HEADACHE? EAT FISH! Eat plenty of fish -- fish oil helps prevent headaches.So does ginger, which reduces inflammation and pain..
HAY FEVER? EAT YOGURT! Eat lots of yogurt before pollen season.Also-eat honey from your area (local region) daily.
TO PREVENT STROKE DRINK TEA! Prevent buildup of fatty deposits on artery walls with regular doses of tea. (actually, tea suppresses my appetite and keeps the pounds from invading....Green tea is great for our immune system)!
INSOMNIA (CAN ' T SLEEP?) HONEY! Use honey as a tranquilizer and sedative.
ASTHMA? EAT ONIONS!!!! Eating onions helps ease constriction of bronchial tubes. (when I was young, my mother would make onion packs to place on our chest, helped the respiratory ailments and actually made us breathe better).
ARTHRITIS? EAT FISH, TOO!! Salmon, tuna, mackerel an d sardines actually prevent arthritis. (fish has omega oils! , good for our immune system)
UPSET STOMACH? BANANAS - GINGER!!!!! Bananas will settle an upset stomach.Ginger will cure morning sickness and nausea.
BLADDER INFECTION? DRINK CRANBERRY JUICE!!!! High-acid cranberry juice controls harmful bacteria.
BONE PROBLEMS? EAT PINEAPPLE!!! Bone fractures and osteoporosis can be prevented by the manganese in pi! neapple.
PREMENSTRUAL SYNDROME? EAT CORNFLAKES!!!! Women can ward off the effects of PMS with cornflakes, which help reduce depression, anxiety and fatigue..
MEMORY PROBLEMS? EAT OYSTERS!Oysters help improve your mental functioning by supplying much-needed zinc.
COLDS? EAT GARLIC! Clear up that stuffy head with garlic. (remember, garlic lowers cholesterol, too.)
COUGHING? USE RED PEPPERS!! A substance similar to that found in the cough syrups is found in hot red pepper. Use red (cayenne) pepper with caution-it can irritate your tummy.
BREAST CANCER? EAT Wheat, bran and cabbageHelps to maintain estrogen at healthy levels.
LUNG CANCER? EAT DARK GREEN AND ORANGE AND VEGGIES!!! A good antidote is beta carotene, a form of Vitamin A found in dark green and orange vegetables.
ULCERS? EAT CABBAGE ALSO!!!Cabbage contains chemicals that help heal both gastric and duodenal ulcers.
DIARRHEA? EAT APPLES! Grate an apple with its skin, let it turn brown and eat it to cure this condition. (Bananas are good for this ailment)
CLOGGED ARTERIES? EAT AVOCADO! Mono unsaturated fat in avocados lowers cholesterol.
HIGH BLOOD PRESSURE? EAT CELERY ! AND OLIVE OIL!!!Olive oil has been shown to lower blood pressure.Celery contains a chemical that lowers pressure too.
BLOOD SUGAR IMBALANCE? EAT BROCCOLI AND PEANUTS!!! The chromium in broccoli and peanuts helps regulate insulin and blood sugar. Kiwi: Tiny but mighty. This is a good source of potassium, magnesium, Vitamin E &fiber. It ' s Vitamin C content is twice that of an orange.
Apple: An apple a day keeps the doctor away? Although an apple has a low Vitamin C content, it has antioxidants & flavonoids which enhances the activity of Vitamin C thereby helping to lower the risks of colon cancer, heart attack & stroke.
Strawberry: Protective fruit. A strawberry have the highest total antioxidant power among major fruits & protects the body from cancer causing, blood vessels clogging free radicals... (Actually, any berry is good for you...they're high in anti-oxidants and they actually keep us young.........blueberries are the best and very versatile in the health field........they get rid of all the free-radicals that invade our bodies)
Orange: Sweetest medicine. Taking 2 - 4 oranges a day may help keep colds away, lower cholesterol, prevent & dissolve kidney stones as well as lessen the risk of colon ca ncer.!
Watermelon: Coolest Thirst Quencher. Composed of 92% water, it is also packed with a giant dose of glutathione which helps boost our immune system. They are also a key source of lycopene - the cancer fighting oxidant. Other nutrientsfound in watermelon are Vitamin C &Potassium. (watermelon also has natural substances [natural SPF sources] that keep our skin healthy, protecting our skin from those darn suv rays)
Guava &Papaya: Top awards for Vitamin C. They are the clear winners for their high Vitamin C content. Guava is also rich in fiber which helps prevent constipation.Papaya is rich in carotene, this is go! od for your eyes. (also good for gas and indigestion)
Tomatoes are very good as a preventative measure for men, keeps those prostrate problems from invading their bodies.
Saturday, September 12, 2009
Tuesday, August 11, 2009
AN ARTICLE FROM MEDSCAPE
by Ganesan
H1N1 Influenza (Swine Flu)
Author: Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Contributor Information and Disclosures
Updated: Jun 29, 2009
Introduction
Swine influenza is a highly contagious respiratory disease in pigs caused by one of several swine influenza A viruses. In addition, influenza C viruses may also cause illness in swine. Current strategies to control swine influenza virus (SIV) in animals typically include one of several commercially available bivalent swine influenza virus vaccines.
Transmission of swine influenza viruses to humans is uncommon. However, the swine influenza virus can be transmitted to humans via contact with infected pigs or environments contaminated with swine influenza viruses. Once a human becomes infected, he or she can then spread the virus to other humans, presumably in the same way as seasonal influenza is spread (ie, via coughing or sneezing).
History
The ability to trace outbreaks of swine flu in humans dates back to investigation of the 1918 Spanish influenza pandemic, which infected one third of the world’s population (an estimated 500 million people) and caused approximately 50 million deaths. In 1918, the cause of human influenza and its links to avian and swine influenza was not understood. The answers did not begin to emerge until the 1930s, when related influenza viruses (now known as H1N1 viruses) were isolated from pigs and then humans.1
In humans, the severity of swine influenza can vary from mild to severe. From 2005 until January 2009, 12 human cases of swine flu were reported in the United States. None were fatal. In 1988, however, a previously healthy 32-year-old pregnant woman in Wisconsin died of pneumonia as a complication of swine influenza.
