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Aug 21

Half of swine flu deaths in high-risk people - study

Posted on Friday, 21st August 2009

About half of people who have died from swine flu have been pregnant or had other health conditions, especially diabetes and conditions linked with obesity, French researchers reported on Thursday.

And although older people seem to be less likely than others to get infected, if they do get the new H1N1 flu, they are more likely to die, the team at the French Institute for Public Health Surveillance in St. Maurice, France, reported.

"Most deaths (51 percent) occurred in the age group of 20-49 year-olds, but there was considerable variation depending on country or continent," the researchers wrote in Eurosurveillance.

"There was documented underlying disease in at least 49 percent of documented fatal cases worldwide to date," they added. "Two risk factors are noticeable: pregnancy and obesity."

Several governments have said pregnant women should be first to be immunized when vaccines become available.

The study also suggested children are not as hard-hit as feared. "Although previous reports suggested that cases of pandemic H1N1 influenza 2009 occurred mainly in children, the mean and median age of the 343 fatal cases in our analysis were 37 years," they wrote.

Twelve percent of people who died were 60 or older. In contrast, more than 90 percent of deaths from seasonal influenza are in people over the age of 65.

HEALTHY VICTIMS

"A high proportion of young children (27 percent of the 0-9 year-olds) and young adults (22 percent of the 20-29 year-olds) had no documented underlying disease, while 60 percent of people over the age of 60 years had heart or respiratory disease," the French team added.

"Diabetes and obesity were the most frequently identified underlying conditions and were found in fatal cases over the age of 20 years."

Several reports have suggested a link with obesity but researchers are not clear whether obesity itself raises the risk of severe complications from H1N1 swine flu, or whether obese people have other conditions that have not been diagnosed.

The case fatality rate for H1N1 swine flu is less than 1 percent -- about 0.4 percent, the researchers said. This is a little higher than for seasonal influenza but lower than the 2 percent to 3 percent fatality rate estimated for the 1918 Spanish influenza pandemic.

They also noted that it is difficult and dangerous to try to estimate fatality rates while an epidemic is ongoing, in part because serious cases and deaths get reported first.

First reports in New York, for instance, suggested a case fatality rate of 0.2 percent, they wrote. But later reports took into account mild cases.

"A telephone survey estimated that in fact 250,000 cases had occurred in that city of 8.3 million inhabitants, resulting in an estimated case fatality rate of 0.0008 percent," they added.

"The pandemic, however, is far from over, and deaths will unfortunately continue to occur."

Companies making vaccines include AstraZeneca's MedImmune unit, CSL, GlaxoSmithKline Plc, Novartis AG and Sanofi-Aventis SA.

Roche AG and Gilead Sciences Inc's Tamiflu and Glaxo's Relenza can treat influenza, and are currently recommended for people who have a high risk of complications or death.

Aug 19

High fever, sore throat? No need for H1N1 testing

Posted on Wednesday, 19th August 2009

Exasperated over complaints from hundreds of hospitals across the country which are unable to control the H1N1 panic and rush to
hospitals, the Union health ministry has clearly spelt out as to who should go for the testing. Accordingly, even those with high fever or sore throat need not go for the test. Only those with breathlessness, chest pain and low BP must undergo the test.

To prevent and contain Influenza-A H1N1 virus for screening, testing and isolation, the following guidelines are to be followed. At first, all individuals seeking consultations for flu-like symptoms should be screened at healthcare facilities — both government and private — or examined by a doctor. These will be categorized as under:

Category A

Patients with mild fever plus cough/sore throat with or without body ache, headache, diarrhoea and vomiting will be categorised as Category-A. They do not require Oseltamivir and should be treated for these symptoms. The patients should be monitored for their progress and reassessed at 24 to 48 hours by the doctor.

No testing of the patient for H1N1 is required.
Patients should stay home and avoid mixing up with public and high-risk members in the family.

