Influenza epidemics occur worldwide annually. The incidence of influenza shows a seasonal pattern in temperate areas, but little is known about influenza seasonality in tropical regions. The objective of this study was to determine the prevalence and the seasonal pattern of influenza infections in children living in the city of Fortaleza in northeastern Brazil. An indirect immunofluorescence assay was performed on nasopharyngeal aspirates collected from children attending in ambulatories, emergency rooms, and wards of the Hospital Infantil Albert Sabin with suspicion of acute respiratory infection during 7 consecutive years (2001-2007). Influenza viruses were detected in 6.3% (234/3,708) of specimens. Laboratory-based surveillance data showed a clear annual epidemic cycle of influenza, with a peak usually occurring in the rainy periods. In Fortaleza, flu infections occurred at a low level throughout the year but exhibit a marked seasonal increase during the rainy season.

The involvement of the central nervous system in dengue infections has been reported in countries where the disease in endemic. The purpose of this study was to determine whether an enzyme-linked immunosorbent assay kit designed to detect the dengue NS1 antigen in serum was able to detect this antigen in cerebral spinal fluid (CSF) samples from patients with fatal outcomes. To evaluate the sensitivity of the kit, 26 dengue-positive CSF samples were used. The Pan-E Dengue Early kit was able to detect the NS1 antigen in 13 of 26 dengue-positive CSF samples, resulting in a sensitivity of 50% (95% confidence interval, 29.9-70.1%) and specificity of 100% (95% confidence interval, 75.3-100%). The kit was able to detect the NS1 antigen in CSF of individuals who had died of dengue. When used in combination with IgM, the detection rate rose to 92.3%. This study reports a method for rapidly detecting the dengue virus in CSF, thereby increasing the diagnosis of dengue fever cases with unusual neurological manifestations.

We investigated the prevalence of dengue in patients with suspected viral meningitis/meningoencephalitis in a dengue-endemic area. Cerebrospinal fluid analysis showed positive results and a 6.74× greater likelihood of identifying positive fluid in patients who died. Our findings support testing patients with neurologic manifestations for the virus in dengue-endemic areas.

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We report on four patients with fatal influenza A(H1N1)pdm09 and dengue virus coinfections. Clinical, necropsy and histopathologic findings presented in all cases were characteristic of influenza-dengue coinfections, and all were laboratory-confirmed for both infections. The possibility of influenza and dengue coinfection should be considered in locations where these two viruses’ epidemic periods coincide to avoid fatal outcomes. Dengue is a mosquito-borne viral infection caused by one of the four dengue viruses (DENV-1 to 4). Each of these viruses is capable of causing nonspecific febrile illnesses, classic dengue fever and dengue haemorrhagic fever (Gubler 1998). As a result, dengue is often difficult to diagnose clinically, especially because peak dengue season often coincides with that of other common febrile illnesses in tropical regions (Chacon et al. 2015). In April 2009, a new virus, influenza A/H1N1/pandemic (FluA/H1N1/09pdm), caused a severe outbreak in Mexico. The virus quickly spread throughout the world, and in June 2009, the World Health Organization declared a pandemic (WHO 2010). In Brazil, the first laboratory confirmed case of FluA/H1N1/09pdm was in July 2009 (Pires Neto et al. 2013). The state of Ceará, in Northeast Brazil, is a dengue endemic area. In this state, the virus influenza A(H1N1)pdm09 has circulated since 2009, and through the first half of 2012, 11 deaths caused by the virus were confirmed (Pires Neto et al. 2013). The influenza and dengue seasons in Ceará overlap, which led to diagnostic difficulties. We report four cases of laboratory-confirmed coinfection of deadly influenza A(H1N1)pdm09 with DENV, which occurred during the dengue and influenza season in 2012 and 2013 in Ceará.