A 1976 outbreak of swine influenza in Fort Dix, New Jersey, involved more than 200 cases, some of them severe, and one death.2 The first discovered case involved a soldier at Fort Dix who complained of feeling weak and tired. He died the next day.
The fear of an influenza pandemic in 1976 led to a national campaign in the United States designed to immunize nearly the entire population. In October, 1976, approximately 40 million people received the A/NewJersey/1976/H1N1 vaccine (ie, swine flu vaccine) before the immunization initiative was halted because of the strong association between the vaccine and Guillain-Barré syndrome (GBS).3,4 About 500 cases of GBS were reported, with 25 deaths due to associated pulmonary complications.5
A recent investigation sought to determine the link between GBS and the 1976 swine flu vaccine, since subsequent influenza vaccines did not have this strong association. Nachamkin et al (2008) found that inoculation of the 1976 swine flu vaccine, as well as the 1991-1992 and 2004-2005 influenza vaccines, into mice prompted production of antibodies to antiganglioside (anti-GM1), which are associated with the development of GBS. They proposed that further research regarding influenza vaccine components is warranted to determine how these components elicit antiganglioside effects.6
Current H1N1 influenza (formerly called swine influenza) outbreak
Human cases of influenza A (H1N1) have been reported worldwide. In 2009, cases of influenzalike illness were first reported in Mexico on March 18; the outbreak was subsequently confirmed as H1N1 influenza A.7 Investigation is continuing to clarify the spread and severity of H1N1 influenza (swine flu) in Mexico. Suspected clinical cases had been reported in 19 of the country's 32 states. Although only 97 of the Mexican cases had been laboratory-confirmed as Influenza A/H1N18 (12 of them genetically identical to Influenza A/H1N1 viruses from California7 ). As of May 5th, 2009, nearly 600 H1N1 influenza cases had been confirmed in Mexico, including 25 deaths.9
On April 17, 2009, the CDC determined that two cases of febrile respiratory illness in children who resided in adjacent counties in southern California were caused by infection with a swine influenza A (H1N1) virus.10 By April 26, 2009, the US Department of Health and Human Services declared a national public health emergency involving H1N1 influenza A, citing its significant potential to affect national security.11 By June 25, 2009, 27,717 lab-defined cases of H1N1 influenza had been confirmed in the United States.8,12,13,14 As of June 25, 2009, over 3,000 hospitalizations and 127 deaths had been attributed to H1N1 flu in the United States.12
For an updated tally and case counts in specific states, see the CDC's H1N1 Flu (Swine Flu) Web page.
As of late June 2009, the World Health Organization (WHO) reported that H1N1 influenza had been confirmed in almost 60,000 people in more than 100 countries and that they are aware of 263 deaths confirmed to have been caused by the disease. On June 11, 2009, WHO raised the pandemic alert level to phase 6 (indicating a global pandemic) because of widespread infection beyond North America to Australia, the United Kingdom, Argentina, Chile, Spain, and Japan.8 For an updated tally of affected countries and counts, see WHO's Influenza A (H1N1) Web page.
Government and public health officials are monitoring this situation worldwide to assess the threat from H1N1 influenza and to provide guidance to health care professionals and the public. Because the situation is changing rapidly, it is important to check regularly for changes in recommendations as new information becomes available. Online resources for daily guidance include the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and Medscape's H1N1 Influenza A (Swine Flu) Alert Center.
See Medscape's H1N1 influenza algorithm adaptation for guidance in managing suspected cases.
Morbidity and Mortality
H1N1 influenza (swine flu) tends to cause high morbidity but low mortality rates (1%-4%).
Symptoms
Manifestations of H1N1 influenza (swine flu) are similar to those of seasonal influenza. Patients present with symptoms of acute respiratory illness, including at least 2 of the following:
* Fever
* Cough
* Sore throat
* Body aches
* Headache
* Chills and fatigue
* Diarrhea and vomiting (possible)
Persons with these symptoms should call their health care provider promptly. If an antiviral agent is warranted, it should ideally be initiated with 48 hours from the onset of symptoms (see Medications). The duration of illness is typically 4-6 days. The infectious period for a confirmed case is defined as 1 day prior to the onset of symptoms to 7 days after onset.
In children, signs of severe disease include apnea, tachypnea, dyspnea, cyanosis, dehydration, altered mental status, and extreme irritability.15
Viral Strain and Testing
Outbreaks of H1N1 influenza (swine flu) are common in pigs year-round. Historically, when humans have become infected, it is a result of close contact with infected pigs (but not consumption of pork). However, the current virus is a novel influenza A (H1N1) virus not previously identified in humans, and it appears to be spread by human-to-human transmission. The WHO has raised its pandemic alert level for H1N1 influenza to phase 6, which means that community-level outbreaks are in at least one additional country in a different WHO region from phase 5. A global pandemic is under way.
Phase 6 criteria: In addition to the criteria defined in Phase 5, the same virus has caused sustained community-level outbreaks in at least one other country in another WHO region. Courtesy of the WHO.
In the current 2009 outbreak in the United States, preliminary testing has shown that, in all cases, the viruses have the same genetic pattern. The virus is being described as a new subtype of influenza A/H1N1 not previously detected in pigs or humans.
Clinicians should consider the possibility of H1N1 influenza virus infections in patients who present with febrile respiratory illness. The CDC criteria for suspected H1N1 influenza are as follows16 :
* Onset of acute febrile respiratory illness within 7 days of close contact with a person who has a confirmed case of H1N1 influenza A virus infection, or
* Onset of acute febrile respiratory illness within 7 days of travel to a community (within the United States or internationally) where one or more H1N1 influenza A cases have been confirmed, or
* Acute febrile respiratory illness in a person who resides in a community where at least one H1N1 influenza case has been confirmed.
If H1N1 flu is suspected, the clinician should obtain a respiratory swab for H1N1 influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact his or her state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.
Laboratories should send all influenza A specimens that they are unable to subtype to the Viral Surveillance and Diagnostic Branch of the CDC's Influenza Division as soon as possible for further diagnostic testing.17
Internationally, scientists have been collaborating on genetic analysis of current animal and human influenza viruses. These researchers have created a human/swine A/H1N1 influenza wiki to facilitate rapid dissemination of the results of this work. The collaboration is producing insights on the origin of the H1N1 virus and should enable scientists to track its evolution as the outbreak spreads around the world. Information from the National Institute of Allergy and Infectious Disease regarding influenza genome sequencing is available to researchers studying how influenza viruses evolve and those developing new and improved ways to prevent, diagnose, and treat influenza disease.