Category B

In addition to all the signs and symptoms mentioned under Category-A, if the patient has high-grade fever and severe sore throat, may require home isolation and Oseltamivir

In addition to all the signs and symptoms mentioned under Category-A, individuals having one or more of the following high-risk conditions shall be treated with Oseltamivir.

Children less than 5 yrs old

Pregnant women

Persons aged 65 or more

Patients with lung diseases, heart disease, liver disease, kidney disease, blood disorders, diabetes, neurological disorders, cancer and HIV/AIDS; patients on long-term cortisone therapy.

No test for H1N1 is required for Category-B (children below 5 yrs) and (pregnant women).

These patients should stay home and avoid mixing with public and high risk members in the family.

Category C

In addition to the above signs and symptoms of Category-A and B, if the patient has one or more of the following:

Breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discolouration of nails

Irritability among small children, refusal to accept feed

Worsening of underlying chronic conditions

All these patients mentioned above in Category-C require testing, immediate hospitalization and treatment.

Aug 19

Living And Non-Living Objects Separated By Brain For Processing

Posted on Wednesday, 19th August 2009

For unknown reasons, the human brain distinctly separates the handling of images of living things from images of non-living things, processing each image type in a different area of the brain. For years, many scientists have assumed the brain segregated visual information in this manner to optimize processing the images themselves, but new research shows that even in people who have been blind since birth the brain still separates the concepts of living and non-living objects.

The research, published in Neuron, implies that the brain categorizes objects based on the different types of subsequent consideration they demand - such as whether an object is edible, or is a landmark on the way home, or is a predator to run from. They are not categorized entirely by their appearance.

"If both sighted people and people with blindness process the same ideas in the same parts of the brain, then it follows that visual experience is not necessary in order for those aspects of brain organization to develop," says Bradford Mahon, postdoctoral fellow in the Department of Brain and Cognitive Sciences at the University of Rochester, and lead author of the study. "We think this means significant parts of the brain are innately structured around a few domains of knowledge that were critical in humans' evolutionary history."

Previous studies have shown that the sight of certain objects, such as a table or mountain, activate regions of the brain other than does the sight of living objects, such as an animal or face - but why the brain would choose to process these two categories differently has remained a mystery, says Mahon. Since the regions were known to activate when the objects were seen, scientists wondered if something about the visual appearance of the objects determined how the brain would process them. For instance, says Mahon, most living things have curved forms, and so many scientists thought the brain prefers to processes images of living things in an area that is optimized for curved forms.

To see if the appearance of objects is indeed key to how the brain conducts its processing, Mahon and his team, led by Alfonso Caramazza, director of the Cognitive Neuropsychology Laboratory at Harvard University, asked people who have been blind since birth to think about certain living and non-living objects. These people had no visual experience at all, so their brains necessarily determined where to do the processing using some criteria other than an object's appearance.

"When we looked at the MRI scans, it was pretty clear that blind people and sighted people were dividing up living and non-living processing in the same way," says Mahon. "We think these findings strongly encourage the view that the human brain's organization innately anticipates the different types of computations that must be carried out for different types of objects."

Mahon thinks it's possible that other parts of the human brain are innately structured around categories of knowledge that may have been important in human evolution. For instance, he says, facial expressions need a specific kind of processing linked to understanding emotions, whereas a landmark needs to be processed in conjunction with a sense of spatial awareness. The brain might choose to process these things in different areas of the brain because those areas have strong connections to other processing centers specializing in emotion or spatial awareness, says Mahon.

Aug 19

IPM ready to test swine flu samples

Posted on Wednesday, 19th August 2009

HYDERABAD: The Institute of Preventive Medicine (IPM) is ready for testing the samples in swine flu cases. The IPM officials are learnt to have successfully cleared the preconditions set by the National Institute of Communicable Diseases (NICD) to become the first `Swine Flu
Diagnostic Lab’ in South India.

According to sources, the IPM officials have already reported to higher officials in the Health
and Medical Department on their ability to accurately test the samples.

