São Paulo, Brazil, over an eight-year period (2005-2013).

Respiratory Syncytial Virus (RSV) poses a global health concern, particularly affecting young children, the elderly, and immunosuppressed individuals. RSV viral load is essential for understanding transmission, disease severity, prevention, and treatment. This retrospective study aimed to analyze the frequency rates and viral loads of RSV infections in different patient cohorts and age groups over an eight-year period in a university hospital in São Paulo, Brazil. This study analyzed 1380 Immunocompetent (IC) and Immunosuppressed (IS) patients with acute respiratory tract infections. IC included patients with chronic Heart Disease (HD), Primary Care service recipients (PC), and a subgroup suspected of having Severe Acute Respiratory Syndrome caused by Influenza A (H1N1)pdm09 virus (SARS H1N1). IS comprised transplant patients and those with HIV infection. Respiratory samples were collected between February 2005 and October 2013, with RSV detection and viral load quantification (Log10 copies of RNA/mL) using RT-qPCR. Overall RSV infection rate was 17.3 %, with higher rates in children (23.9 %) than in adults (12.9 %), particularly in children under two years of age (28.2 %). Children in the SARS H1N1 and PC subgroups had higher infection rates (16.4 % and 34.9 %, respectively), with the highest rate in PC children aged 1 to < 2 years (45.45 %). Adults with HD had a significantly higher frequency rate (27.83 %) than those in the SARS H1N1 (2.65 %) and IS (15.16 %) subgroups and higher hospitalization rate among adults under 65 years. RSV viral load ranged from 2.43 to 10.15 Log10 RNA copies/mL (mean ± SD 5.82 ± 2.19), with hospitalized patients exhibiting significantly higher viral loads (7.34 ± 1.9) than outpatients (4.38 ± 1.89). Elderly bone marrow transplant patients also had significantly higher viral loads (7.57 ± 2.41) than younger adults (5.12 ± 1.87). This study provides insights into the RSV infection patterns in different patient cohorts in Brazil. Further investigations are needed to understand susceptibility and risk factors associated with RSV infection. In conclusion, high RSV viral load among hospitalized patients could serve as a surrogate marker of disease severity. Additionally, patients with chronic heart disease deserve greater attention regarding complications associated with RSV infection.

Development, Histological, and Ultrastructural Evaluation of Sheep Hyperimmune Serum Therapy for COVID-19 / Desarrollo, Evaluación Histológica y Ultraestructural de la Terapia con Suero Hiperinmune de Oveja para COVID-19

SUMMARY: In response to the threat posed by new variants of SARS-CoV-2 and the urgent need for effective treatments in the absence of vaccines, the aim of this study was to develop a rapid and cost-effective hyperimmune serum (HS) derived from sheep and assess its efficacy. The utilization of a halal-certified, easily maintained in certain geographic regions, easy-to-handle animal such as sheep could provide a viable alternative to the expensive option of horses. Sheep were immunized with a whole inactivated SARS-CoV- 2 antigen to produce HS, which was evaluated for neutralizing potency using the PRNT50 assay. K18-hACE2 transgenic mice (n=35) were divided into three groups: control, SARS-CoV-2 exposure through inhalation, and SARS-CoV-2 exposed mice treated with HS. HS efficacy was assessed through serum proinflammatory cytokine levels, qRT-PCR analysis, histopathological examination of lungs and hearts, and transmission electron microscopy. Purified HS exhibited significant neutralizing activity (1/24,576). The SARS-CoV-2+HS group showed lower levels of TNF-α, IL-10, and IL-6 (P<0.01) and relatively lower levels of MCP-1 compared to the SARS-CoV-2 group. HS prevented death, reduced viral RNA levels in the lungs and hearts, protected against severe interstitial pneumonia, preserved lung tissue integrity, and prevented myocyte damage, while the SARS-CoV-2 group exhibited viral presence in the lungs. This study successfully developed a sheep-derived HS against the entire SARS-CoV-2 virus, resulting in a significant reduction in infection severity, inflammation, and systemic cytokine production. The findings hold promise for treating severe COVID-19 cases, including emerging viral variants, and immunocompromised patients.