Treatment Recommendations
Treatment is largely supportive and consists of bedrest, increased fluid consumption, cough suppressants, and antipyretics and analgesics (eg, acetaminophen, nonsteroidal anti-inflammatory drugs) for fever and myalgias. Severe cases may require intravenous hydration and other supportive measures. Antiviral agents may also be considered for treatment or prophylaxis (see Medications).
Patients should be encouraged to stay home if they become ill, to avoid close contact with people who are sick, to wash their hands often, and to avoid touching their eyes, nose, and mouth. The CDC recommends the following actions when human infection with H1N1 influenza (swine flu) is confirmed in a community15 :
Home isolation
* Patients who develop flulike illness (ie, fever with either cough or sore throat) should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved, whichever is longer.
* To seek medical care, patient should contact their health care providers to report illness (by telephone or other remote means) before seeking care at a clinic, physician's office, or hospital.
* Patients who have difficulty breathing or shortness of breath or who are believed to be severely ill should seek immediate medical attention.
* If the patient must go into the community (eg, to seek medical care), he or she should wear a face mask to reduce the risk of spreading the virus in the community when coughing, sneezing, talking, or breathing. If a face mask is unavailable, ill persons who need to go into the community should use tissues to cover their mouth and nose while coughing.
* While in home isolation, patients and other household members should be given infection control instructions, including frequent hand washing with soap and water. Use alcohol-based hand gels (containing at least 60% alcohol) when soap and water are not available and hands are not visibly dirty. Patients with H1N1 influenza should wear a face mask when within 6 feet of others at home.
Household contacts who are not ill
* Remain home at the earliest sign of illness.
* Minimize contact in the community to the extent possible.
* Designate a single household family member as caregiver for the patient to minimize interactions with asymptomatic persons.
School dismissal and childcare facility closure
* Strong consideration should be given to close schools upon a confirmed case of H1N1 flu or a suspected case epidemiologically linked to a confirmed case.
* Decisions regarding broader school dismissal within these communities should be left to local authorities, taking into account the extent of influenzalike illness within the community.
* Cancelation of all school or childcare related gatherings should also be announced.
* Encourage parents and students to avoid congregating outside of the school if school is canceled.
* Duration of schools and childcare facilities closings should be evaluated on an ongoing basis depending on epidemiological findings.
* Consultation with local or state health departments is essential for guidance concerning when to reopen schools. If no additional confirmed or suspected cases are identified among students (or school-based personnel) for a period of 7 days, schools may consider reopening.
* Schools and childcare facilities in unaffected areas should begin preparation for possible school closure.
Social distancing
* Large gatherings linked to settings or institutions with laboratory-confirmed cases should be canceled (eg, sporting events or concerts linked to a school with cases); other large gatherings in the community may not need to be canceled at this time.
* Additional social distancing measures are currently not recommended.
* Persons with underlying medical conditions who are at high risk for complications of influenza should consider avoiding large gatherings.
Patient education
Patients should be referred to the eMedicine Health article Swine Flu.
Preventive measures for health care personnel
The CDC has issued interim recommendations for controlling the spread of H1N1 influenza in health care settings.20 Recommended measures for care of patients with suspected or confirmed H1N1 influenza include the following:
* Place patients in a single-patient room with the door kept closed. An airborne-infection isolation room with negative-pressure air handling can be used, if available. Air can be exhausted directly outside or can be recirculated after filtration by a high efficiency particulate air (HEPA) filter.
* Suctioning, bronchoscopy, or intubation should be performed in a procedure room with negative-pressure air handling.
* Patients should wear a surgical mask when outside their room.
* Encourage patients to wash their hands frequently and to follow respiratory hygiene practices. Cups and other utensils used by the ill person should be washed with soap and water before use by other persons.
* Routine cleaning and disinfection strategies used during influenza seasons can be applied.
* Standard, droplet, and contact precautions should be used for all patient care activities and maintained for 7 days after illness onset or until symptoms have resolved.
* Health care personnel should wash their hands with soap and water or use hand sanitizer immediately after removing gloves and other equipment and after any contact with respiratory secretions.
* Personnel providing care to or collecting clinical specimens from patients should wear disposable nonsterile gloves, gowns, and eye protection (eg, goggles) to prevent conjunctival exposure.
* As per previous recommendations regarding mask and respirator use during influenza pandemics, personnel engaged in aerosol-generating activities (eg, collection of clinical specimens, endotracheal intubation, nebulizer treatment, bronchoscopy) and/or resuscitation involving emergency intubation or cardiac pulmonary resuscitation should wear a fit-tested disposable N95 respirator.
* Pending clarification of transmission patterns for the 2009 H1N1 influenza A (swine flu) virus, personnel providing direct patient care for suspected or confirmed cases should wear a fit-tested disposable N95 respirator when entering the patient's room.
H1N1 influenza in pregnancy
As of May 10, 2009, a total of 20 cases of novel influenza A (H1N1) virus (swine flu) infection had been reported among pregnant women in the United States, including 15 confirmed cases and 5 probable cases. Among the 13 women from 7 states for whom data are available, the median age was 26 years (range, 15-39 y); 3 women were hospitalized, one of whom died.
Pregnant women with confirmed, probable, or suspected novel influenza A (H1N1) virus infection should receive antiviral treatment for 5 days. Oseltamivir is the preferred treatment for pregnant women, and the drug regimen should be initiated within 48 hours of symptom onset, if possible. Pregnant women who are in close contact with a person with confirmed, probable, or suspected novel influenza A (H1N1) infection should receive a 10-day course of chemoprophylaxis with zanamivir or oseltamivir.21
Medications
Laboratory testing has found the H1N1 influenza A (swine flu) virus susceptible to the prescription antiviral drugs oseltamivir and zanamivir, and the CDC has issued interim guidance for the use of these drugs to treat and prevent infection with swine influenza viruses.22,23 As part of its preparation for the emergency, the US Department of Homeland Security is releasing 25% of stockpiled antiviral agents (ie, oseltamivir [Tamiflu], zanamivir [Relenza]).