The officials are to submit a report to Chief Minister YS Rajasekhara Reddy during a review meeting to be held in a couple of days. The `Swine Flu Diagnostic Lab’ at the IPM is likely to be operationalised by this weekend.

``The Chief Minister will announce the operation of the Diagnostic Lab officially during the meeting on swine flu,’’ said a senior official in the Health and Medical Department.

Till date, the doctors
of the Government Chest Hospital had to send the throat and nasal swabs of suspected swine flu patients to NICD at New Delhi wait for at least two days to get a final report. The operation of the Diagnostic Lab at the IPM will save time and also airfare for transportation of the samples to New Delhi, which was about Rs 2,000 for each sample.

The efforts of the Centre for Cellular Molecular Biology (CCMB) for establishing another diagostic centre on its premises by next month, is in progress.

Meanwhile, two new cases of the A H1N1 Influenza were confirmed in the State today. Both cases were indigenous cases with no history of foreign travel, according to an official release.

Aug 19

Freedom from shots, kids can sniff measles vaccine

Posted on Wednesday, 19th August 2009

A single deep breath could soon vaccinate a child against measles. Next year, India will start human trials of a measles vaccine that
will not require a syringe. Instead, a single long breath will deliver the vaccine straight into the child’s lungs.

This breakthrough — dry powder inhalable measles vaccine, if found to be as effective as the present day injectible vaccine — will do away with risks of dirty needle infections like HIV and hepatitis and will greatly benefit countries like India which seriously lack proper cold chain facilities and clean water.

The creator of the dry-powder vaccine, Robert Sievers from the University of Colorado, said, “The vaccine is moving toward clinical trials next year in India. Childhood vaccines that can be inhaled and delivered directly to mucosal surfaces offer significant advantages over injection. They may not only reduce the risk of infection from unsterilized needles, but may also prove more effective against the disease.”

According to Sievers, the present candidate vaccine could be a perfect option for areas of developing countries that often lack electricity for refrigeration, clean water and sterile needles needed to administer traditional liquid vaccines.

Dr Anupam Sibal, senior pediatrician of Apollo hospital, said, “Measles mortality among malnourished children is an important concern in India. So improvement in measles vaccine coverage will be a boon.”
He said, “Any option which is a non-injectible oral or inhalation is usually more attractive for parents who fear taking their children for an injection.” The Indian trials will be conducted by the Serum Institute of India. Officials in SII told TOI the human trials would start only next year when the animal studies prove successful. The Phase-1 study would see the vaccine’s safety on around 30 adults.

The inhaler developed by Siever’s team has been found to be just as effective in delivering measles vaccine as the injection during the animal tests. So far, an inhalable vaccine is available for only one disease. It is a wet mist vaccine for influenza
.

The weakened measles virus is mixed with supercritical carbon dioxide — part gas, part liquid — to produce microscopic bubbles and droplets, which are then dried to make an inhalable powder. The powder is puffed into a small, cylindrical, plastic sack, with an opening like the neck of a plastic water bottle, and administered.

Aug 17

Don't worry about swine flu vaccines, says WHO

Posted on Monday, 17th August 2009

There’s no need to worry on the safety or efficacy of the anti-swine flu vaccines being currently developed in different countries, said the World Health Organization.

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Taking notice of the fears being expressed in different quarters on the safety or risks in using the vaccines, the WHO said the regulatory procedures in place for the licencing of pandemic vaccines, including procedures for expediting regulatory approval, are rigorous and do not compromise safety or quality.

Drug companies in several countries are in an advanced stage of developing a H1N1 influenza vaccine to check the swine flu pandemic which has swept across over 160 countries, affecting over 1.5 million (confirmed cases; actual number may be far higher) and killing nearly 1,000 persons. In India, too, over two dozen people have lost their lives due to swine flu in recent weeks, in different cities.

Some Indian drug companies are also engaged in developing a swine flu vaccine based on the seed strain of H1N1 influenza virus provided by the WHO. However, it may take a few months to develop and test the vaccines and get approval for their general use.

