Neuraminidase inhibitors were widely used during the 2009-10 influenza A H1N1 pandemic, but evidence for their effectiveness in reducing mortality is uncertain. We did a meta-analysis of individual ...participant data to investigate the association between use of neuraminidase inhibitors and mortality in patients admitted to hospital with pandemic influenza A H1N1pdm09 virus infection.
We assembled data for patients (all ages) admitted to hospital worldwide with laboratory confirmed or clinically diagnosed pandemic influenza A H1N1pdm09 virus infection. We identified potential data contributors from an earlier systematic review of reported studies addressing the same research question. In our systematic review, eligible studies were done between March 1, 2009 (Mexico), or April 1, 2009 (rest of the world), until the WHO declaration of the end of the pandemic (Aug 10, 2010); however, we continued to receive data up to March 14, 2011, from ongoing studies. We did a meta-analysis of individual participant data to assess the association between neuraminidase inhibitor treatment and mortality (primary outcome), adjusting for both treatment propensity and potential confounders, using generalised linear mixed modelling. We assessed the association with time to treatment using time-dependent Cox regression shared frailty modelling.
We included data for 29,234 patients from 78 studies of patients admitted to hospital between Jan 2, 2009, and March 14, 2011. Compared with no treatment, neuraminidase inhibitor treatment (irrespective of timing) was associated with a reduction in mortality risk (adjusted odds ratio OR 0·81; 95% CI 0·70-0·93; p=0·0024). Compared with later treatment, early treatment (within 2 days of symptom onset) was associated with a reduction in mortality risk (adjusted OR 0·48; 95% CI 0·41-0·56; p<0·0001). Early treatment versus no treatment was also associated with a reduction in mortality (adjusted OR 0·50; 95% CI 0·37-0·67; p<0·0001). These associations with reduced mortality risk were less pronounced and not significant in children. There was an increase in the mortality hazard rate with each day's delay in initiation of treatment up to day 5 as compared with treatment initiated within 2 days of symptom onset (adjusted hazard ratio HR 1·23 95% CI 1·18-1·28; p<0·0001 for the increasing HR with each day's delay).
We advocate early instigation of neuraminidase inhibitor treatment in adults admitted to hospital with suspected or proven influenza infection.
F Hoffmann-La Roche.
Zbog jedinstvene farmakokinetike, odnosno kliničke učinkovitosti, jednostavnog doziranja i dobre podnošljivosti azitromicin je dvadesetak godina imao status izuzetno poželjnog antibiotika, posebno u ...liječenju akutnih respiratornih infekcija. Pojavom sve učestalije rezistencije pneumokoka na penicilin i makrolide taj je primat sada potisnut, no i danas je azitromicin vrlo važan i nezaobilazan antibiotik. Zbog neučinkovitosti beta-laktamskih antibiotika azitromicin je ostao antibiotikom prvog izbora u liječenju atipičnih pneumonija i hripavca. Također ima vrlo važnu ulogu u liječenju težih oblika pneumonija u kombinaciji s beta-laktamskim antibioticima. U liječenju bakterijskih infekcija gornjeg dijela dišnog sustava (faringitis, sinusitis, otitis media) te akutnih egzacerbacija kronične opstruktivne plućne bolesti azitromicin je alternativni izbor pri alergiji na betalaktamske antibiotike. Nova saznanja o imunomodulaciji i protuupalnom ucinku makrolida pozicionirala su uporabu azitromicina u cističnoj fibrozi i drugim kroničnim bolestima dišnog sustava.
Nakon ofenzive hrvatske i njemačke vojske na području planine Kozare u ljeto 1942. godine nastao je zbjeg s velikim brojem izgladnjele i bolesne djece. Kad je slomljen otpor partizanskih snaga, veće ...skupine djece iz zbjega privremeno su smještane u nekoliko prihvatnih centara (logor Stara Gradiška, sabirališta u selima Mlaka, Jablanac, Uštica i drugdje), a zatim su, bez prethodnih priprema, prevezene u različita prihvatilišta s ciljem pružanja pomoći i zdravstvene skrbi te su potom udomljavana u obitelji. U organizaciji zbrinjavanja djece presudna je bila uloga države, a iz dostupnih dokumenata jasno se razabire da je djeci u prihvatilištima uz smještaj i prehranu pružana i odgovarajuća zdravstvena skrb, odnosno da djeca nisu bila diskriminirana i zanemarivana. Osnovna je namjera ovoga rada, korištenjem izvornog arhivskog gradiva i izjava sudionika događaja (sudski zapisnici), pokazati da su djeca s Kozare i Potkozarja 1942. godine u prihvatilištima u Jastrebarskom, Sisku i Zagrebu imala odgovarajuću opću i zdravstvenu skrb u skladu s mogućnostima tadašnje medicine u zadanim ratnim okolnostima. Naime, sve do danas u različitim medijima postoji cijeli niz stavova o namjernom izgladnjivanju, trovanju i mučenju te djece. Ovdje želimo istaknuti da su to proizvoljni i činjenično neutemeljeni navodi koje su plasirale jugoslavenske komunističke vlasti odmah nakon završetka Drugoga svjetskog rata, ali i pojedine društvene, političke pa i znanstvene strukture. Stoga, u duhu znanstvenih spoznaja, mislimo da su nazivi dječji ili ustaški logori neprimjereni te da bi bilo uputnije koristiti nazive prihvatilišta ili sabirališta za djecu, pa i privremene bolnice za djecu.