The usual vaccine for influenza administered at the beginning of the flu season is not effective for this viral strain. Also, other antiviral agents (eg, amantadine, rimantadine) are not recommended because of recent resistance to other influenza strains documented over the past several years.
Basic supportive care (ie, hydration, analgesics, cough suppressants) should be prescribed. Empiric antiviral treatment should be considered for confirmed, probable, or suspected cases of H1N1 influenza. Treatment of hospitalized patients and patients at higher risk for influenza complications should be prioritized.
Initiation of antiviral agents within 48 hours of symptom onset is imperative for providing treatment efficacy against influenza virus. In studies of seasonal influenza, evidence for benefits of treatment is strongest when treatment is started within 48 hours of illness onset. However, some studies of treatment of seasonal influenza have indicated benefit, including reductions in mortality or duration of hospitalization, even in patients in whom treatment was started more than 48 hours after illness onset. The recommended duration of treatment is 5 days.22,23
* Prophylaxis with antiviral agents should also be considered in the following individuals (pre-exposure or postexposure):
o Close household contacts of a confirmed or suspected case who are at high risk for complications (eg, chronic medical conditions, persons >65 y or <5>65 y or <5>65 y, pregnant women)
o Individuals not considered to be at high risk but who are nonetheless traveling to Mexico, first responders, or border workers who are working in areas with confirmed cases
Antiviral Agents
Drugs indicated for treatment of H1N1 influenza A virus include neuraminidase inhibitors (ie, oseltamivir and zanamivir).
Oseltamivir (Tamiflu)
Oseltamivir inhibits neuraminidase, which is a glycoprotein on the surface of influenza virus that destroys an infected cell's receptor for viral hemagglutinin. By inhibiting viral neuraminidase, this agent decreases the release of viruses from infected cells and, thus, viral spread. Oseltamivir is effective in the treatment of influenza A or B and must be administered within 48 hours of symptom onset to provide optimal treatment. The sooner the drug is administered after symptom onset, the better the likelihood of a good outcome. However, some studies of treatment of seasonal influenza have indicated benefit, including reductions in mortality or duration of hospitalization even for patients whose treatment was started more than 48 hours after illness onset.22 Oseltamivir reduces the length of illness by an average of 1.5 days. (In a subgroup of high-risk patients, illness was reduced by 2.5 d.) In addition, the severity of symptoms is also reduced.
Duration of administration for treatment is 5 days. Postexposure prophylaxis should be initiated within 7 d of exposure and continued for at least 10 days. Pre-exposure prophylaxis should be initiated during potential exposure period and continue for 10 days after last known exposure.22
Oseltamivir is available as 30-mg, 45-mg, and 75-mg oral capsules and as a powder for suspension that contains 12 mg/mL after reconstitution.
* Adult dose
o Treatment for acute illness: 75 mg PO bid for 5 d
o Prophylaxis: 75 mg PO qd (Please refer to duration of prophylaxis specific for postexposure.)
* Pediatric dose
o Treatment for acute illness and age <1>1 year
+ <15>40 kg: Administer as in adults
o Prophylaxis and age <1>1 year
+ <15>40 kg: Administer as in adults
Zanamivir (Relenza)
Zanamivir inhibits neuraminidase, which is a glycoprotein on the surface of the influenza virus that destroys the infected cell's receptor for viral hemagglutinin. By inhibiting viral neuraminidase, release of viruses from infected cells and viral spread are decreased. Zanamivir is effective against both influenza A and B. The preparation of zanamivir is in powder form for inhalation via the Diskhaler oral inhalation device. Circular foil discs that contain 5-mg blisters of drug are inserted into the supplied inhalation device. Individuals with asthma or other respiratory conditions that may decrease ability to inhale drug should be given oseltamivir.
* Adult dose
o Treatment for acute illness: 10 mg inhaled orally bid for 5 d
o Prophylaxis of household contact: 10 mg inhaled orally qd for 10 d (initiate within 36 h)
o Prophylaxis for community outbreak: 10 mg inhaled orally qd for 28 d (initiate within 5 d of outbreak)
* Pediatric dose
o Treatment for acute illness
+ <7>7 years: Administer as in adults
o Prophylaxis in household contact
+ <5>5 years: Administer as in adults
o Prophylaxis in community outbreak
+ Adolescents 12-16 years: Administer as in adults
Additional pediatric considerations
Aspirin or aspirin-containing products (eg, bismuth subsalicylate [Pepto Bismol]) should not be included in the treatment of confirmed or suspected viral infection in persons aged 18 years or younger because of the risk of Reye syndrome. For relief of fever, other antipyretic medications (eg, acetaminophen, nonsteroidal anti-inflammatory drugs) are recommended.
Pregnant women
Oseltamivir and zanamivir are "Pregnancy Category C" medications, indicating that no clinical studies have been conducted to assess the safety of these medications in pregnant women.
Because of the unknown effects of influenza antiviral drugs on pregnant women and their fetuses, oseltamivir or zanamivir should be used during pregnancy only if the potential benefit justifies the potential risk to the embryo or fetus; the manufacturers' package inserts should be consulted. However, no adverse effects have been reported among women who received seltamivir or zanamivir during pregnancy or among infants born to women who have received oseltamivir or zanamivir.
Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use. Because zanamivir is an inhaled medication and has less systemic absorption, some experts prefer zanamivir over oseltamivir for use in pregnant women, when feasible.
Keywords
H1N1 influenza, H1N1 flu, swine flu, swine influenza, swine influenza virus, swine influenza A (H1N1) virus, human swine flu, influenza A, influenza (H1N1), SIV, swine flu symptoms, swine flu diagnosis, swine flu treatment, swine flu antiviral, swine flu pandemic, swine flu outbreak, H1N1 flu symptoms, H1N1 flu diagnosis, H1N1 flu treatment, H1N1 flu antiviral, H1N1 flu pandemic, H1N1 flu outbreak
by Ganesan
H1N1 Influenza (Swine Flu)
Author: Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Contributor Information and Disclosures
Updated: Jun 29, 2009
Introduction
Swine influenza is a highly contagious respiratory disease in pigs caused by one of several swine influenza A viruses. In addition, influenza C viruses may also cause illness in swine. Current strategies to control swine influenza virus (SIV) in animals typically include one of several commercially available bivalent swine influenza virus vaccines.
