Lessons From The Epidemiological Surveillance Program, During The Influenza A (h1n1) Virus Epidemic, In A Reference University Hospital Of Southeastern Brazil [lições Aprendidas Pelo Programa De Vigilância Epidemiológica, Durante A Epidemia Pelo Vírus Da Influenza A (h1n1), Em Um Hospital Universitário Na Região Sudeste Do Brasil]

Introduction: The case definition of influenza-like illness (ILI) is a powerful epidemiological tool during influenza epidemics. Methods: A prospective cohort study was conducted to evaluate the impact of two definitions used as epidemiological tools, in adults and children, during the influenza A H1N1 epidemic. Patients were included if they had upper respiratory samples tested for influenza by real-time reverse transcriptase polymerase chain reaction during two periods, using the ILI definition (coughing + temperature ≥ 38°C) in period 1, and the definition of severe acute respiratory infection (ARS) (coughing + temperature ≥ 38°C and dyspnoea) in period 2. Results: The study included 366 adults and 147 children, covering 243 cases of ILI and 270 cases of ARS. Laboratory confirmed cases of influenza were higher in adults (50%) than in children (21.6%) (p < 0.0001) and influenza infection was more prevalent in the ILI definition (53%) than ARS (24.4%) (p < 0.0001). Adults reported more chills and myalgia than children (p = 0.0001). Oseltamivir was administered in 58% and 46% of adults and children with influenza A H1N1, respectively. The influenza A H1N1 case fatality rate was 7% in adults and 8.3% in children. The mean time from onset of illness until antiviral administration was 4 days. Conclusions: The modification of ILI to ARS definition resulted in less accuracy in influenza diagnosis and did not improve the appropriate time and use of antiviral medication.444405411Dawood, F.S., Jain, S., Finelli, L., Shaw, M.W., Lindstrom, S., Emergence of a novel swineorigin influenza A (H1N1) virus in humans (2009) N Engl J Med, 360, pp. 2605-2615. , Novel swine-origin influenza A (H1N1) virus investigation team, et alPeiris, J.S., Poon, L.L., Guan, Y., Emergence of a novel swine-origin influenza A virus (S-OIV) H1N1 virus in humans (2009) J Clin Virol, 45, pp. 169-173Antigenic and genetic characteristics of swine-origin 2009 A (H1N1) influenza viruses circulating in humans (2009) Science, 325, pp. 197-201. , WHO Collaborating Center for Influenza, Centers for Disease Control and Prevention, et alSmith, G.J.D., Vijaykrishna, D., Bahl, J., Lycett, S.J., Worobey, M., Pybus, O.G., Origins and evolutionary genomics of the 2009 swine-origin H1N1 influenza A epidemic (2009) Nature, 450, pp. 1122-1126Oliveira, W.K., Penna, G., Kuchenbecker, R., Santos, H., Araujo, W., (2009) Pandemic H1N1 Influenza in Brazil: Analysis of the First 34,506 Notified Cases of Influenza-like Illness with Severe Acute Respiratory Infection (SARI), , http://www.eurosurveillance.org/viewarticle.aspx?articleid=19362/, Surveillance Team for the pandemic influenza A(H1N1) 2009 in the Ministry of Health, et al, Euro Surveill, Available fromBerts, R.F., Flu virus (1995) Principles and Practice of Infectious Diseases, pp. 1546-1567. , In: Mandell GL, Bennett JE, Dolin R, editors, 4th ed. New York: Churchill LivingstoneBoivin, G., Hardy, I., Tellier, G., Maziade, J., Predicting flu infections during epidemics with the use of a clinical definition (2000) Clin Infect Dis, 31, pp. 1166-1169Monto, A.S., Gravenstein, S., Elliott, M., Colopy, M., Schweinle, J., Clinical signs and symptoms predicting influenza infection (2000) Arch Int Med, 160, pp. 3243-3247Ong, A.K., Chen, M.I., Lin, L., Tan, A.S., Nwe, N.W., Barkham, T., A comparative analysis of new influenza A (H1N1) cases (2009) PlosONE, 4, pp. e8453. , Improving the clinical diagnosis of influenzaChan, M.C., Chan, R.W., Yu, W.C., Ho, C.C., Yuen, K.M., Fong, J.H., Tropism and innate host responses of the 2009 pandemic H1N1 influenza virus in ex vivo and in vitro cultures of human conjunctiva and respiratory tract (2010) Am J Pathol, 176, pp. 1828-1840O'Riordan, S., Barton, M., Yau, Y., Read, S.E., Allen, U., Tran, D., Risk factors and outcomes among children admitted to hospital with pandemic H1N1 influenza (2010) CMAJ, 182, pp. 39-44Babcock, H.M., Merz, L.R., Fraser, V.J., Is influenza an influenza-like illness? Clinical presentation of influenza in hospitalized patients (2006) Infect Control Hosp Epidemiol, 27, pp. 266-270Kelly, H., Birch, C., The causes and diagnosis of influenza-like illness (2004) Aust Family Physician, 33, pp. 305-309Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection (2010) N Engl J Med, 362, pp. 1708-1719. , Writing Committee of the WHO consultation on Clinical Aspects of Pandemic (H1N1) 2009 InfluenzaPresanis, A.M., de Angelis, D., Hagy, A., Reed, C., Riley, S., The severity of pandemic H1N1 influenza in the United States from April to July 2009: A Bayesian analysis (2009) PLoS Med, 6, pp. e1000207. , New York City Swine Flu Investigation TeamDonaldson, L.J., Rutter, P.D., Ellis, B.M., Greaves, F.E., Mytton, O.T., Pebody, R.G., Mortality from pandemic A/H1N1 2009 influenza in England: Public health surveillance study (2009) BMJ, 339, pp. b5213(2010), http://portal.salud.gov.mx/contenidos/noticias/influenza/estadisticas.html/, Secretaria de Salud Mexico. Estadísticas [Internet]. Assessed in October, [cited 2011 Feb 15]. Available fromEchavarría, M., Querci, M., Marcone, D., Videla, C., Martinez, A., Bonvehi, P., Pandemic (H1N1) 2009 cases, Buenos Aires, Argentina (2010) Emerg Infect Dis, 16, pp. 311-313Uyeki, T., Diagnostic testing for 2009 pandemic influenza A (H1N1) virus infection in hospitalized patients (2009) N Engl J Med, 361, pp. e114Blyth, C.C., Iredell, J.R., Dwyer, D.E., Rapid-test sensitivity for novel swine-origin influenza A (H1N1) virus in humans (2009) N Engl J Med, 361, p. 25Lee, N., Chan, P.K., Hui, D.S., Rainer, T.H., Wong, E., Choi, K.W., Viral loads and duration of viral shedding in adult patients hospitalized with influenza (2009) J Infect Dis, 200, pp. 492-500Chang, Y.S., van Hal, S.J., Spencer, P.M., Gosbell, I.B., Collett, P.W., Comparison of adult patients hospitalized with pandemic (H1N1) 2009 influenza and seasonal influenza during the "PROJECT" phase of the pandemic response (2010) Med J Aust, 192, pp. 90-93Shieh, W., Blau, D.M., Denison, A.M., Deleon-Carnes, M., Adem, P., Bhatnagar, J., 2009 pandemic influenza A (H1N1): Pathology and pathogenesis of 100 fatal cases in the United States (2010) Am J Pathol, 177, pp. 166-17