The current epidemic of a new coronavirus disease
(COVID-19), caused by a novel coronavirus (2019-nCoV),
recently officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has ...reopened the issue
of the role and importance of coronaviruses in human pathology (1-5). This epidemic definitively confirms that this
heretofore relatively harmless family of viruses, Coronaviridae, includes major pathogens of epidemic potential. The
COVID-19 epidemic has clearly demonstrated the power
of infectious diseases, which have been responsible for
many devastating epidemics throughout history. The epidemiological potential of emerging infectious diseases, especially zoonoses, is affected by numerous environmental,
epidemiological, social, and economic factors (6,7). Emerging zoonoses pose both epidemiological and clinical challenges to health care professionals.
Akutne respiratorne infekcije (ARI), odnosno virusne upalne bolesti dišnog sustava najučestalije su infekcije i najčešće bolesti čovjeka uopće. Bolesnici s ARI, posebno gornjeg dijela dišnog sustava, ...najčešći su posjetitelji pedijatrijskih i drugih ordinacija primarne zdravstvene zaštite. Osobito često obolijevaju mala djeca – i do 10 puta na godinu. Razlozi za ovako veliku učestalost ARI nalaze se u građi i položaju dišnog sustava, koji je jedan od najotvorenijih organskih sustava čovjeka, u mnoštvu različitih uzročnika koji se vrlo lako prenose (kapljičnim putem i dodirom) te u skromnim mogućnostima sprječavanja i liječenja. Klinički se ARI očituju cijelim spektrom različitih sindroma i različitom težinom bolesti, a najčešće su blage infekcije gornjeg dijela dišnog sustava uzrokovane virusima (obična prehlada, febrilni respiratorni katar). Influenca je teža bolest koja se svake godine pojavljuje epidemijski, a praćena je brojnim komplikacijama, osobito u male djece i bolesnika s kroničnim bolestima. Iako se vrlo često primjenjuju, antibiotici nemaju nikakav učinak u virusnim respiratornim infekcijama, a posljedica nepotrebnog liječenja jesu brojni neželjeni događaji. Liječenje antibioticima rezervirano je samo za sekundarne bakterijske infekcije. Osim za viruse influence, i to s ograničenim djelovanjem, ne postoje protuvirusni lijekovi za ostale respiratorne viruse. Osnovno je liječenje ARI simptomatsko, a uključuje mirovanje, uzimanje dosta tekućine i antipiretike te eventualno lijekove protiv kašlja i za olakšavanje disanja na nos. Djeci se ne smiju davati salicilati zbog njihove povezanosti s virusima influence u nastanku Reyeova sindroma. Još nije konačno evaluirana učinkovitost vitamina C, preparata cinka i biljnih pripravaka u liječenju i sprječavanju virusnih respiratornih infekcija.
Please cite this paper as: Papic et al. (2011) Liver involvement during influenza infection: perspective on the 2009 influenza pandemic. Influenza and Other Respiratory Viruses 6(3), e2–e5.
Elevation ...of liver transaminase levels is a frequent observation during systemic infections. The aim of our study was to investigate liver damage during pandemic 2009 influenza A/H1N1 infection in comparison with seasonal influenza. Serum levels of aspartate aminotransferase, alanine aminotransferase, and gamma‐glutamyl transpeptidase (GGT) were significantly higher in patients with pandemic influenza compared to seasonal influenza, which was strongly correlated with hypoxia. Moreover, a positive correlation between C‐reactive protein and serum GGT, alkaline phosphatase, and lactate dehydrogenase was noticed. Our findings support the hypothesis that the pandemic 2009 influenza A/H1N1 is an illness with a significant immune response to infection leading to hepatocellular injury.
Abstract
Background
The effect of neuraminidase inhibitor (NAI) treatment on length of stay (LoS) in patients hospitalized with influenza is unclear.
Methods
We conducted a one-stage individual ...participant data (IPD) meta-analysis exploring the association between NAI treatment and LoS in patients hospitalized with 2009 influenza A(H1N1) virus (AH1N1pdm09) infection. Using mixed-effects negative binomial regression and adjusting for the propensity to receive NAI, antibiotic, and corticosteroid treatment, we calculated incidence rate ratios (IRRs) and 95% confidence intervals (CIs). Patients with a LoS of <1 day and those who died while hospitalized were excluded.