Transmission of swine influenza viruses to humans is uncommon. However, the swine influenza virus can be transmitted to humans via contact with infected pigs or environments contaminated with swine influenza viruses. Once a human becomes infected, he or she can then spread the virus to other humans, presumably in the same way as seasonal influenza is spread (ie, via coughing or sneezing).
History
The ability to trace outbreaks of swine flu in humans dates back to investigation of the 1918 Spanish influenza pandemic, which infected one third of the world’s population (an estimated 500 million people) and caused approximately 50 million deaths. In 1918, the cause of human influenza and its links to avian and swine influenza was not understood. The answers did not begin to emerge until the 1930s, when related influenza viruses (now known as H1N1 viruses) were isolated from pigs and then humans.1
In humans, the severity of swine influenza can vary from mild to severe. From 2005 until January 2009, 12 human cases of swine flu were reported in the United States. None were fatal. In 1988, however, a previously healthy 32-year-old pregnant woman in Wisconsin died of pneumonia as a complication of swine influenza.
A 1976 outbreak of swine influenza in Fort Dix, New Jersey, involved more than 200 cases, some of them severe, and one death.2 The first discovered case involved a soldier at Fort Dix who complained of feeling weak and tired. He died the next day.
The fear of an influenza pandemic in 1976 led to a national campaign in the United States designed to immunize nearly the entire population. In October, 1976, approximately 40 million people received the A/NewJersey/1976/H1N1 vaccine (ie, swine flu vaccine) before the immunization initiative was halted because of the strong association between the vaccine and Guillain-Barré syndrome (GBS).3,4 About 500 cases of GBS were reported, with 25 deaths due to associated pulmonary complications.5
A recent investigation sought to determine the link between GBS and the 1976 swine flu vaccine, since subsequent influenza vaccines did not have this strong association. Nachamkin et al (2008) found that inoculation of the 1976 swine flu vaccine, as well as the 1991-1992 and 2004-2005 influenza vaccines, into mice prompted production of antibodies to antiganglioside (anti-GM1), which are associated with the development of GBS. They proposed that further research regarding influenza vaccine components is warranted to determine how these components elicit antiganglioside effects.6
Current H1N1 influenza (formerly called swine influenza) outbreak
Human cases of influenza A (H1N1) have been reported worldwide. In 2009, cases of influenzalike illness were first reported in Mexico on March 18; the outbreak was subsequently confirmed as H1N1 influenza A.7 Investigation is continuing to clarify the spread and severity of H1N1 influenza (swine flu) in Mexico. Suspected clinical cases had been reported in 19 of the country's 32 states. Although only 97 of the Mexican cases had been laboratory-confirmed as Influenza A/H1N18 (12 of them genetically identical to Influenza A/H1N1 viruses from California7 ). As of May 5th, 2009, nearly 600 H1N1 influenza cases had been confirmed in Mexico, including 25 deaths.9
On April 17, 2009, the CDC determined that two cases of febrile respiratory illness in children who resided in adjacent counties in southern California were caused by infection with a swine influenza A (H1N1) virus.10 By April 26, 2009, the US Department of Health and Human Services declared a national public health emergency involving H1N1 influenza A, citing its significant potential to affect national security.11 By June 25, 2009, 27,717 lab-defined cases of H1N1 influenza had been confirmed in the United States.8,12,13,14 As of June 25, 2009, over 3,000 hospitalizations and 127 deaths had been attributed to H1N1 flu in the United States.12
For an updated tally and case counts in specific states, see the CDC's H1N1 Flu (Swine Flu) Web page.
As of late June 2009, the World Health Organization (WHO) reported that H1N1 influenza had been confirmed in almost 60,000 people in more than 100 countries and that they are aware of 263 deaths confirmed to have been caused by the disease. On June 11, 2009, WHO raised the pandemic alert level to phase 6 (indicating a global pandemic) because of widespread infection beyond North America to Australia, the United Kingdom, Argentina, Chile, Spain, and Japan.8 For an updated tally of affected countries and counts, see WHO's Influenza A (H1N1) Web page.
Government and public health officials are monitoring this situation worldwide to assess the threat from H1N1 influenza and to provide guidance to health care professionals and the public. Because the situation is changing rapidly, it is important to check regularly for changes in recommendations as new information becomes available. Online resources for daily guidance include the Centers for Disease Control and Prevention (CDC), World Health Organization (WHO), and Medscape's H1N1 Influenza A (Swine Flu) Alert Center.
See Medscape's H1N1 influenza algorithm adaptation for guidance in managing suspected cases.
Morbidity and Mortality
H1N1 influenza (swine flu) tends to cause high morbidity but low mortality rates (1%-4%).
Symptoms
Manifestations of H1N1 influenza (swine flu) are similar to those of seasonal influenza. Patients present with symptoms of acute respiratory illness, including at least 2 of the following:
* Fever
* Cough
* Sore throat
* Body aches
* Headache
* Chills and fatigue
* Diarrhea and vomiting (possible)
Persons with these symptoms should call their health care provider promptly. If an antiviral agent is warranted, it should ideally be initiated with 48 hours from the onset of symptoms (see Medications). The duration of illness is typically 4-6 days. The infectious period for a confirmed case is defined as 1 day prior to the onset of symptoms to 7 days after onset.
In children, signs of severe disease include apnea, tachypnea, dyspnea, cyanosis, dehydration, altered mental status, and extreme irritability.15
Viral Strain and Testing
Outbreaks of H1N1 influenza (swine flu) are common in pigs year-round. Historically, when humans have become infected, it is a result of close contact with infected pigs (but not consumption of pork). However, the current virus is a novel influenza A (H1N1) virus not previously identified in humans, and it appears to be spread by human-to-human transmission. The WHO has raised its pandemic alert level for H1N1 influenza to phase 6, which means that community-level outbreaks are in at least one additional country in a different WHO region from phase 5. A global pandemic is under way.
Phase 6 criteria: In addition to the criteria defined in Phase 5, the same virus has caused sustained community-level outbreaks in at least one other country in another WHO region. Courtesy of the WHO.