In a statement issued from Geneva, the WHO has said: “Influenza vaccines have been used for over 60 years and have an established record of safety in all age groups.”

At the same time, it has also cautioned that some adverse events may arise during a pandemic when the vaccine is administered on a massive scale.

“Some adverse events, which may be too rare to show up even in large clinic trials, may become apparent when very large numbers of people receive a pandemic vaccine,” the WHO has said, while maintaining that such cases will be rare.

It has observed that nearly 50 million people had died in the 1918 world-wide influenza pandemic, largely because vaccines had not been developed by then.

Aug 17

Obstructive Sleep Apnea Is Prevalent In Adults With Down Syndrome

Posted on Monday, 17th August 2009

A study in the Aug. 15 issue of the Journal of Clinical Sleep Medicine shows that adults with Down syndrome also frequently suffer from obstructive sleep apnea (OSA). However, complications of untreated OSA such as cardiovascular disease, daytime sleepiness and impaired cognitive functioning overlap with the manifestations of Down syndrome; therefore, OSA may not be detected.

Results indicate that 94 percent of subjects with Down syndrome had OSA; 88 percent had at least moderate OSA with an apnea-hypopnea index (AHI) of more than 15 breathing pauses per hour of sleep; and 69 percent had severe OSA with an AHI of more than 30. Twelve of the 16 subjects with Down syndrome were obese, and there was a significant correlation between body mass index (BMI) and AHI. Total sleep time in subjects with Down syndrome (307 minutes) was more than an hour less than in controls (380 minutes). Despite the severity of OSA in the study group, medical evaluation had been sought in only one case.

According to senior author Carole Marcus, M.B.B.Ch., professor of pediatrics at the University of Pennsylvania and director of the Children's Hospital of Philadelphia Sleep Center, it is well known that children with Down syndrome are at risk for OSA, with a prevalence of 30 to 55 percent, and adults with Down syndrome have even more predisposing factors for OSA than children, as they still have the craniofacial anomalies and are more likely to be obese or hypothyroid.

"Patients with Down syndrome have a great deal of risk factors for OSA (based on their narrow midface, large tongue, floppy muscle tone, tendency towards being overweight, and thyroid disease)," said Marcus. "However, the fact that almost all of the subjects studied had OSA was a much higher prevalence than we expected. It was surprising how severe the illness was, and how the OSA was unsuspected by their caregivers."

The cohort study included information from 16 adults with DS who underwent evaluation for sleep disordered breathing. Subjects were recruited from the local association of Retarded Citizens (ARC), parents of Down Syndrome (PODS) group meetings and the Kennedy Krieger Down Syndrome Clinic. Eight subjects were recruited from the clinic while the other eight responded to fliers and letters. Participants ranged between 19 and 56 years of age with a median age of 33. Half of the subjects were female (four of whom were postmenopausal); 15 were Caucasian, and one was Asian.

Polysomnographic results were matched and compared to a retrospective control sample of 48 adult patients who underwent standard diagnostic nocturnal polysomnography at the John Hopkins University adult Sleep Center for evaluation of suspected OSA. Controls had less severe sleep apnea with a median AHI of 16; 54 percent had an AHI of more than15; 38 percent had an AHI of more than 30.

The authors suggest that obesity, a common and potentially treatable problem in Down syndrome, appears to play an important role in the pathophysiology of OSA in this population.

Aug 17

Elderly Depression And Dementia

Posted on Monday, 17th August 2009

When senior citizens become depressed, agitated, or show signs of dementia, it is often difficult to know what the best ways to keep them healthy and happy are. Before you consider long-term care as a solution, there are things you can do to keep your loved ones in their homes.

According to the American Association for Geriatric Psychiatry (AAGP), nearly 20 percent of those who are 55 years and older have mental disorders that are not part of normal aging. Some of the most common illnesses are anxiety, severe cognitive impairment and mood disorders.

