Efficacy of oseltamivir compared with zanamivir in COPD patients with seasonal influenza virus infection: a randomized controlled trial

Influenza viruses exacerbate chronic obstructive pulmonary disease (COPD) with considerable morbidity and mortality. Zanamivir and oseltamivir are effective in treating influenza. However, their efficacy in relieving influenza symptoms in COPD patients remains unknown, with the lack of controlled trials in this subject. Therefore, we conducted this randomized controlled trial to investigate the clinical efficacy of both interventions in this population. Patients were allocated to two groups (80 patients each): oseltamivir (OSELTA) and zanamivir (ZANA) groups. Oseltamivir (75 mg) was orally administered twice daily for 5 days, while zanamivir (10 mg) was inhaled twice daily for 5 days. Clinical parameters including body temperature, influenza symptoms (i.e., sore throat, cough, etc.), and serial blood tests were recorded on days 1, 3, and 7. We analyzed primary (changes in body temperature) and secondary outcomes (changes in non-specific symptoms) using the pre-protocol and intention-to-treat analyses. Differences between groups were assessed using t-test. Oseltamivir and zanamivir significantly reduced body temperature on the 3rd day after treatment; however, the number of patients who reported clinical improvement in influenza-like symptoms was significantly higher in the OSELTA group compared to the ZANA group on days 3 (85 vs 68.8%, P=0.015) and 7 (97.5 vs 83.8%, P=0.003). However, no significant changes in hematological (white blood cells and its subtypes) and inflammatory (C-reactive protein) parameters were noted (P>0.05). Our results suggested that oseltamivir and zanamivir are effective in reducing body temperature, while oseltamivir led to better clinical improvement regarding influenza-like symptoms in patients with COPD.

Fármacos utilizados no tratamento do COVID-19 em pediatria: revisão integrativa / Drugs used for COVID ­19 treatment in pediatrics: an integrative review

A pandemia causada pelo novo coronavírus (2019-nCoV) tem causado milhares de mortes, sendo buscadas vacinas ou tratamentos específicos. Crianças não têm apresentado alta gravidade. Pretendeu-se identificar tratamentos disponíveis para a pediatria. Realizou-se revisão bibliográfica integrativa, incluindo estudos publicados entre o período de 1º de Janeiro e 24 de Abril de 2020, utilizando-se as palavras-chave: 2019-nCOV; COVID-19; SARS-CoV-2 e Pediatrics. Foram pesquisados os bancos de dados PubMed, Periódicos CAPES, Science Direct, Scielo, Biblioteca Virtual em Saúde e Lilacs. Um total de 10 artigos foram considerados elegíveis. Entre as principais classes terapêuticas citadas estavam os antivirais lopinavir/ritonavir, oseltamivir, o uso do interferon e de imunoglobulinas. Quase todos os tratamentos mencionados foram considerados potencialmente eficazes contra o COVID-19, no entanto ensaios clínicos são necessários para tal confirmação visto que há poucos estudos e que o uso dos medicamentos mencionados se encontra baseado no tratamento de outras doenças respiratória.(AU)

The pandemic caused by the new coronavirus (2019-nCoV) has been causing thousands of deaths, being searched vaccines or specific treatments. Children havenot shown high severity. The aim of this article was to identify available treatments for children. An integrative review of studies recently published between January 1st and April 24th of 2020 was carried out, using the keywords: 2019-nCOV; COVID-19; SARS-CoV-2 and pediatrics. The PubMed, Períodicos CAPES, Science Direct, Scielo, Biblioteca Virtual em Saúde and Lilacs databases were searched. A total of 10 articles were considered eligible. Among the main therapeutic classes cited were antivirals lopinavir/ritonavir, oseltamivir, the use of interferon and immunoglobulins. Almost all the treatments mentioned were considered to be potentially effective against COVID-19, however clinical trials are necessary for such confirmation since there are few studies and the use of the mentioned drugs is based on the treatment of other respiratory diseases.(AU)

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)

Influenza pandêmica A (H1N1) 2009: fatores de risco para o internamento / Pandemic influenza A (H1N1) 2009: risk factors for hospitalization