Introduction: In pandemic times, in which the “lockdown strategy” has been adopted, the use of innovations using technological resources such as the creation of instruments that can replace traditional teaching-learning methods in the training of health professionals is essential. Objective: the aim of this study was to develop and evaluate the usability of a realistic interactive simulation computer system using three-dimensional imaging technology and virtual reality with free-access computational tools available on the web. Methods: the development of a prototype (OSCE 3D) was based on the steps used for the construction of a “Serious Game” simulation software. The free-access version of the Unity Editor 3D platform (Unity Technologies, version 2018), used for developing educational games, the software GNU Image Manipulation Program (GIMP, version 2.10.12), Blender (version 2.79) and MakeHuman (version 1.1.1) were utilized for creating textures and building models of the 3D environments. An experimental phase was carried out to assess usability, through a questionnaire based on the System Usability Scale. The study was approved by the Research Ethics Committee of the institution and all participants signed the Informed Consent Form. Results: a total of 39 undergraduate medical students attending the 6th semester of a private university center of northeastern Brazil voluntarily participated in the evaluation of the OSCE 3D. The usability evaluation resulted in a mean score of 75.4 with a margin of error of 3.2, which is considered a good usability score according to the literature. Conclusions: this study allowed the development of a low-cost prototype, using a three-dimension realistic simulation system for clinical skills assessment. This product, even in the prototype phase, showed good usability.

Introdução: O vírus da Influenza A (H1N1) 2009 pdm tornou-se uma cepa sazonal da gripe a partir de 2010. Provoca doença leve na maioria dos pacientes e pequena proporção dos acometidos evolui para a forma grave da doença, necessitando de tratamento hospitalar e cuidados intensivos. Durante a pandemia de Influenza A (H1N1) 2009, ainda não era conhecida a patogenicidade e virulência da nova cepa. Este fato ressalta a necessidade de estudos para determinar as características epidemiológicas, clínicas e indicadores de mortalidade, especialmente nas formas graves e óbitos. Objetivo: Identificar os fatores associados à ocorrência de gravidade e óbitos durante a pandemia de Influenza A (H1N1) 2009 pdm no Ceará. Metodologia: Trata-se de uma coorte observacional, retrospectiva, dos pacientes admitidos em hospitais da capital do Ceará e detectados por meio dos casos notificados no Sistema de Informação de Agravos de Notificação (SINAN), no período pandêmico 2009-2010. Foram trabalhados os casos com diagnóstico de infecção aguda por vírus A (H1N1) por RT-PCR. Após identificado o paciente, buscou-se na unidade de hospitalização o prontuário de acompanhamento médico. Utilizou-se como instrumento para coleta de dados a APACHE II e questionário contendo dados da hospitalização, exames clínicos e laboratoriais. Após Teste Qui-quadrado, foram considerados significativos P<0,05 e IC de 95%. Resultados: Foram confirmados 40 casos graves por influenza A (H1N1) 2009 pdm, com 8 (20%) óbitos. Em 2010, os pacientes graves apresentaram duas vezes mais chances de serem internados na UTI e o percentual de óbitos foi 50% maior que em 2009. A letalidade foi 2,4 vezes maior entre os homens. Os pacientes com ensino fundamental completo tinham uma vez mais chances de evoluir para óbito que os pós-graduados. O tempo médio entre a data dos primeiros sintomas e o início do tratamento com Fosfato de Oseltamivir foi de 4,13 dias entre os que evoluíram para cura e 11 dias entre os que evoluíram para óbito (P=0,00). 72,5% (29/40) tinham algum fator associado ou comorbidade. Na admissão, 25% (10/40) dos pacientes tinham entre 11 e 50% de risco de morte e 10% (4/40) tinham injúria cerebral severa. Em relação à necessidade de cuidados intensivos, todos os aspectos estudados foram significativos. Conclusão: A procura por assistência de saúde, retardo no início da terapia antiviral e a presença de comorbidades, principalmente obesidade foram relevantes para a gravidade dos casos.

Background : In pandemic times where the “lockdown strategy” has been adopted, the use of innovations using technological resources such as the creation of instruments that can replace traditional teaching-learning methods in the training of health professionals is essential. The aim of this study was to develop and evaluate the usability of a realistic interactive simulation computer system using three-dimensional imaging technology and virtual reality with free-access computational tools available on the web. Methods : the development of a prototype (OSCE 3D) was based on the steps used for the construction of simulation software of a "Serious Game". An experimental phase was carried out to assess usability, through a questionnaire based on the System Usability Scale. The study was approved by the Research Ethics Committee of the institution and all patients signed the Informed Consent Form. Results : a total of 39 undergraduate medical students from the 6th semester of a private university center of northeast do Brazil voluntarily participated in the evaluation of the OSCE 3D. The usability evaluation presented a mean score of 75.4 with a margin of error of 3.2, considered a good usability according to the literature. Conclusions : this work allowed the development of a low-cost prototype, using a three-dimension realistic simulation system for OSCE assessment stations. This product, even in the prototype phase, showed good usability.