Results
We analyzed data on 18 309 patients from 70 clinical centers. After adjustment, NAI treatment initiated at hospitalization was associated with a 19% reduction in the LoS among patients with clinically suspected or laboratory-confirmed influenza A(H1N1)pdm09 infection (IRR, 0.81; 95% CI, .78–.85), compared with later or no initiation of NAI treatment. Similar statistically significant associations were seen in all clinical subgroups. NAI treatment (at any time), compared with no NAI treatment, and NAI treatment initiated <2 days after symptom onset, compared with later or no initiation of NAI treatment, showed mixed patterns of association with the LoS.
Conclusions
When patients hospitalized with influenza are treated with NAIs, treatment initiated on admission, regardless of time since symptom onset, is associated with a reduced LoS, compared with later or no initiation of treatment.
We found that neuraminidase inhibitor (NAI) treatment initiated on hospital admission to patients with clinically diagnosed or laboratory-confirmed A(H1N1)pdm09 virus infection was associated with a reduction in hospital length of stay when compared to later or no NAI treatment.
Influenca ili gripa akutna je bolest dišnog sustava uzrokovana virusima influence. Virusi influence neprestano se mijenjaju, a antigenske promjene virusa influence A odgovorne su za epidemije koje se ...pojavljuju svake godine u zimskim mjesecima te za pandemijsko pojavljivanje influence svakih nekoliko desetljeća. Influenca je klinički obilježena ponajprije općim simptomima, povišenom temperaturom i glavoboljom, umorom te bolima u mišićima. Respiratorni simptomi se obično pridružuju nakon dan-dva, poglavito suhi kašalj i grlobolja. Influenca je, u pravilu, teška bolest zbog brojnih komplikacija koje mogu biti uzrokovane samim virusom influence ili sekundarnim bakterijskim infekcijama. Komplikacije su najčešće u dišnom sustavu, osobito upale pluća, ali mogu biti zahvaćeni i drugi organski sustavi. Upala pluća vrlo je česta i teška, a nerijetko i pogibeljna komplikacija influence jer je odgovorna za golemu većinu smrtnih slučajeva. Klinički i patofiziološki razlikuju se dva oblika pneumonija u influenci. To je primarna virusna pneumonija uzrokovana samim virusom influence, a pojavljuje se u početku bolesti i sekundarna bakterijska pneumonija koja se obično pojavljuje u drugom tjednu bolesti. U djece se pneumonija pojavljuje mnogo rjeđe nego u odraslih, a relativno često dijagnosticiraju se laringitis, krup i bronhiolitis, zatim pogoršanje kroničnog bronhitisa i astme te česte bakterijske superinfekcije s upalom uha i sinusa. Zahvaćenost živčanog sustava u tijeku influence češća je u djece nego u odraslih. Neurološke komplikacije influence uključuju konvulzije, encefalopatiju, meningitis i encefalitis, Guillain-Barréov sindrom, transverzalni mijelitis te Reyeov sindrom. Relativno često registrira se oštećenje jetre, a rjeđe miozitis, miokarditis i perikarditis. U nekih se bolesnika razvija rabdomioliza s akutnim zatajenjem bubrega. Bolest koju uzrokuje pandemijski virus A(H1N1) klinički se bitno ne razlikuje od sezonske influence. Najvažnija je razlika češće obolijevanje s većim brojem komplikacija i smrtnih ishoda u mlađih od 55 godina, a u sezonskoj influenci većina se komplikacija i smrti registrira u starijih od 65 godina. Najčešća je komplikacija pandemijske influence primarna virusna pneumonija, nerijetko s razvojem akutnoga respiratornog distres sindroma (ARDS), a sekundarne bakterijske infekcije pojavljuju se rijetko.
The main aim of this pilot project was to introduce multimodal smoking cessation intervention in the hospital setting and to analyze users' satisfaction and efficacy of the intervention within six ...months post-discharge. Multimodal intervention for smoking cessation was used and it consisted of the "5 A's" model (Ask, Advice, Assess, Assist, Arrange) for behavior change, printed self-help materials for smoking cessation, and telephone counseling (one, three and six months after discharge from the hospital). The main outcome of the study was smoking status at six months. A total of 103 participants were included in this pilot project. At six-month follow-up, 49% of participants self-reported continuous non-smoking. Among the remaining participants, 20 reported smoking reduction, 19 were still smoking, and 16 participants were unable to make contact with. In the logistic regression, among all analyzed variables, only two of them were positively associated with smoking cessation after six months: participants' response that they would like to quit smoking within the next six months (B=4.688; p=0.018) and answering that they did not smoke when they were ill and bed-ridden due to illness (B=3.253; p=0.020). Satisfaction with the intervention was very high; 70% of participants rated the intervention as 'excellent'. Therefore, multimodal smoking cessation intervention can be successfully introduced at hospital setting yielding high smoking abstinence rates at six months post-discharge and high level of user satisfaction. Healthcare workers who work in hospitals should be educated so they can provide such intervention on a regular basis.
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