In the current 2009 outbreak in the United States, preliminary testing has shown that, in all cases, the viruses have the same genetic pattern. The virus is being described as a new subtype of influenza A/H1N1 not previously detected in pigs or humans.
Clinicians should consider the possibility of H1N1 influenza virus infections in patients who present with febrile respiratory illness. The CDC criteria for suspected H1N1 influenza are as follows16 :
* Onset of acute febrile respiratory illness within 7 days of close contact with a person who has a confirmed case of H1N1 influenza A virus infection, or
* Onset of acute febrile respiratory illness within 7 days of travel to a community (within the United States or internationally) where one or more H1N1 influenza A cases have been confirmed, or
* Acute febrile respiratory illness in a person who resides in a community where at least one H1N1 influenza case has been confirmed.
If H1N1 flu is suspected, the clinician should obtain a respiratory swab for H1N1 influenza testing and place it in a refrigerator (not a freezer). Once collected, the clinician should contact his or her state or local health department to facilitate transport and timely diagnosis at a state public health laboratory.
Laboratories should send all influenza A specimens that they are unable to subtype to the Viral Surveillance and Diagnostic Branch of the CDC's Influenza Division as soon as possible for further diagnostic testing.17
Viral tracking and research
Internationally, scientists have been collaborating on genetic analysis of current animal and human influenza viruses. These researchers have created a human/swine A/H1N1 influenza wiki to facilitate rapid dissemination of the results of this work. The collaboration is producing insights on the origin of the H1N1 virus and should enable scientists to track its evolution as the outbreak spreads around the world. Information from the National Institute of Allergy and Infectious Disease regarding influenza genome sequencing is available to researchers studying how influenza viruses evolve and those developing new and improved ways to prevent, diagnose, and treat influenza disease.
Treatment Recommendations
Treatment is largely supportive and consists of bedrest, increased fluid consumption, cough suppressants, and antipyretics and analgesics (eg, acetaminophen, nonsteroidal anti-inflammatory drugs) for fever and myalgias. Severe cases may require intravenous hydration and other supportive measures. Antiviral agents may also be considered for treatment or prophylaxis (see Medications).
Patients should be encouraged to stay home if they become ill, to avoid close contact with people who are sick, to wash their hands often, and to avoid touching their eyes, nose, and mouth. The CDC recommends the following actions when human infection with H1N1 influenza (swine flu) is confirmed in a community15 :
Home isolation
* Patients who develop flulike illness (ie, fever with either cough or sore throat) should be strongly encouraged to self-isolate in their home for 7 days after the onset of illness or at least 24 hours after symptoms have resolved, whichever is longer.
* To seek medical care, patient should contact their health care providers to report illness (by telephone or other remote means) before seeking care at a clinic, physician's office, or hospital.
* Patients who have difficulty breathing or shortness of breath or who are believed to be severely ill should seek immediate medical attention.
* If the patient must go into the community (eg, to seek medical care), he or she should wear a face mask to reduce the risk of spreading the virus in the community when coughing, sneezing, talking, or breathing. If a face mask is unavailable, ill persons who need to go into the community should use tissues to cover their mouth and nose while coughing.
* While in home isolation, patients and other household members should be given infection control instructions, including frequent hand washing with soap and water. Use alcohol-based hand gels (containing at least 60% alcohol) when soap and water are not available and hands are not visibly dirty. Patients with H1N1 influenza should wear a face mask when within 6 feet of others at home.
Household contacts who are not ill
* Remain home at the earliest sign of illness.
* Minimize contact in the community to the extent possible.
* Designate a single household family member as caregiver for the patient to minimize interactions with asymptomatic persons.
School dismissal and childcare facility closure
* Strong consideration should be given to close schools upon a confirmed case of H1N1 flu or a suspected case epidemiologically linked to a confirmed case.
* Decisions regarding broader school dismissal within these communities should be left to local authorities, taking into account the extent of influenzalike illness within the community.
* Cancelation of all school or childcare related gatherings should also be announced.
* Encourage parents and students to avoid congregating outside of the school if school is canceled.
* Duration of schools and childcare facilities closings should be evaluated on an ongoing basis depending on epidemiological findings.
* Consultation with local or state health departments is essential for guidance concerning when to reopen schools. If no additional confirmed or suspected cases are identified among students (or school-based personnel) for a period of 7 days, schools may consider reopening.
* Schools and childcare facilities in unaffected areas should begin preparation for possible school closure.
Social distancing
* Large gatherings linked to settings or institutions with laboratory-confirmed cases should be canceled (eg, sporting events or concerts linked to a school with cases); other large gatherings in the community may not need to be canceled at this time.
* Additional social distancing measures are currently not recommended.
* Persons with underlying medical conditions who are at high risk for complications of influenza should consider avoiding large gatherings.
Patient education
Patients should be referred to the eMedicine Health article Swine Flu.
Preventive measures for health care personnel
The CDC has issued interim recommendations for controlling the spread of H1N1 influenza in health care settings.20 Recommended measures for care of patients with suspected or confirmed H1N1 influenza include the following:
* Place patients in a single-patient room with the door kept closed. An airborne-infection isolation room with negative-pressure air handling can be used, if available. Air can be exhausted directly outside or can be recirculated after filtration by a high efficiency particulate air (HEPA) filter.
* Suctioning, bronchoscopy, or intubation should be performed in a procedure room with negative-pressure air handling.
* Patients should wear a surgical mask when outside their room.
* Encourage patients to wash their hands frequently and to follow respiratory hygiene practices. Cups and other utensils used by the ill person should be washed with soap and water before use by other persons.
* Routine cleaning and disinfection strategies used during influenza seasons can be applied.
* Standard, droplet, and contact precautions should be used for all patient care activities and maintained for 7 days after illness onset or until symptoms have resolved.
* Health care personnel should wash their hands with soap and water or use hand sanitizer immediately after removing gloves and other equipment and after any contact with respiratory secretions.
* Personnel providing care to or collecting clinical specimens from patients should wear disposable nonsterile gloves, gowns, and eye protection (eg, goggles) to prevent conjunctival exposure.