Jeffery Lafferman, M.D., a psychiatrist at Levindale Hebrew Geriatric Center and Hospital's Partial Hospitalization Program and Outpatient Services, says that too often mental health illnesses are underreported. "As people age, their health needs become more complicated. Medical problems, such as high blood pressure and arthritis, are common and can mask the emotional challenges that the elderly face, until it has reached a critical stage."

But there is help and hope available. One of the ways to keep an elderly loved one at home for as long as possible when they are experiencing depression, dementia, agitation and other emotional challenges is through day treatment programs.

"Some adult day services programs are specifically designed to help elders relearn how to again be a useful part of their communities. The programs have group and individual therapy sessions in a stimulating environment. In addition, participants can reminisce with people their own age, take part in activities designed to renew their enthusiasm for life and be in their own homes in the evening," says Dr. Lafferman.

Many people do not understand that clinical depression and other mental illnesses are treatable. Some of the symptoms to look for are a change in personality, a decline in memory, isolation from friends and family, excessive feelings of guilt or hopelessness, frequent crying, sleep problems, unexplained physical illnesses, loss of function, changes in appetite, loss of interest in personal hygiene and irritability, and anxiety.

However, Dr. Lafferman advises, "Before you entrust your loved one to any program, try to visit to see with your own eyes what the program is like. Although your elder loved one needs supervision, his or her dignity must be preserved. In addition, check to see if there are medical professionals on site, and if there are different therapies to engage them."

When a loved one is experiencing emotional issues, it can also affect the whole family, so giving caregivers a break during the day is also important.

Aug 17

Health ministry issues fresh guidelines on swine flu

Posted on Monday, 17th August 2009

With swine flu
cases continuing to rise sharply, the Union Health Ministry on Saturday issued fresh guidelines specifying screening
and testing module for patients to contain the disease in the country.

The guidelines were finalised at a high-level meeting chaired by the Health Minister Ghulam Nabi Azad last night in connection with the various actions taken by the government for containment and mitigation of H1N1 cases across the country.

During the meeting that lasted for more than five hours till 10 pm last night, the Health Minister also discussed various guidelines and protocols developed by the World Health Organisation in Geneva, Centre for Disease Prevention and Control, Atlanta, USA and National Health Service, United Kingdom.

The meeting was attended by eminent experts from public and private hospitals/organisations besides senior officers of Health Ministry and Directorate General of Health Services.

As per guidelines, all individuals seeking consultation for flu-like symptoms would be screened at healthcare facilities -- both government and private -- or examined by a doctor and will be categorised broadly under three categories A, B and C depending on their health status, as per an official release here.

They will be given treatment and isolated as specified in the guidelines.
Patients with mild fever plus cough/sore throat with or without body ache, headache, diarrhoea and vomiting will be categorised as Category-A. They do not require Oseltamivir and should be treated for the symptoms mentioned above.

The patients should be monitored for their progress and reassessed after 24 to 48 hours by the doctor. For this category, no testing of the patient for H1N1 is required. Patients should confine themselves at home and avoid mixing up with public and high risk members in the family.

Category B has two subcategories. Category BI is for those patients, who have high grade fever and severe sore throat in addition to all the signs and symptoms mentioned under Category-A. They may require home isolation and Oseltamivir.

Category BII is for those, who have in addition to all the signs and symptoms mentioned under Category-A are having one or more of the following high risk conditions like children less than 5-years-old, pregnant women, persons aged 65 years or older, patients with lung diseases, heart disease, liver disease, kidney disease, blood disorders, diabetes, neurological disorders, cancer and HIV/AIDS, patients on long term cortisone therapy. They shall be treated with Oseltamivir but no tests for H1N1 is required for Category-B (I) and (II).

However, all patients of Category-B (I) and (II) should confine themselves at home and avoid mixing with public and high risk members in the family.

In category C, those patients fall, who in addition to the above signs and symptoms of Category-A and B, have one or more of the following problems like breathlessness, chest pain, drowsiness, fall in blood pressure, sputum mixed with blood, bluish discolouration of nails, irritability among small children, refusal to accept food, worsening of underlying chronic conditions.