Clinical Evaluation And Hepatic Laboratory Assessment In Individuals With Congestive Heart Failure [avaliação Clínica E Laboratorial Hepática Em Indivíduos Com Insuficiência Cardíaca Congestiva]

Objectives: To verify the clinical alterations and, in particular, hepatic laboratory alterations in patients in each of the heart failure (HE) functional classes. Methods: The clinical and laboratory data - alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (AP), gamma-glutamyl transpeptidase (GGT), bilirubin and coagulogram - of 50 patients admitted in 2002 to a tertiary hospital with the diagnosis of heart failure were researched by means of a cross sectional study. The patients were separated in accordance with their HF class and their data were compared statistically. Patients with hepatopathy of any etiology were excluded. Results: Analysis of the mean transaminase values revealed a significant increase only for the Class IV patients. On the other hand, alkaline phosphatase and GGT presented a progressive increase in accordance with the HF class. Conclusion: HF is characterized by a progressive cholestatic profile of laboratory alterations, while transaminase values are only elevated in advanced HF. It is of utmost importance to understand these alterations in order to avoid unnecessary hepatic investigations in individuals with heart failure.885590595Naschitz, J.E., Slobodin, G., Lewis, R.J., Zuckerman, E., Yeshurun, D., Heart diseases affecting the liver and liver diseases affecting the heart (2000) Am Heart J, 1, p. 140Ridruejo, E., Laurini, J., Cingolani, O., Fulminant hepatic failure. Atypical form of cardiac failure presentation (2000) Medicina (B. Aires), 4 (60), pp. 491-494Bailey, R.W., Brengman, M.L., Fuh, K.C., Hamilton, S.R., Herlong, H.F., Bulkley, G.B., Hemodynamic pathogenesis of ischemic hepatic injury following cardiogenic shock/resuscitation (2000) Shock, 4 (14), pp. 451-459Vilas-Boas, F., Monachini, M.C., Farias, A., Kopel, L., Lage, S.G., Pileggi, F., Acute liver failure secondary to cardiogenic shock in patients with congestive heart failure (1994) Arq Bras Cardiol, 6 (62), pp. 427-430Rodriguez-Artalejo, F., Banegas Banegas, J.R., Guallar-Castillon, P., Epidemiology of heart failure (2004) Rev Esp Cardiol, 57 (2), pp. 161-162Cox, R.A., Torres, C.Z., Acute heart failure in adults (2004) P R Health Sci J, 23 (4), pp. 265-271Kay, J.D., Colan, S.D., Graham, T.P., Congestive heart failure in pediatric patients (2001) Am Heart J, 142 (5), pp. 923-927Biondi-Zoccai, G.G., Baldi, A., Biasucci, L.M., Abbate, A., Female gender, myocardial remodeling and cardiac failure: Are women protected from increased myocardiocyte apoptosis? (2004) Ital Heart J, 5 (7), pp. 498-504Lund, L.H., Mancini, D., Heart failure in women (2004) Med Clin North Am, 88 (5), pp. 1321-1345Regitz-Zagrosek, V., Cardiovascular disease in postmenopausal women (2003) Climacteric, 6 (3), pp. 13-20Tendera, M., The epidemiology of heart failure (2004) J Renin Angiotensin Aldosterone Syst, 5 (SUPPL. 1), pp. S2-S6Mesquita, E.T., Heart failure in Brazil. The EPICA-Niteroi study (2004) Rev Port Cardiol, 23 (3), pp. 25-30Kubo, S.H., Walter, B.A., John, D.H., Clark, M., Cody, R.J., Liver function abnormalities in chronic heart failure. Influence of systemic hemodynamics (1987) Arch Intern Med, 147 (7), pp. 1227-1230Lau, G.T., Tan, H.C., Kritharides, L., Type of liver dysfunction in heart failure and its relation to the severity of tricuspid regurgitation (2002) Am J Cardiol, 90, pp. 1405-1409Cogger, V.C., Fraser, R., LeCouteur, D.G., Liver dysfunction and heart failure (2003) Am J Cardiol, 91, p. 139