* As per previous recommendations regarding mask and respirator use during influenza pandemics, personnel engaged in aerosol-generating activities (eg, collection of clinical specimens, endotracheal intubation, nebulizer treatment, bronchoscopy) and/or resuscitation involving emergency intubation or cardiac pulmonary resuscitation should wear a fit-tested disposable N95 respirator.
* Pending clarification of transmission patterns for the 2009 H1N1 influenza A (swine flu) virus, personnel providing direct patient care for suspected or confirmed cases should wear a fit-tested disposable N95 respirator when entering the patient's room.
H1N1 influenza in pregnancy
As of May 10, 2009, a total of 20 cases of novel influenza A (H1N1) virus (swine flu) infection had been reported among pregnant women in the United States, including 15 confirmed cases and 5 probable cases. Among the 13 women from 7 states for whom data are available, the median age was 26 years (range, 15-39 y); 3 women were hospitalized, one of whom died.
Pregnant women with confirmed, probable, or suspected novel influenza A (H1N1) virus infection should receive antiviral treatment for 5 days. Oseltamivir is the preferred treatment for pregnant women, and the drug regimen should be initiated within 48 hours of symptom onset, if possible. Pregnant women who are in close contact with a person with confirmed, probable, or suspected novel influenza A (H1N1) infection should receive a 10-day course of chemoprophylaxis with zanamivir or oseltamivir.21
Medications
Laboratory testing has found the H1N1 influenza A (swine flu) virus susceptible to the prescription antiviral drugs oseltamivir and zanamivir, and the CDC has issued interim guidance for the use of these drugs to treat and prevent infection with swine influenza viruses.22,23 As part of its preparation for the emergency, the US Department of Homeland Security is releasing 25% of stockpiled antiviral agents (ie, oseltamivir [Tamiflu], zanamivir [Relenza]).
The usual vaccine for influenza administered at the beginning of the flu season is not effective for this viral strain. Also, other antiviral agents (eg, amantadine, rimantadine) are not recommended because of recent resistance to other influenza strains documented over the past several years.
Basic supportive care (ie, hydration, analgesics, cough suppressants) should be prescribed. Empiric antiviral treatment should be considered for confirmed, probable, or suspected cases of H1N1 influenza. Treatment of hospitalized patients and patients at higher risk for influenza complications should be prioritized.
Initiation of antiviral agents within 48 hours of symptom onset is imperative for providing treatment efficacy against influenza virus. In studies of seasonal influenza, evidence for benefits of treatment is strongest when treatment is started within 48 hours of illness onset. However, some studies of treatment of seasonal influenza have indicated benefit, including reductions in mortality or duration of hospitalization, even in patients in whom treatment was started more than 48 hours after illness onset. The recommended duration of treatment is 5 days.22,23
* Prophylaxis with antiviral agents should also be considered in the following individuals (pre-exposure or postexposure):
o Close household contacts of a confirmed or suspected case who are at high risk for complications (eg, chronic medical conditions, persons >65 y or <5>65 y or <5>65 y, pregnant women)
o Individuals not considered to be at high risk but who are nonetheless traveling to Mexico, first responders, or border workers who are working in areas with confirmed cases
Antiviral Agents
Drugs indicated for treatment of H1N1 influenza A virus include neuraminidase inhibitors (ie, oseltamivir and zanamivir).
Oseltamivir (Tamiflu)
Oseltamivir inhibits neuraminidase, which is a glycoprotein on the surface of influenza virus that destroys an infected cell's receptor for viral hemagglutinin. By inhibiting viral neuraminidase, this agent decreases the release of viruses from infected cells and, thus, viral spread. Oseltamivir is effective in the treatment of influenza A or B and must be administered within 48 hours of symptom onset to provide optimal treatment. The sooner the drug is administered after symptom onset, the better the likelihood of a good outcome. However, some studies of treatment of seasonal influenza have indicated benefit, including reductions in mortality or duration of hospitalization even for patients whose treatment was started more than 48 hours after illness onset.22 Oseltamivir reduces the length of illness by an average of 1.5 days. (In a subgroup of high-risk patients, illness was reduced by 2.5 d.) In addition, the severity of symptoms is also reduced.
Duration of administration for treatment is 5 days. Postexposure prophylaxis should be initiated within 7 d of exposure and continued for at least 10 days. Pre-exposure prophylaxis should be initiated during potential exposure period and continue for 10 days after last known exposure.22
Oseltamivir is available as 30-mg, 45-mg, and 75-mg oral capsules and as a powder for suspension that contains 12 mg/mL after reconstitution.
* Adult dose
o Treatment for acute illness: 75 mg PO bid for 5 d
o Prophylaxis: 75 mg PO qd (Please refer to duration of prophylaxis specific for postexposure.)
* Pediatric dose
o Treatment for acute illness and age <1>1 year
+ <15>40 kg: Administer as in adults
o Prophylaxis and age <1>1 year
+ <15>40 kg: Administer as in adults
Zanamivir (Relenza)
Zanamivir inhibits neuraminidase, which is a glycoprotein on the surface of the influenza virus that destroys the infected cell's receptor for viral hemagglutinin. By inhibiting viral neuraminidase, release of viruses from infected cells and viral spread are decreased. Zanamivir is effective against both influenza A and B. The preparation of zanamivir is in powder form for inhalation via the Diskhaler oral inhalation device. Circular foil discs that contain 5-mg blisters of drug are inserted into the supplied inhalation device. Individuals with asthma or other respiratory conditions that may decrease ability to inhale drug should be given oseltamivir.
* Adult dose
o Treatment for acute illness: 10 mg inhaled orally bid for 5 d
o Prophylaxis of household contact: 10 mg inhaled orally qd for 10 d (initiate within 36 h)
o Prophylaxis for community outbreak: 10 mg inhaled orally qd for 28 d (initiate within 5 d of outbreak)
* Pediatric dose
o Treatment for acute illness
+ <7>7 years: Administer as in adults
o Prophylaxis in household contact
+ <5>5 years: Administer as in adults
o Prophylaxis in community outbreak
+ Adolescents 12-16 years: Administer as in adults
Additional pediatric considerations
Aspirin or aspirin-containing products (eg, bismuth subsalicylate [Pepto Bismol]) should not be included in the treatment of confirmed or suspected viral infection in persons aged 18 years or younger because of the risk of Reye syndrome. For relief of fever, other antipyretic medications (eg, acetaminophen, nonsteroidal anti-inflammatory drugs) are recommended.