All these patients mentioned above in Category-C require testing, immediate hospitalisation and treatment.

The release said that these guidelines will be reviewed and revised from time to time as per need and on the basis of spread of the disease.

Aug 12

Antivirals Unlikely To Prevent Swine Flu Complications In Children, Study

Posted on Wednesday, 12th August 2009

Research published this week in a leading medical journal says that based on current evidence, which is limited and not easily generalized to children in the current swine flu epidemic, the antivirals oseltamivir (Tamiflu) and zanamivir (Relenza) are unlikely to prevent complications in children infected with swine flu.

The study was led by Dr Matthew Thompson, senior clinical scientist at the University of Oxford, UK, and appears online in the 10 August issue of the BMJ.

Children are a high risk group during seasonal flu epidemics, which typically affect 40 per cent of pre-schoolers and 30 per cent of school age children, who are also the main route of transmission into households, said the researchers.

They went on to explain that the current control strategy for treating patients who get the flu and preventing its spread includes use of antivirals because vaccination coverage is often low and there is not enough time to make vaccine and get it to everyone who needs it because it's a continual race against emerging strains.

The last time this strategy was examined was in 2005 which is why they decided to do a new review and re-assess the benefits and harms of antivirals.

For this review Thompson and colleagues pooled and re-analyzed data from randomized controlled trials of the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza) in treatment of children with seasonal influenza who were treated at home (ie not hospitalized).

They found that the antivirals provided a small benefit by shortening the duration of illness by a day and a half, and they reduced transmission in households, but they had little effect on asthma flare ups, increased ear infections and the likelihood of children needing antibiotics. Tamiflu also carries an increased risk of vomiting.

The effects of these drugs on the incidence of serious complication and the current A/H1N1 swine flu strain remain undetermined, they wrote.

For their analysis they reviewed data from published and unpublished controlled trials. They searched well known registeries, consulted with manufacturers and authors to make a comprehensive list of the trials.

They then selected only those trials that were randomized and controlled, assessed neuraminidase inhibitors in children aged 12 and under who were treated in the community (that is, not in hospital), with confirmed or clinically suspected influenza and did a systematic meta-analysis where they re-analyzed the pooled data.

The main measures of effectiveness that they looked for were how long it took for the illness to resolve and how many children in the households involved caught the flu.

After applying the eligibility criteria, the researchers found a total of four trials testing the antivirals in children treated at home for the flu. Two used Tamiflu (oseltamivir ) and two used Relenza (zanamivir). Between them the four trials covered 1,766 children (1,243 with confirmed influenza, of whom 55 to 69 per cent had influenza A).

They also found another three randomized trials (one with Tamiflu and two with Relenza) that tested the antivirals for postexposure prophylaxis (ability to prevent flu). These covered a total of 863 children.

The researchers emphasized that none of these trials tested the effectiveness of the two drugs against the current pandemic strain of swine flu.

After reviewing the results of these trials, Thompson and colleagues found that:

* The treatment trials showed a reduction in median times to resolution of symptoms, or return to normal activities, or both, of between 0.5 and 1.5 days, but this was significant in only two trials.

* Treatment was not linked with a reduced use of antibiotics.

* In the three postexposure prophylaxis trials, a 10 day course of oseltamivir (Tamiflu) and zanamivir (Relenza) resulted in an 8 per cent decrease in the incidence of symptomatic influenza (the 95 per cent confidence interval ranged from 5 to 12 per cent).

* Based on only one trial, oseltamivir (Tamiflu) "did not reduce asthma exacerbations or improve peak flow in children with asthma".

* While zanamivir (Relenza) was well tolerated, oseltamivir (Tamiflu) was linked with an increased risk of vomiting.

The authors concluded that:

"Neuraminidase inhibitors provide a small benefit by shortening the duration of illness in children with seasonal influenza and reducing household transmission. They have little effect on asthma exacerbations or the use of antibiotics."

"Their effects on the incidence of serious complications, and on the current A/H1N1 influenza strain remain to be determined," they added.

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