En respuesta a la amenaza que suponen las nuevas variantes del SARS-CoV-2 y la urgente necesidad de tratamientos eficaces en ausencia de vacunas, el objetivo de este estudio fue desarrollar un suero hiperinmune (HS) rápido y rentable derivado de ovejas. y evaluar su eficacia. La utilización de un animal con certificación halal, de fácil mantenimiento en determinadas regiones geográficas y de fácil manejo, como las ovejas, podría proporcionar una alternativa viable a la costosa opción de los caballos. Las ovejas fueron inmunizadas con un antígeno de SARS-CoV-2 completamente inactivado para producir HS, cuya potencia neutralizante se evaluó mediante el ensayo PRNT50. Los ratones transgénicos K18-hACE2 (n = 35) se dividieron en tres grupos: control, exposición al SARS-CoV-2 mediante inhalación y ratones expuestos al SARS-CoV-2 tratados con HS. La eficacia de HS se evaluó mediante niveles de citoquinas proinflamatorias en suero, análisis qRT-PCR, examen histopatológico de pulmones y corazones y microscopía electrónica de transmisión. El HS purificado exhibió una actividad neutralizante significativa (1/24,576). El grupo SARS-CoV-2+HS mostró niveles más bajos de TNF-α, IL-10 e IL-6 (P<0,01) y niveles relativamente más bajos de MCP-1 en comparación con el grupo SARS-CoV-2. HS evitó la muerte, redujo los niveles de ARN viral en los pulmones y el corazón, protegió contra la neumonía intersticial grave, preservó la integridad del tejido pulmonar y evitó el daño de los miocitos, mientras que el grupo SARS-CoV-2 exhibió presencia viral en los pulmones. Este estudio desarrolló con éxito un HS derivado de ovejas contra todo el virus SARS-CoV-2, lo que resultó en una reducción significativa de la gravedad de la infección, la inflamación y la producción sistémica de citocinas. Los hallazgos son prometedores para el tratamiento de casos graves de COVID- 19, incluidas las variantes virales emergentes y los pacientes inmunocomprometidos.

Boletim Epidemiológico Síndrome Gripal: monitoramento de Vírus Respiratórios ano 2023 nº 26

Os objetivos da vigilância sentinela de Síndrome Gripal é acompanhar a circulação de vírus respiratórios identificados nas unidades sentinela e identificar prontamente novos subtipos virais circulantes.

Boletim Epidemiológico Síndrome Gripal: monitoramento de Vírus Respiratórios ano 2023 nº 27

Os objetivos da vigilância sentinela de Síndrome Gripal é acompanhar a circulação de vírus respiratórios identificados nas unidades sentinela e identificar prontamente novos subtipos virais circulantes.

Boletim Epidemiológico Síndrome Gripal: monitoramento de Vírus Respiratórios ano 2023 nº 28

Os objetivos da vigilância sentinela de Síndrome Gripal é acompanhar a circulação de vírus respiratórios identificados nas unidades sentinela e identificar prontamente novos subtipos virais circulantes.

Boletim Epidemiológico Síndrome Gripal: monitoramento de Vírus Respiratórios ano 2023 nº 29

Os objetivos da vigilância sentinela de Síndrome Gripal é acompanhar a circulação de vírus respiratórios identificados nas unidades sentinela e identificar prontamente novos subtipos virais circulantes.

Boletim Epidemiológico Síndrome Gripal: monitoramento de Vírus Respiratórios ano 2023 nº 30

Os objetivos da vigilância sentinela de Síndrome Gripal é acompanhar a circulação de vírus respiratórios identificados nas unidades sentinela e identificar prontamente novos subtipos virais circulantes.

Boletim Epidemiológico Síndrome Gripal: monitoramento de Vírus Respiratórios ano 2023 nº 31

Os objetivos da vigilância sentinela de Síndrome Gripal é acompanhar a circulação de vírus respiratórios identificados nas unidades sentinela e identificar prontamente novos subtipos virais circulantes.

Boletim Epidemiológico Síndrome Gripal: monitoramento de Vírus Respiratórios ano 2023 nº 32

Os objetivos da vigilância sentinela de Síndrome Gripal é acompanhar a circulação de vírus respiratórios identificados nas unidades sentinela e identificar prontamente novos subtipos virais circulantes.

Boletim Epidemiológico Síndrome Gripal: monitoramento de Vírus Respiratórios ano 2023 nº 33

Os objetivos da vigilância sentinela de Síndrome Gripal é acompanhar a circulação de vírus respiratórios identificados nas unidades sentinela e identificar prontamente novos subtipos virais circulantes.

Boletim Epidemiológico Síndrome Gripal: monitoramento de Vírus Respiratórios ano 2023 nº 34

Os objetivos da vigilância sentinela de Síndrome Gripal é acompanhar a circulação de vírus respiratórios identificados nas unidades sentinela e identificar prontamente novos subtipos virais circulantes.

Boletim Epidemiológico Síndrome Gripal: monitoramento de Vírus Respiratórios ano 2023 nº 35

Os objetivos da vigilância sentinela de Síndrome Gripal é acompanhar a circulação de vírus respiratórios identificados nas unidades sentinela e identificar prontamente novos subtipos virais circulantes.

Boletim Epidemiológico Síndrome Gripal: monitoramento de Vírus Respiratórios ano 2023 nº 36

Os objetivos da vigilância sentinela de Síndrome Gripal é acompanhar a circulação de vírus respiratórios identificados nas unidades sentinela e identificar prontamente novos subtipos virais circulantes.

Boletim Epidemiológico Síndrome Gripal: monitoramento de Vírus Respiratórios ano 2023 nº 37

Os objetivos da vigilância sentinela de Síndrome Gripal é acompanhar a circulação de vírus respiratórios identificados nas unidades sentinela e identificar prontamente novos subtipos virais circulantes.

Boletim Epidemiológico Síndrome Gripal: monitoramento de Vírus Respiratórios ano 2023 nº 38

Os objetivos da vigilância sentinela de Síndrome Gripal é acompanhar a circulação de vírus respiratórios identificados nas unidades sentinela e identificar prontamente novos subtipos virais circulantes.