Pregnant women
Oseltamivir and zanamivir are "Pregnancy Category C" medications, indicating that no clinical studies have been conducted to assess the safety of these medications in pregnant women.
Because of the unknown effects of influenza antiviral drugs on pregnant women and their fetuses, oseltamivir or zanamivir should be used during pregnancy only if the potential benefit justifies the potential risk to the embryo or fetus; the manufacturers' package inserts should be consulted. However, no adverse effects have been reported among women who received seltamivir or zanamivir during pregnancy or among infants born to women who have received oseltamivir or zanamivir.
Pregnancy should not be considered a contraindication to oseltamivir or zanamivir use. Because zanamivir is an inhaled medication and has less systemic absorption, some experts prefer zanamivir over oseltamivir for use in pregnant women, when feasible.
Keywords
H1N1 influenza, H1N1 flu, swine flu, swine influenza, swine influenza virus, swine influenza A (H1N1) virus, human swine flu, influenza A, influenza (H1N1), SIV, swine flu symptoms, swine flu diagnosis, swine flu treatment, swine flu antiviral, swine flu pandemic, swine flu outbreak, H1N1 flu symptoms, H1N1 flu diagnosis, H1N1 flu treatment, H1N1 flu antiviral, H1N1 flu pandemic, H1N1 flu outbreak
Sunday, August 9, 2009
Thursday, August 6, 2009
Azizah
Special thought of the day:-
The smiles you spread with tender loving
care is what makes you special.
* 'Pantun' in BI.
A cat wear a hat,
And the colour is blue,
Just remind to say that,
I'm right here waiting for you.( ikut tema lagu Ganesh)
Wednesday, August 5, 2009
TAHNIAH KEPADA KOGI DIATAS KENAIKAN PANGKAT
KITA UCAPKAN TAHNIAH KEPADA RAKAN KITA - KOGI , KERANA DAPAT KENAIKKAN PANGKAT KE JURUPULIH ANGGOTA U32 ! SEMOGA KEHIDUPAN BARU INI AKAN MEMBERI LEBIH KEGEMBIRAAN, KEJAYAAN DAN TANGGA PERTAMA KPD KEJAYAAN2 YANG LAIN!
CONGRATULATION !
GANESAN
CONGRATULATION !
GANESAN
Monday, August 3, 2009
Bila nak jumpa lagi
Azizah nak berpantun..
Pokok kayu, pokok padi,
Buah jambu rasanye manis,
Bila kita nak jumpa lagi,
Dalam blog selalu miss.
Benang di sulam menjadi kain,
Kain di tenun jangan la nipis,
Mana dia kengkawan lain,
Tak ingatlagi ke kenangan manis?
Pergi UK naik kereta,
Singgah US jumpa si Lim
Idea nak pantun dah tak de,
Jangan lupe calling clling.
Sunday, August 2, 2009
LAST DAY FOR HSR SUBMISSION
ATTENTION TO ALL FRIENDS!
MR.LOCK JUST INFORM ME THAT HALF OF OUR GROUP DIDNT SUBMIT YET THE HSR. PLS KINDLY INFORM YOUR GROUP MEMBERS (GRP 1-7) TO SEND URGENTLY.
ACCORDING TO MR.LOCK, THE LAST DAY OF HSR SUBMISSION IS 3rd AUGUST 2009 (MONDAY). WE DONT WANT OUR GROUP TO GET A BAD IMAGE. PLEASE COMPLETE AND SEND THE HSR AS SOON AS POSSIBLE.
SEE AT THE CHATBOX, MR.LOCK HAD JOINED AND GAVE THE REMINDER.
THANK YOU
GANESAN
MR.LOCK JUST INFORM ME THAT HALF OF OUR GROUP DIDNT SUBMIT YET THE HSR. PLS KINDLY INFORM YOUR GROUP MEMBERS (GRP 1-7) TO SEND URGENTLY.
ACCORDING TO MR.LOCK, THE LAST DAY OF HSR SUBMISSION IS 3rd AUGUST 2009 (MONDAY). WE DONT WANT OUR GROUP TO GET A BAD IMAGE. PLEASE COMPLETE AND SEND THE HSR AS SOON AS POSSIBLE.
SEE AT THE CHATBOX, MR.LOCK HAD JOINED AND GAVE THE REMINDER.
THANK YOU
GANESAN
Monday, July 27, 2009
Monday, July 20, 2009
URGENT! PLS GIVE UR DETAILS
ATTENTION TO ALL PBMX FRENS, (3rd attempt)
MR.LOCK WANTS OUR DETAILS AS BELOW :
I STILL DIDNT GET INFORMATION FROM MOST OF OUR GROUP! TILL NOW ONLY 11 MEMBERS SUBMIT THE DETAILS.
To group leaders (kump 1-7) & frens here, pls kindly give reminder to ur members. Thank you very much.
THE DETAILS WANTED :
1. FULL NAME
2. MATRIX NO
3. ADDRESS (DEPARTMENT)
4. HOME ADDRESS
5. H/P NO
6. EMAIL ADD
Kindly give details and send to my email add - pfganesh@gmail.com , so that i can compile and sent to Mr.Lock as soon as posibble.
Thank you
GANESAN
MR.LOCK WANTS OUR DETAILS AS BELOW :
I STILL DIDNT GET INFORMATION FROM MOST OF OUR GROUP! TILL NOW ONLY 11 MEMBERS SUBMIT THE DETAILS.
To group leaders (kump 1-7) & frens here, pls kindly give reminder to ur members. Thank you very much.
THE DETAILS WANTED :
1. FULL NAME
2. MATRIX NO
3. ADDRESS (DEPARTMENT)
4. HOME ADDRESS
5. H/P NO
6. EMAIL ADD
Kindly give details and send to my email add - pfganesh@gmail.com , so that i can compile and sent to Mr.Lock as soon as posibble.
Thank you
GANESAN
Saturday, July 18, 2009
Azizah
HAI FRENS,
MARI LA RAMAI RAMAI MASUK BLOG.
RALLY MISSED YOU ALL.
AMEK KURSUS LAGI NAK??? HE HE HE
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