OBJETIVO: Avaliar os aspectos da influenza pandêmica A (H1N1) 2009 em pacientes hospitalizados a fim de identificar os fatores de risco para o internamento e, consequentemente, para o agravamento da doença. MÉTODOS: Estudo observacional e retrospectivo realizado entre março e dezembro de 2010. Os dados foram coletados a partir do Sistema Nacional de Agravos de Notificação do Ministério da Saúde. Foram incluídos somente os pacientes hospitalizados e não hospitalizados com confirmação laboratorial da infecção durante o período de estudo. As variáveis referentes às características demográficas e clínicas foram avaliadas estatisticamente a fim de comparar as taxas de internamento na presença ou na ausência desses fatores. Os fatores de risco foram identificados por regressão logística. RESULTADOS: Foram incluídos no estudo 4.740 pacientes com confirmação laboratorial da infecção. Desses, 1.911 foram internados, e 258 (13,5 por cento) foram a óbito. Os fatores de risco para o internamento foram idade (faixa etária de 20 a 29 anos), etnia negra ou indígena, presença de algumas comorbidades (cardiopatias, pneumopatias, nefropatias, hemoglobinopatia, imunodepressão, diabetes, obesidade, puerpério e tabagismo), número alto de comorbidades associadas, e alguns sintomas (dispneia, diarreia, vômito, dor torácica, hemoptise, pneumonia e sibilos). Níveis maiores de escolaridade e uso precoce do oseltamivir foram relacionados a fatores de proteção. A hospitalização contribuiu para o aumento da sobrevida. CONCLUSÕES: O conhecimento das características epidemiológicas que podem estar associadas a internação, gravidade da doença e mortalidade podem ser úteis na adoção de medidas preventivas e no diagnóstico e tratamento precoce da doença, colaborando para a diminuição dos óbitos e da necessidade de hospitalização.

OBJECTIVE: To evaluate pandemic influenza A (H1N1) 2009 in hospitalized patients in order to identify risk factors for hospitalization and, consequently, for the worsening of the disease. METHODS: This retrospective observational study was conducted between March and December of 2010. The data were collected from the Brazilian Ministry of Health National Case Registry Database. We included only patients (inpatients and outpatients) in whom H1N1 infection was confirmed (via laboratory testing) during the study period. The variables regarding demographic and clinical characteristics were statistically evaluated in order to compare the hospitalization rates in the presence or absence of these factors. Risk factors were identified by logistic regression analysis. RESULTS: We included 4,740 patients with laboratory confirmation of H1N1 infection. Of these, 1,911 individuals were hospitalized, and 258 (13.5 percent) died. The risk factors for hospitalization were age (20-29 years), African or Indigenous ethnicity, presence of specific comorbidities (heart disease, lung disease, kidney disease, hemoglobinopathy, immunosuppression, diabetes, obesity, puerperium, and smoking), a high number of comorbidities, and specific symptoms (dyspnea, diarrhea, vomiting, chest pain, hemoptysis, pneumonia, and wheezing). Higher levels of education and early use of oseltamivir were found to be protective factors. Hospitalization contributed to an increase in survival. CONCLUSIONS: Knowledge of the epidemiological characteristics that can be associated with hospitalization, disease severity, and mortality can be helpful in the adoption of preventive measures, as well as in the early diagnosis and treatment of disease, which might contribute to the reduction in the numbers of hospitalizations and deaths.

Influenza pandémica a un año de la primera ola: ¿qué podemos decir ahora? / Pandemic influenza one year after the first wave: what did we learn?

During year 2009 our nation experimented the first influenza pandemic wave due to the novel influenza A (H1N1) 2009 virus that emerged in the Northern hemisphere at the end of April, 2009. Estimated attack rate was about 6 to 12 percent affecting mainly to schoolchildren who presented with a mild disease. Age groups with highest risk of hospitalization were elderly people and children under 5 years old. Elderly patients and patients with co-morbidities had the highest risk to die. We have learnt that clinical diagnosis of influenza has a laboratory confirmation in about 80 percent of cases but its correlation is lower in kids under 5 years old, especially in infants when RSV co-circulates with influenza virus. Laboratory diagnostic methods like DFA and immuno-cromatography have about 80 percent of sensitivity but a significantly lower rate in elderly patients compared to PCR. The clinical impact of this new virus justifies the recommendation to vaccinate traditionally established risk groups and to prescribe antiviral treatment to patients that acquire severe influenza or have risk factors to progress to complications.

Durante el año 2009 nuestro país vivió la primera ola pandémica causada por el nuevo virus de influenza A (H1N1) 2009 aparecido en el hemisferio norte a fines de abril del ese año. La tasa de ataque estimada fue entre 6 a 12 por ciento afectando más frecuentemente a los escolares quienes presentaron una enfermedad leve. Los grupos etáreos con mayor riesgo de hospitalización fueron los adultos mayores y los niños bajo 5 años de edad. Tuvieron mayor riesgo de fallecer los adultos mayores y aquellas personas con una co-morbilidad asociada. Aprendimos que el diagnóstico clínico de influenza se confirma por laboratorio en alrededor del 80 por ciento pero tiene una baja correlación en los niños bajo 5 años de edad, especialmente en lactantes bajo 1 año de edad, al circular concomitantemente con VRS. Los métodos de diagnóstico como la IFD y los inmunocromatográficos tienen una sensibilidad que no supera el 80 por ciento y es muy baja en los adultos mayores cuando se compara con PCR. Dado el impacto clínico de este nuevo virus se justifica el uso de vacunación en los grupos de riesgo previamente descritos y el tratamiento con antivirales en los pacientes que cursan con enfermedad grave o con riesgo de evolucionar a una enfermedad más complicada.